Use of computational modeling to predict responses to upper airway surgery in obstructive sleep apnea
Use of computational modeling to predict responses to upper airway surgery in obstructive sleep apnea
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DOI：
10.1097/mlg.0b013e318030ca55
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发表时间：
2007-04-01
期刊：
影响因子：
2.6
通讯作者：
Malhotra, Atul
中科院分区：
文献类型：
--
作者：
Huang, Yaqi;White, David P.;Malhotra, Atul
目标。尽管阻塞性睡眠呼吸暂停(OSA)的后果已经广为人知，但其治疗仍然不令人满意。治疗策略变得复杂，在持续正压的情况下往往依从性差，或者在许多上呼吸道手术的情况下疗效高度可变。上呼吸道的计算模型使用有限元分析来模拟各种解剖和生理手法对咽力学的影响，这可能有助于预测手术成功。研究设计。计算和生理学研究。方法：利用具有代表性的OSA磁共振图像和实验测量的上呼吸道扩张器肌肉活动，建立了上呼吸道的工作二维和局部三维模型。结果：与实验测量结果一致，OSA模型气道关闭压为-2 cm H2O。如腭硬化术、腭切除术术和舌硬化术等手法都对咽力学有明显的影响。我们还开发了一个局部三维OSA模型，在该模型中我们模拟了正中矢状面和矢状面旁的咽部呼吸道的力学行为。切片，厚度超过1英寸。利用这一模型，我们观察到舌部和腭部僵硬对咽部呼吸道前后塌陷的重要影响。结论：我们的数据表明，计算模型是可行的，并可用于为随后的OSA解剖操作临床试验生成假说。我们进一步相信，基于潜在机制的OSA个体化治疗的目标可以通过计算建模来促进。
Objectives. Despite the well-recognized consequences of obstructive sleep apnea (OSA), its treatment remains unsatisfactory. Therapeutic strategies are complicated by often poor adherence in the case of continuous positive airway pressure or the highly variable efficacy in the case of many upper airway surgeries. Computational models of the upper airway using finite element analysis to simulate the effects of various anatomic and physiologic manipulations on pharyngeal mechanics could be helpful in predicting surgical success. Study Design. Computational and physiologic study. Methods: Using representative OSA magnetic resonance images and experimentally measured upper airway dilator muscle activities, we developed a working two-dimensional and a partial three-dimensional model of the upper airway. Results: As predicted from experimental measurements, the OSA model airway has a closing pressure of -2 cm H2O. Manipulations such as palatal stiffening, palatal resection, and tongue stiffening all have demonstrable effects on pharyngeal mechanics. We have also developed a partial three-dimensional OSA model in which we simulate the mechanics of the pharyngeal airway in the midsagittal and parasagittal. slices, spanning more than 1 inch in thickness. Using this model, we have observed important effects of tongue and palatal stiffening on anteroposterior collapse of the pharyngeal airway. Conclusions: Our data suggest that computational modeling is feasible and can be used to generate hypotheses for subsequent clinical trials regarding anatomic manipulations in OSA. We further believe that the goal of individualizing OSA therapy on the basis of underlying mechanisms could be facilitated by computational modeling.