Computational fluid dynamics endpoints for assessment of adenotonsillectomy outcome in obese children with obstructive sleep apnea syndrome.
Computational fluid dynamics endpoints for assessment of adenotonsillectomy outcome in obese children with obstructive sleep apnea syndrome.
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DOI：
10.1016/j.jbiomech.2014.03.023
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发表时间：
2014-07-18
影响因子：
2.4
通讯作者：
Wootton, David M.
中科院分区：
文献类型：
--
作者：
Luo, Haiyan;Sin, Sanghun;McDonough, Joseph M.;Isasi, Carmen R.;Arens, Raanan;Wootton, David M.
阻塞性睡眠呼吸暂停综合征（OSAS）严重程度的改善可能与腺样体扁桃体切除术（AT）后咽部流体力学的改善有关。本研究的目的是使用基于图像的计算流体动力学（CFD）来模拟患有OSAS和腺样体扁桃体肥大的肥胖儿童AT后咽部压力的变化。在10名患有OSAS的肥胖儿童队列中，从清醒时获得的磁共振图像中获得AT前后从鼻孔到气管的上气道三维模型。使用商业软件计算峰潮吸气流量期间的速度、压力和湍流场。使用斯皮尔曼等级相关（rs）将CFD终点与AT前后的多导睡眠图终点相关。AT后呼吸暂停低通气指数（AHI）降低与扁桃体和腺样体收缩咽部区域的最大压力降（dPTAmax）降低（rs=0.78，P = 0.011）以及dPTAmax与流速比值降低（rs = 0.82，P = 0.006）密切相关。AHI降低与解剖结构、重叠区域的负压（包括鼻流阻）或整个咽部的压降的相关性不显著。在AHI改善超过10%的受试者亚组中，血流变量与AHI降低之间的相关性强于所有受试者。dPTAmax的变化与改善的AHI之间的相关性表明，dPTAmax可能是由于解剖狭窄导致的内气道负荷的有用指标，并且可能比直接气道解剖测量与AHI更好地相关。
Improvements in obstructive sleep apnea syndrome (OSAS) severity may be associated with improved pharyngeal fluid mechanics following adenotonsillectomy (AT). The study objective is to use image-based computational fluid dynamics (CFD) to model changes in pharyngeal pressures after AT, in obese children with OSAS and adenotonsillar hypertrophy. Three-dimensional models of the upper airway from nares to trachea, before and after AT, were derived from magnetic resonance images obtained during wakefulness, in a cohort of 10 obese children with OSAS. Velocity, pressure, and turbulence fields during peak tidal inspiratory flow were computed using commercial software. CFD endpoints were correlated with polysomnography endpoints before and after AT using Spearman’s rank correlation (rs). Apnea hypopnea index (AHI) decrease after AT was strongly correlated with reduction in maximum pressure drop (dPTAmax) in the region where tonsils and adenoid constrict the pharynx (rs=0.78, P = 0.011), and with decrease of the ratio of dPTAmax to flow rate (rs = 0.82, P = 0.006). Correlations of AHI decrease to anatomy, negative pressure in the overlap region (including nasal flow resistance), or pressure drop through the entire pharynx, were not significant. In a subgroup of subjects with more than 10% improvement in AHI, correlations between flow variables and AHI decrease were stronger than in all subjects. The correlation between change in dPTAmax and improved AHI suggests that dPTAmax may be a useful index for internal airway loading due to anatomical narrowing, and may be better correlated to AHI than direct airway anatomic measurements.
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DOI：
10.1513/pats.200708-135mg
发表时间：
2008-02-15
期刊：
Proceedings of the American Thoracic Society
影响因子：
--
作者：
Lumeng, Julie C;Chervin, Ronald D
通讯作者：
Chervin, Ronald D
DOI：
10.1164/ajrccm.164.4.2101127
发表时间：
2001-08-15
影响因子：
24.7
作者：
Arens, R;McDonough, JM;Pack, AI
通讯作者：
Pack, AI
影响因子：
5.6
作者：
Nandalike, Kiran;Shifteh, Keivan;Arens, Raanan
通讯作者：
Arens, Raanan
DOI：
10.1164/rccm.200206-613oc
发表时间：
2003-01-01
影响因子：
24.7
作者：
Arens, R;McDonough, JM;Udupa, JK
通讯作者：
Udupa, JK
影响因子：
3.3
作者：
SCHWARTZ, AR;SMITH, PL;PERMUTT, S
通讯作者：
PERMUTT, S