Computational fluid dynamics endpoints to characterize obstructive sleep apnea syndrome in children
Computational fluid dynamics endpoints to characterize obstructive sleep apnea syndrome in children
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DOI：
10.1152/japplphysiol.00746.2013
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发表时间：
2014-01-01
影响因子：
3.3
通讯作者：
Arens, Raanan
中科院分区：
文献类型：
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作者：
Wootton, David M.;Luo, Haiyan;Arens, Raanan
计算流体动力学(CFD)分析可以比单纯的解剖学测量更好地量化阻塞性睡眠呼吸暂停综合征(OSAS)解剖性气道限制的严重程度。然而，用于表征或评估OSAS的最佳CFD模型终点尚未确定。使用CFD模拟上呼吸道流体动力学，并调查患有OSAS的肥胖儿童和对照组中不同CFD终点、解剖终点和OSAS严重程度之间的相关性。从磁共振图像得到的CFD模型在受试者特定的潮汐吸气峰值流速下求解；后鼻孔的压力由鼻阻力设定。模型终点包括气道壁最小压力(P-min)、咽部流动阻力(R-咽)和从后鼻孔到扁桃体和腺样体收缩咽部的最小横截面的压降(Dp(TAmax))。用配对比较(t检验或Wilcoxon符号等级检验)和Spearman相关分析终点的显著性。共分析了15对受试者。阻塞性睡眠呼吸暂停低通气指数(OAHI)与阻塞性呼吸暂停低通气指数(OAHI)呈高度正相关，相关系数分别为0.48和0.49(P<0.01)。气道最小横断面与oAHI的相关性较弱(r=-0.39)，P-min相关不显著。基于咽部压力降的CFD模型终点与OSAS的存在和严重程度的关系比包括鼻阻力或解剖终点在内的压力更密切。这项研究支持CFD在描述咽部解剖受限方面的有效性，并作为评估OSAS受试者的另一种工具。
Computational fluid dynamics (CFD) analysis may quantify the severity of anatomical airway restriction in obstructive sleep apnea syndrome (OSAS) better than anatomical measurements alone. However, optimal CFD model endpoints to characterize or assess OSAS have not been determined. To model upper airway fluid dynamics using CFD and investigate the strength of correlation between various CFD endpoints, anatomical endpoints, and OSAS severity, in obese children with OSAS and controls. CFD models derived from magnetic resonance images were solved at subject-specific peak tidal inspiratory flow; pressure at the choanae was set by nasal resistance. Model endpoints included airway wall minimum pressure (P-min), flow resistance in the pharynx (R-pharynx), and pressure drop from choanae to a minimum cross section where tonsils and adenoids constrict the pharynx (dP(TAmax)). Significance of endpoints was analyzed using paired comparisons (t-test or Wilcoxon signed rank test) and Spearman correlation. Fifteen subject pairs were analyzed. R-pharynx and dP(TAmax) were higher in OSAS than control and most significantly correlated to obstructive apnea-hypopnea index (oAHI), r = 0.48 and r = 0.49, respectively (P < 0.01). Airway minimum cross-sectional correlation to oAHI was weaker (r = -0.39); P-min was not significantly correlated. CFD model endpoints based on pressure drops in the pharynx were more closely associated with the presence and severity of OSAS than pressures including nasal resistance, or anatomical endpoints. This study supports the usefulness of CFD to characterize anatomical restriction of the pharynx and as an additional tool to evaluate subjects with OSAS.