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Exploring Sleep Behavior and Language Outcomes in Children with Cleft Lip and Palate Using Data from a National Cohort Study

Lookup NU author(s): Dr Stephanie Van EedenORCiD, Dr Vic KnowlandORCiD

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This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License (CC BY-NC 4.0).

Abstract

© 2026, American Cleft Palate Craniofacial Association. This article is distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 License (https://creativecommons.org/licenses/by-nc/4.0/) which permits non-commercial use, reproduction and distribution of the work without further permission provided the original work is attributed as specified on the SAGE and Open Access page (https://us.sagepub.com/en-us/nam/open-access-at-sage). Objective: To explore the relationship between sleep behaviors and language development in children with cleft lip and palate (CP ± L). Design: Cross-sectional analysis of questionnaire data from a national cohort study. Setting: All participants were treated within a national health service specialist cleft center. Participants: 1990 questionnaires were analyzed. All cleft phenotypes, including 10.2% with Robin Sequence (RS) and 8.5% with syndromic diagnoses, were included. Measures: Sleep outcome measures from parent report included sufficient sleep in a 24-h period and reports of concern about sleep behavior. Language outcome measures included answers to the Ages and Stages Questionnaire (3rd edition) (ASQ-3). Results: Parental concern about sleep was low overall (13.0% at 18 months, 7.9% at 3 years), but higher in children with RS and syndromic diagnoses. At 3 years, parents of children with cleft palate were more likely to be concerned about sleep than those with cleft lip only (P = .009). Reports of sufficient sleep were high (>88% across all ages), but children with RS showed a decline over time. Significant positive correlations were found between sufficient sleep and language outcomes at all ages (τ = .087, P = .004 at 18 months; τ = .131, P = .002 at 3 years; τ = .445, P < .001 at 5 years). At 5 years, this association remained after controlling for confounders (r = .347, P < .001). Conclusions: Sleep behaviors were associated with language development in children with CP ± L. These findings highlight the need for longitudinal and interventional studies to better understand the role of sleep on developmental outcomes in this population.

Publication metadata

Author(s): van Eeden S, Knowland VCP

Publication type: Article

Publication status: Published

Journal: Cleft Palate Craniofacial Journal

Year: 2026

Pages: Epub ahead of print

Online publication date: 19/02/2026

Acceptance date: 02/04/2018

Date deposited: 03/03/2026

ISSN (print): 1055-6656

ISSN (electronic): 1545-1569

Publisher: SAGE Publications Ltd

URL: https://doi.org/10.1177/10556656261423833

DOI: 10.1177/10556656261423833

Data Access Statement: The data underlying this article were provided by The Cleft Collective under project number CC057-SvE following approval from the Cleft Collective Project Management Group. Data are available from the Cleft Collective resource following approval of a project proposal and ethical approval from a research ethics committee for each study. For further information on how you can access data please visit: https://www.bristol.ac.uk/cleft-collective/professionals/access/

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