11/11/2020
Prematurity and high narrow palates
It is well known that premature infants are at greater risk of developing obstructive Sleep Disturbed Breathing (SDB). These sleep disorders are well linked to increased risk of developmental, neurocognitive and behavioural problems in children.
We also know that narrow high palates are a risk factor for SDB.
Last year, a research study of 244 premature infants exploring the links between high arch palates, the development of SDB and developmental outcomes at 2 years, was published by Huang et al. in the journal Sleep Medicine.
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What were the findings?
62% of pre-term babies had a high narrow palate at birth, compared to 10% of the control group (infants born 37-40 weeks).
The high palate persisted during the two year follow up period.
At the end of two years, 79% of the premature infant group had Obstructive Sleep Apnoea (OSA) compared to 10% of the control group.
Within the subgroup of premature infants with narrow high palate, the incidence of OSA was 84.7%.
Neurodevelopmental outcomes were assessed at 6, 12, 18 and 24 months using Bayley Scales of Infant Development and the Denver Developmental Screening Tests (DDT).
There was a greater proportion of children with developmental delay in the premature infant group at every stage. Within the premature infant group, there was a significantly greater proportion of children with developmental delay in the narrow high palate group compared to the normal palate group.
Overall, the data supports that high narrow palate is an important risk factor in the development of abnormal breathing.
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Why is there a link with prematurity and high palate?
The last three months of pregnancy are critical for the fetus to train normal reflexes and prepare for the functions of sucking, swallowing, chewing and nasal breathing.
Prematurity interrupts this training time, leading to incomplete muscle development. This includes the tongue, which needs to function correctly to stimulate the midpalate suture and properly develop the palate structure.
The palate is the floor of the nose. When it is high and narrow, the nasal passages are narrowed and there is increased resistance to nasal breathing. It promotes nasal disuse and the development of mouth breathing over time. Mouth breathing is also associated with poor stimulation of palate development. The cycle of dysfunction and poor structural development is perpetuated.
The palate is also an important part of the skeletal framework that supports our collapsible tube of airway muscles. A narrow palate offers reduced support. The upper airway is more prone to collapse during sleep when its muscles (including the tongue) are more relaxed.
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As a dentist involved in with managing adult OSA, I see the narrow high palate in many of my patients. I often find it despairing to listen to the impacts it has had on people’s health, mood and quality of life and wish the problem had been intervened earlier.
I believe normalizing both orofacial muscle functions and palate structures as early in life as possible is a very worthwhile goal.
Of great interest to me is that the same group of researchers has previously shared data demonstrating that myofunctional therapy exercises to stimulate more normal oral function helps normalise palate development and breathing over time. (Huang et al. 2012)
They excluded a group of children who were having myofunctional therapy from the premature infant group in the 2019 published study for this reason.
I have a special interest and am closely following the research in this area. I hope to learn more approaches with interdisciplinary colleagues to help this high-risk group in the future.
I also hope to see more focus on prevention as early as conception – and specifically through addressing maternal sleep disturbed breathing, a known risk factor in pre-term births.
