Sleep disordered breathing and myelomeningocele in the era of prenatal repair: A systematic review towards evidence-informed care.

Children with myelomeningocele (MMC) are at risk for sleep disordered breathing (SDB). This systematic review evaluated the prevalence, presentation, mortality, and behavioral features of SDB in this population. It is registered with PROSPERO (CRD42024610178) and was completed according to PRISMA guidelines. Embase, PubMed, Scopus, and Clinical Trials were queried for articles published through December 2024. Of the 2654 articles screened, 28 met inclusion criteria. The prevalence of SDB in infants with postnatal repair of MMC was 46-100 %, and 92-97 % among those prenatally repaired. The degree of prematurity did not appear to influence the presence of SDB. Mortality rates in infancy due to SDB were 0-69 %. The prevalence of SDB in individuals aged ≥12 months to 21 years was 49-100 % among the symptomatic, and 39-63 % among the asymptomatic. SDB accounted for 22 % of deaths in one study. Two studies found statistically significant ages when central sleep apnea and obstructive sleep apnea were diagnosed (3 and 4.7 years vs. 8.5 and 11.5 years, respectively). Adolescents with MMC, particularly females, experienced poorer quality and quantity of sleep beginning at an earlier age than their typically developing peers. Poor sleep may impair executive functioning skills. Regardless of the presence or absence of symptoms, this systematic review supports the recommendation that children with MMC should be screened for SDB during three time periods: (1) prior to discharge from the NICU, (2) between 3 and 4 years of age, and (3) between 8 and 11 years of age.