Improving Outcomes in Pediatric Obstructive Sleep Apnea with Computational Fluid Dynamics

该项目旨在创建一种有效的计算工具来预测儿科患者的手术结果 阻塞性睡眠呼吸暂停(OSA)。阻塞性睡眠呼吸暂停是一种常见的疾病，仅在美国就有220万儿童受到影响。它是 以睡眠中的上呼吸道阻塞为特征的，这会导致睡眠中断并导致 发育迟缓、心血管并发症和发育受损。儿童的一线治疗 OSA的治疗方法是摘除扁桃体和腺样体；然而，这些手术并不总是能治愈患者。 另一种治疗方法是持续气道正压治疗(CPAP)，只有50%的儿童能耐受。因此， 许多儿童接受针对呼吸道周围软组织结构的外科干预，例如 扁桃体、舌头和软腭，和/或面部的骨质结构。然而，这些项目的成功率 手术，以阻塞性呼吸暂停低通气指数(每小时阻塞性事件)的减少为衡量标准 睡眠)，低得令人惊讶。因此，显然需要一种工具来提高这些手术的疗效。 并预测各种手术选择中的哪一种将最有效地使每个患者受益。 上呼吸道中呼吸气流的计算流体动力学(CFD)模拟可以提供这一点 预测性工具，允许虚拟比较各种手术方案的效果，以及最有可能的方案 以改善患者的病情可供选择。以前的CFD模拟无法提供 关于阻塞性睡眠呼吸暂停综合征的信息，因为它们基于严格的几何形状，或者不包括神经肌肉运动，这是一个关键 OSA中的组件。该项目使用实时磁共振成像(MRI)来提供解剖和 将呼吸道的运动转化为CFD模拟，这意味着首次建立了准确的活体运动模型。 此外，由于建模基于MRI，这是一种不使用电离辐射的方式，因此它是合适的 对手术前后的患者进行纵向评估。这些模型的体内验证 将首次通过比较基于CFD的气流速度场和生成的气流速度场来实现 吸入超极化129Xe气体的相位对比磁共振成像。 辛辛那提儿童医院在儿科肺部和睡眠医学领域处于世界领先地位 放射学，是进行拟议研究和PI开发基本知识的理想环境 作为一名独立调查员拥有成功职业生涯的技能。PI已经在这两个项目中确定了主要导师 技术和临床领域，以及一个进一步的指导团队，以协助该项目的具体方面。介于 他们在核磁共振，睡眠医学，肺部医学，CFD建模，呼吸道外科， 放射学、生物统计学，以及通过这一奖励机制的职业发展。他们的知识 加强和补充了圆周率在计算模型内的呼吸道和气流的背景。 这个项目的成功获奖将为国际和平协会提供机会，使他在 以改善儿童阻塞性睡眠呼吸暂停综合征患者的生活质量。

This project aims to create a validated computational tool to predict surgical outcomes for pediatric patients with obstructive sleep apnea (OSA). OSA is a common condition, affecting 2.2 million children in the USA alone. It is characterized as upper airway obstruction during sleep, which causes disrupted sleep and leads to developmental delay, cardiovascular complications and impaired growth. The first line of treatment for children with OSA is to remove their tonsils and adenoids; however, these surgeries do not always cure the patient. Another treatment, continuous positive airway pressure (CPAP) is only tolerated by 50% of children. Therefore, many children undergo surgical interventions aimed at soft tissue structures surrounding the airway, such as tonsils, tongue, and soft palate, and/or the bony structures of the face. However, the success rates of these surgeries, measured as a reduction in the obstructive apnea-hypopnea index (obstructive events per hour of sleep), is surprisingly low. Therefore, there is a clear need for a tool to improve the efficacy of these surgeries and predict which of the various surgical options is going to benefit each individual patient most effectively. Computational fluid dynamics (CFD) simulations of respiratory airflow in the upper airways can provide this predictive tool, allowing the effects of various surgical options to be compared virtually and the option most likely to improve the patient’s condition to be chosen. Previous CFD simulations have been unable to provide information about OSA as they were based on rigid geometries, or did not include neuromuscular motion, a key component in OSA. This project uses real-time magnetic resonance imaging (MRI) to provide the anatomy and motion of the airway to the CFD simulation, meaning that the exact in vivo motion is modeled for the first time. Furthermore, since the modeling is based on MRI, a modality which does not use ionizing radiation, it is suitable for longitudinal assessment of patients before and after surgical procedures. In vivo validation of these models will be achieved for the first time through comparison of CFD-based airflow velocity fields with those generated by phase-contrast MRI of inhaled hyperpolarized 129Xe gas. Cincinnati Children’s Hospital is a world leader in the fields of pediatric pulmonary and sleep medicine and radiology, and is the ideal environment to conduct the proposed research and for the PI to develop the essential skills to have a successful career as an independent investigator. The PI has identified primary mentors in both technical and clinical fields, and a further mentoring team to assist with specific aspects of this project. Between them, they have experience in MRI, sleep medicine, pulmonary medicine, CFD modeling, airway surgery, radiology, and biostatistics, as well as career development through this award mechanism. Their knowledge strengthens and complements the PI’s background in computational modeling of the airways and airflow within. The successful award of this project would afford the PI the opportunity to establish himself as a world leader in airway biomechanics and to improve the quality of life for pediatric patients with OSA.