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Xiao Q, Gunatilaka C, McConnell K, Bates A. The effect of including dynamic imaging derived airway wall motion in CFD simulations of respiratory airflow in patients with OSA. Sci Rep 2024; 14:17242. [PMID: 39060561 PMCID: PMC11282179 DOI: 10.1038/s41598-024-68180-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2024] [Accepted: 07/22/2024] [Indexed: 07/28/2024] Open
Abstract
Obstructive sleep apnea (OSA) is an airway disease caused by periodic collapse of the airway during sleep. Imaging-based subject-specific computational fluid dynamics (CFD) simulations allow non-invasive assessment of clinically relevant metrics such as total pressure loss (TPL) in patients with OSA. However, most of such studies use static airway geometries, which neglect physiological airway motion. This study aims to quantify how much the airway moves during the respiratory cycle, and to determine how much this motion affects CFD pressure loss predictions. Motion of the airway wall was quantified using cine MRI data captured over a single respiratory cycle in three subjects with OSA. Synchronously-measured respiratory airflow was used as the flow boundary condition for all simulations. Simulations were performed for full respiratory cycles with 5 different wall boundary conditions: (1) a moving airway wall, and static airway walls at (2) peak inhalation, (3) end inhalation, (4) peak exhalation, and (5) end exhalation. Geometric analysis exposed significant local airway cross-sectional area (CSA) variability, with local CSA varying as much as 300%. The comparative CFD simulations revealed the discrepancies between dynamic and static wall simulations are subject-specific, with TPL differing by up to 400% between static and dynamic simulations. There is no consistent pattern to which static wall CFD simulations overestimate or underestimate the airway TPL. This variability underscores the complexity of accurately modeling airway physiology and the importance of considering dynamic anatomical factors to predict realistic respiratory airflow dynamics in patients with OSA.
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Affiliation(s)
- Qiwei Xiao
- Division of Pulmonary Medicine, Cincinnati Children's Hospital Medical Center, MLC2021, 3333 Burnet Ave, Cincinnati, OH, 45229, USA
| | - Chamindu Gunatilaka
- Division of Pulmonary Medicine, Cincinnati Children's Hospital Medical Center, MLC2021, 3333 Burnet Ave, Cincinnati, OH, 45229, USA
| | - Keith McConnell
- Division of Pulmonary Medicine, Cincinnati Children's Hospital Medical Center, MLC2021, 3333 Burnet Ave, Cincinnati, OH, 45229, USA
| | - Alister Bates
- Division of Pulmonary Medicine, Cincinnati Children's Hospital Medical Center, MLC2021, 3333 Burnet Ave, Cincinnati, OH, 45229, USA.
- Department of Pediatrics, University of Cincinnati, Cincinnati, OH, USA.
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Gandhi DB, Higano NS, Hahn AD, Gunatilaka CC, Torres LA, Fain SB, Woods JC, Bates AJ. Comparison of weighting algorithms to mitigate respiratory motion in free-breathing neonatal pulmonary radial UTE-MRI. Biomed Phys Eng Express 2024; 10:10.1088/2057-1976/ad3cdd. [PMID: 38599190 PMCID: PMC11182662 DOI: 10.1088/2057-1976/ad3cdd] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Accepted: 04/10/2024] [Indexed: 04/12/2024]
Abstract
Background. Thoracoabdominal MRI is limited by respiratory motion, especially in populations who cannot perform breath-holds. One approach for reducing motion blurring in radially-acquired MRI is respiratory gating. Straightforward 'hard-gating' uses only data from a specified respiratory window and suffers from reduced SNR. Proposed 'soft-gating' reconstructions may improve scan efficiency but reduce motion correction by incorporating data with nonzero weight acquired outside the specified window. However, previous studies report conflicting benefits, and importantly the choice of soft-gated weighting algorithm and effect on image quality has not previously been explored. The purpose of this study is to map how variable soft-gated weighting functions and parameters affect signal and motion blurring in respiratory-gated reconstructions of radial lung MRI, using neonates as a model population.Methods. Ten neonatal inpatients with respiratory abnormalities were imaged using a 1.5 T neonatal-sized scanner and 3D radial ultrashort echo-time (UTE) sequence. Images were reconstructed using ungated, hard-gated, and several soft-gating weighting algorithms (exponential, sigmoid, inverse, and linear weighting decay outside the period of interest), with %Nprojrepresenting the relative amount of data included. The apparent SNR (aSNR) and motion blurring (measured by the maximum derivative of image intensity at the diaphragm, MDD) were compared between reconstructions.Results. Soft-gating functions produced higher aSNR and lower MDD than hard-gated images using equivalent %Nproj, as expected. aSNR was not identical between different gating schemes for given %Nproj. While aSNR was approximately linear with %Nprojfor each algorithm, MDD performance diverged between functions as %Nprojdecreased. Algorithm performance was relatively consistent between subjects, except in images with high noise.Conclusion. The algorithm selection for soft-gating has a notable effect on image quality of respiratory-gated MRI; the timing of included data across the respiratory phase, and not simply the amount of data, plays an important role in aSNR. The specific soft-gating function and parameters should be considered for a given imaging application's requirements of signal and sharpness.
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Affiliation(s)
- Deep B Gandhi
- Center for Pulmonary Imaging Research, Division of Pulmonary Medicine and Department of Radiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States of America
| | - Nara S Higano
- Center for Pulmonary Imaging Research, Division of Pulmonary Medicine and Department of Radiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States of America
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, United States of America
| | - Andrew D Hahn
- Department of Medical Physics, University of Wisconsin, Madison, WI, United States of America
| | - Chamindu C Gunatilaka
- Center for Pulmonary Imaging Research, Division of Pulmonary Medicine and Department of Radiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States of America
| | - Luis A Torres
- Department of Medical Physics, University of Wisconsin, Madison, WI, United States of America
| | - Sean B Fain
- Department of Medical Physics, University of Wisconsin, Madison, WI, United States of America
- Department of Radiology, University of Iowa, Iowa City, IA, United States of America
| | - Jason C Woods
- Center for Pulmonary Imaging Research, Division of Pulmonary Medicine and Department of Radiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States of America
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, United States of America
| | - Alister J Bates
- Center for Pulmonary Imaging Research, Division of Pulmonary Medicine and Department of Radiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States of America
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, United States of America
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Xiao Q, Ignatiuk D, McConnell K, Gunatilaka C, Schuh A, Fleck R, Ishman S, Amin R, Bates A. The interaction between neuromuscular forces, aerodynamic forces, and anatomical motion in the upper airway predicts the severity of pediatric OSA. J Appl Physiol (1985) 2024; 136:70-78. [PMID: 37942529 PMCID: PMC11212793 DOI: 10.1152/japplphysiol.00071.2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Revised: 10/16/2023] [Accepted: 11/07/2023] [Indexed: 11/10/2023] Open
Abstract
Upper airway neuromuscular response to air pressure during inhalation is an important factor in assessing pediatric subjects with obstructive sleep apnea (OSA). The neuromuscular response's strength, timing, and duration all contribute to the potential for airway collapses and the severity of OSA. This study quantifies these factors at the soft palate, tongue, and epiglottis to assess the relationship between neuromuscular control and OSA severity in 20 pediatric subjects with and without trisomy 21, under dexmedetomidine-induced sedation. The interaction between neuromuscular force and airflow pressure force was assessed based on power transferred between the airway wall and airflow calculated from airway wall motion (from cine magnetic resonance images) and air pressure acting on the airway wall (from computational fluid dynamics simulations). Airway wall motion could be asynchronous with pressure forces due to neuromuscular activation, or synchronous with pressure forces, indicating a passive response to airflow. The obstructive apnea-hypopnea index (oAHI) quantified OSA severity. During inhalation, the normalized work done through asynchronous dilation of the airway at the soft palate, tongue, and epiglottis correlated significantly with oAHI (Spearman's ρ = 0.54, 0.50, 0.64; P = 0.03, 0.03, 0.003). Synchronous collapse at the epiglottis correlated significantly with oAHI (ρ = 0.52; P = 0.02). Temporal order of synchronous and asynchronous epiglottis motion during inhalation predicted the severity of OSA (moderate vs. severe) with 100% sensitivity and 70% specificity. Subjects with severe OSA and/or trisomy 21 have insufficient neuromuscular activation during inhalation, leading to collapse and increased neuromuscular activation. Airflow-driven airway wall motion during late inhalation likely is the main determinant of OSA severity.NEW & NOTEWORTHY This is the first study that combines cine MRI and computational fluid dynamics with in vivo synchronous respiratory flow measurement to quantify the interaction between airway neuromuscular forces, aerodynamic forces, and airway anatomy noninvasively in pediatric patients with obstructive sleep apnea (OSA). The results indicate power transfer predicts OSA severity.
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Affiliation(s)
- Qiwei Xiao
- Division of Pulmonary Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, United States
- Center for Pulmonary Imaging Research, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, United States
| | - Daniel Ignatiuk
- Division of Pulmonary Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, United States
| | - Keith McConnell
- Division of Pulmonary Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, United States
| | - Chamindu Gunatilaka
- Division of Pulmonary Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, United States
- Center for Pulmonary Imaging Research, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, United States
| | | | - Robert Fleck
- Center for Pulmonary Imaging Research, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, United States
- Department of Radiology and Medical Imaging, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, United States
| | - Stacey Ishman
- Department of Otolaryngology, Head & Neck Surgery, University of Cincinnati, Cincinnati, Ohio, United States
| | - Raouf Amin
- Division of Pulmonary Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, United States
- Department of Pediatrics, University of Cincinnati, Cincinnati, Ohio, United States
| | - Alister Bates
- Division of Pulmonary Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, United States
- Department of Pediatrics, University of Cincinnati, Cincinnati, Ohio, United States
- Center for Pulmonary Imaging Research, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, United States
- Department of Radiology and Medical Imaging, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, United States
- Department of Biomedical Engineering, University of Cincinnati, Cincinnati, Ohio, United States
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吴 楚, 卢 镇, 陈 李, 聂 国, 卢 永, 陶 晶. [Effects of orofacial myofunctional therapy on postoperative outcomes of upper airway surgery for adults with severe obstructive sleep apnea]. LIN CHUANG ER BI YAN HOU TOU JING WAI KE ZA ZHI = JOURNAL OF CLINICAL OTORHINOLARYNGOLOGY, HEAD, AND NECK SURGERY 2022; 36:916-920. [PMID: 36543398 PMCID: PMC10128283 DOI: 10.13201/j.issn.2096-7993.2022.12.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Indexed: 12/24/2022]
Abstract
Objective:To investigate the effect of orofacial myofunctional therapy on the clinical efficacy of upper airway surgery for adults with severe obstructive sleep apnea(OSA). Methods:A total of 48 patients with OSA who underwent upper airway surgery in the Shenzhen Second People's Hospital from June 2020 to September 2021 were included in this study. These patients were randomly divided into the combination group(21 cases) and the surgery group(27 cases). The effective rate, AHI, minimum blood oxygen saturation, snoring events and Epworth sleepiness scale scores at 6 months after operation were compared and analyzed between the two groups. Results:The proportions of AHI, LSaO2, snoring events, and total snoring time in the combined group at 6 months after operation were(14.77±9.15) times/h, (81.19±6.52)%, (172.43±73.67) times, and(13.16±6.02)%. The proportion of AHI, LSaO2, snoring events, and total snoring time in surgical group at 6 months after operation was(23.87±10.6) times/h, (80.78±4.88)%, (235.81±83.23) times, (17.58±5.94)%. Compared with preoperative 6 months after operation, the proportion of AHI, snoring events, and total snoring time was significantly decreased, and LSaO2was significantly increased, and the differences were statistically significant(P<0.05). The time of snoring and the proportion of snoring to time were significantly improved compared with those in the simple operation group, and the differences were statistically significant(P<0.05). Conclusion:This study verified that orofacial myofunctional therapy can improve the clinical efficacy after upper airway surgery for adults with severe obstructive sleep apnea.
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Affiliation(s)
- 楚城 吴
- 深圳市第二人民医院耳鼻咽喉头颈外科(广东深圳, 518000)Department of Otorhinolaryngology Head and Neck Surgery, the Second Hosipital of Shenzhen, Shenzhen, 518000, China
| | - 镇章 卢
- 深圳大学附属华南医院耳鼻咽喉头颈外科Department of Otorhinolaryngology Head and Neck Surgery, South China Hospital of Shenzhen University
| | - 李清 陈
- 深圳大学总医院耳鼻咽喉头颈外科Department of Otorhinolaryngology Head and Neck Surgery, Shenzhen University General Hospital
| | - 国辉 聂
- 深圳市第二人民医院耳鼻咽喉头颈外科(广东深圳, 518000)Department of Otorhinolaryngology Head and Neck Surgery, the Second Hosipital of Shenzhen, Shenzhen, 518000, China
| | - 永田 卢
- 深圳市第二人民医院耳鼻咽喉头颈外科(广东深圳, 518000)Department of Otorhinolaryngology Head and Neck Surgery, the Second Hosipital of Shenzhen, Shenzhen, 518000, China
| | - 晶 陶
- 深圳市第二人民医院耳鼻咽喉头颈外科(广东深圳, 518000)Department of Otorhinolaryngology Head and Neck Surgery, the Second Hosipital of Shenzhen, Shenzhen, 518000, China
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