How does distraction osteogenesis maxillary expansion (DOME) reduce severity of obstructive sleep apnea?
How does distraction osteogenesis maxillary expansion (DOME) reduce severity of obstructive sleep apnea?
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DOI：
10.1007/s11325-019-01948-7
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发表时间：
2020-03-01
影响因子：
2.5
通讯作者：
Liu, Stanley Yung
中科院分区：
文献类型：
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作者：
Iwasaki, Tomonori;Yoon, Audrey;Liu, Stanley Yung
目的采用牵张成骨上颌扩大术（DOME）对成人阻塞性睡眠呼吸暂停综合征（OSA）患者进行鼻底和硬腭穹隆的扩大，是一种可靠的方法。DOME导致呼吸暂停低通气指数（AHI）降低和鼻呼吸改善的主观报告。使用测压增强的计算流体动力学（CFD）建模，我们提出了一个机制，如何DOME减少上气道咽部塌陷的成人OSA。材料和方法一个回顾性队列，20名受试者，平均年龄29.6 ± 8岁，于2014年9月至2016年4月在斯坦福大学完成DOME。如果可以使用多导睡眠图、气道形态学和肺动脉测压，则纳入受试者。从CBCT数据中，生成3D鼻和咽气道模型。在以下条件下分析了气道模型的数值CFD模拟：（1）空气体积以300 cm（3）/s的速度流动，（2）壁表面不光滑，（3）模拟重复1000次以计算平均值。使用SPSS v24软件的统计分析包括配对t检验、非参数Wilcoxon秩检验、具有Bonferroni校正的Friedman检验和斯皮尔曼相关系数（p < 0.05）。结果平均AHI从17.8 ± 17.6次/小时改善至7.8 ± 7.1次/小时（p < 0.001）。平均最低血氧饱和度从88.2 +/- 7.2改善至90.9 +/- 4.2%（p < 0.05）。DOME后鼻气道内的平均气流速度从15.6 +/- 7.3 m/s降至7.4 +/- 2.1 m/s（p < 0.001）。鼻气道、腭后气道、口咽气道和下咽气道的平均负压从-158.4 +/- 115.3降至-48.6 +/- 28.7 Pa，从-174.8 +/- 119.9降至-52.5 +/- 31.3 Pa，分别为-177.0 +/- 118.4至-54.9 +/- 31.8 Pa和-177.9 +/- 117.9至-56.9 +/- 32.1 Pa（p < 0.001）。AHI与鼻血流速度呈正相关（p < 0.05），与咽气道压呈负相关（p < 0.05）。ODI与鼻流速呈正相关（p < 0.05），与鼻气道压（p < 0.05）、腭后气道压（p < 0.001）、口咽气道压（p < 0.001）和下咽气道压（p < 0.05）呈负相关。结论DOME扩大硬腭穹隆导致鼻底解剖性扩张，鼻气流速度降低，咽部气道负压下降。这种动态相互作用与呼吸暂停低通气指数（AHI）和氧减饱和指数（ODI）的降低相关。
Objective Distraction osteogenesis maxillary expansion (DOME) is a reliable method to expand the nasal floor and hard palatal vault in adults with obstructive sleep apnea (OSA). DOME results in a reduction in the apnea-hypopnea index (AHI) and subjective report of improved nasal breathing. Using rhinomanometry augmented computational fluid dynamic (CFD) modeling, we propose a mechanism of how DOME reduces upper airway pharyngeal collapse in adults with OSA. Material and method A retrospective cohort with 20 subjects and mean age of 29.6 +/- 8 years who completed DOME at Stanford University from September 2014 to April 2016. Subjects were included if polysomnography, airway morphology, and rhinomanometry were available for use. From the CBCT data, 3D nasal and pharyngeal airway model were generated. Numeric CFD simulation of the airway models were analyzed under the following conditions: (1) the volume of air was flowing at a velocity of 300 cm(3)/s, (2) the wall surface was not slippery, and (3) the simulations were repeated 1000 times to calculate mean values. Statistical analyses using SPSS v24 software included paired t tests, nonparametric Wilcoxon rank test, Friedman test with Bonferroni correction, and Spearman's correlation coefficients (p < 0.05). Results Mean AHI improved from 17.8 +/- 17.6 to 7.8 +/- 7.1 events per hour (p < 0.001). Mean lowest oxygen saturation improved from 88.2 +/- 7.2 to 90.9 +/- 4.2% (p < 0.05). Mean airflow velocity within the nasal airway decreased from 15.6 +/- 7.3 to 7.4 +/- 2.1 m/s (p < 0.001) after DOME. Mean negative pressure of the nasal airway, retropalatal airway, oropharyngeal airway, and hypopharyngeal airway is reduced from - 158.4 +/- 115.3 to - 48.6 +/- 28.7 Pa, from - 174.8 +/- 119.9 to - 52.5 +/- 31.3 Pa, from - 177.0 +/- 118.4 to - 54.9 +/- 31.8 Pa and from - 177.9 +/- 117.9 to - 56.9 +/- 32.1 Pa (p < 0.001), respectively. AHI positively correlated with nasal flow velocity (p < 0.05) and negatively correlated with pharyngeal airway pressure (p < 0.05). ODI was positively correlated with nasal velocity (p < 0.05) and negatively correlated with nasal airway pressure (p < 0.05), retropalatal airway pressure (p < 0.001), oropharyngeal airway pressure (p < 0.001), and hypopharyngeal airway pressure (p < 0.05). Conclusion Anatomic expansion of the nasal floor with widening of the hard palatal vault from DOME is associated with reduction of nasal airflow velocity and downstream reduction of negative pressure in the pharyngeal airway. This dynamic interaction correlates with a reduction in the apnea-hypopnea index (AHI) and Oxygen Desaturation Index (ODI).