title: Computational Modeling of Airway Obstruction in Sleep Apnea in Down Syndrome: A Feasibility Study.
abstract: Current treatment options are successful in 40% to 60% of children with persistent obstructive sleep apnea after adenotonsillectomy. Residual obstruction assessments are largely subjective and do not clearly define multilevel obstruction. We endeavor to use computational fluid dynamics to perform virtual surgery and assess airflow changes in patients with Down syndrome and persistent obstructive sleep apnea. Three-dimensional airway models were reconstructed from respiratory-gated computed tomography and magnetic resonance imaging. Virtual surgeries were performed on 10 patients, mirroring actual surgeries. They demonstrated how surgical changes affect airflow resistance. Airflow and upper airway resistance was calculated from computational fluid dynamics. Virtual and actual surgery outcomes were compared with obstructive apnea-hypopnea index values. Actual surgery successfully treated 6 of 10 patients (postoperative obstructive apnea-hypopnea index <5). In 8 of 10 subjects, both apnea-hypopnea index and the calculated upper airway resistance after virtual surgery decreased as compared with baseline values. This is a feasibility and proof-of-concept study. Further studies are needed before using these techniques in surgical planning.
authors.affiliation: Division of Pulmonary Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.
authors.forename: Goutham
authors.initials: G
authors.lastname: Mylavarapu
authors.affiliation: Department of Aerospace Engineering and Engineering Mechanics, University of Cincinnati, Cincinnati, Ohio, USA.
authors.forename: Dhananjay
authors.initials: D
authors.lastname: Subramaniam
authors.affiliation: Department of Aerospace Engineering and Engineering Mechanics, University of Cincinnati, Cincinnati, Ohio, USA.
authors.forename: Raghuvir
authors.initials: R
authors.lastname: Jonnagiri
authors.affiliation: Department of Aerospace Engineering and Engineering Mechanics, University of Cincinnati, Cincinnati, Ohio, USA Department of Otolaryngology-Head and Neck Surgery, University of Cincinnati Medical Center, Cincinnati, Ohio, USA.
authors.forename: Ephraim J
authors.initials: EJ
authors.lastname: Gutmark
authors.affiliation: Department of Radiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Fleck
authors.affiliation: Division of Pulmonary Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA Department of Pediatrics, University of Cincinnati, College of Medicine, Cincinnati, Ohio, USA.
authors.forename: Raouf S
authors.initials: RS
authors.lastname: Amin
authors.affiliation: Department of Pediatric Anesthesia, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.
authors.forename: Mohamed
authors.initials: M
authors.lastname: Mahmoud
authors.affiliation: Division of Pulmonary Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA Department of Otolaryngology-Head and Neck Surgery, University of Cincinnati Medical Center, Cincinnati, Ohio, USA Department of Pediatric Otolaryngology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.
authors.forename: Stacey L
authors.initials: SL
authors.lastname: Ishman
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, University of Cincinnati Medical Center, Cincinnati, Ohio, USA Department of Pediatric Otolaryngology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA sally.shott@cchmc.org.
authors.forename: Sally R
authors.initials: SR
authors.lastname: Shott
mesh_terms: D000233:Adenoidectomy; D002648:Child; D003198:Computer Simulation; D004314:Down Syndrome / Q000150:complications*; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D057446:Hydrodynamics; D021621:Imaging, Three-Dimensional; D008279:Magnetic Resonance Imaging; D008297:Male; D055425:Respiratory-Gated Imaging Techniques; D020181:Sleep Apnea, Obstructive / Q000150:complications* / Q000000981:diagnostic imaging* / Q000601:surgery*; D025321:Surgery, Computer-Assisted / Q000379:methods*; D014057:Tomography, X-Ray Computed; D014068:Tonsillectomy; D016896:Treatment Outcome
keywords: Down syndrome; airway modeling; computational fluid dynamics; obstructive sleep apnea; virtual surgery