How does distraction osteogenesis maxillary expansion (DOME) reduce severity of obstructive sleep apnea?
Objective Distraction osteogenesis maxillary expansion (DOME) is a reliable method to expand the nasal floor and hard palatal vault in adults with obstructive sleep apnea (OSA). DOME results in a reduction in the apnea-hypopnea index (AHI) and subjective report of improved nasal breathing. Using rhi...
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| Published in | Sleep & breathing Vol. 24; no. 1; pp. 287 - 296 |
|---|---|
| Main Authors | , , , , |
| Format | Journal Article |
| Language | English |
| Published |
Cham
Springer International Publishing
01.03.2020
Springer Nature B.V |
| Subjects | |
| Online Access | Get full text |
| ISSN | 1520-9512 1522-1709 1522-1709 |
| DOI | 10.1007/s11325-019-01948-7 |
Cover
| Abstract | Objective
Distraction osteogenesis maxillary expansion (DOME) is a reliable method to expand the nasal floor and hard palatal vault in adults with obstructive sleep apnea (OSA). DOME results in a reduction in the apnea-hypopnea index (AHI) and subjective report of improved nasal breathing. Using rhinomanometry augmented computational fluid dynamic (CFD) modeling, we propose a mechanism of how DOME reduces upper airway pharyngeal collapse in adults with OSA.
Material and method
A retrospective cohort with 20 subjects and mean age of 29.6 ± 8 years who completed DOME at Stanford University from September 2014 to April 2016. Subjects were included if polysomnography, airway morphology, and rhinomanometry were available for use. From the CBCT data, 3D nasal and pharyngeal airway model were generated. Numeric CFD simulation of the airway models were analyzed under the following conditions: (1) the volume of air was flowing at a velocity of 300 cm
3
/s, (2) the wall surface was not slippery, and (3) the simulations were repeated 1000 times to calculate mean values. Statistical analyses using SPSS v24 software included paired
t
tests, nonparametric Wilcoxon rank test, Friedman test with Bonferroni correction, and Spearman’s correlation coefficients (
p
< 0.05).
Results
Mean AHI improved from 17.8 ± 17.6 to 7.8 ± 7.1 events per hour (
p
< 0.001). Mean lowest oxygen saturation improved from 88.2 ± 7.2 to 90.9 ± 4.2% (
p
< 0.05). Mean airflow velocity within the nasal airway decreased from 15.6 ± 7.3 to 7.4 ± 2.1 m/s (
p
< 0.001) after DOME. Mean negative pressure of the nasal airway, retropalatal airway, oropharyngeal airway, and hypopharyngeal airway is reduced from − 158.4 ± 115.3 to − 48.6 ± 28.7 Pa, from − 174.8 ± 119.9 to − 52.5 ± 31.3 Pa, from − 177.0 ± 118.4 to − 54.9 ± 31.8 Pa and from − 177.9 ± 117.9 to − 56.9 ± 32.1 Pa (
p
< 0.001), respectively. AHI positively correlated with nasal flow velocity (
p
< 0.05) and negatively correlated with pharyngeal airway pressure (
p
< 0.05). ODI was positively correlated with nasal velocity (
p
< 0.05) and negatively correlated with nasal airway pressure (
p
< 0.05), retropalatal airway pressure (
p
< 0.001), oropharyngeal airway pressure (
p
< 0.001), and hypopharyngeal airway pressure (
p
< 0.05).
Conclusion
Anatomic expansion of the nasal floor with widening of the hard palatal vault from DOME is associated with reduction of nasal airflow velocity and downstream reduction of negative pressure in the pharyngeal airway. This dynamic interaction correlates with a reduction in the apnea-hypopnea index (AHI) and Oxygen Desaturation Index (ODI). |
|---|---|
| AbstractList | Distraction osteogenesis maxillary expansion (DOME) is a reliable method to expand the nasal floor and hard palatal vault in adults with obstructive sleep apnea (OSA). DOME results in a reduction in the apnea-hypopnea index (AHI) and subjective report of improved nasal breathing. Using rhinomanometry augmented computational fluid dynamic (CFD) modeling, we propose a mechanism of how DOME reduces upper airway pharyngeal collapse in adults with OSA.OBJECTIVEDistraction osteogenesis maxillary expansion (DOME) is a reliable method to expand the nasal floor and hard palatal vault in adults with obstructive sleep apnea (OSA). DOME results in a reduction in the apnea-hypopnea index (AHI) and subjective report of improved nasal breathing. Using rhinomanometry augmented computational fluid dynamic (CFD) modeling, we propose a mechanism of how DOME reduces upper airway pharyngeal collapse in adults with OSA.A retrospective cohort with 20 subjects and mean age of 29.6 ± 8 years who completed DOME at Stanford University from September 2014 to April 2016. Subjects were included if polysomnography, airway morphology, and rhinomanometry were available for use. From the CBCT data, 3D nasal and pharyngeal airway model were generated. Numeric CFD simulation of the airway models were analyzed under the following conditions: (1) the volume of air was flowing at a velocity of 300 cm3/s, (2) the wall surface was not slippery, and (3) the simulations were repeated 1000 times to calculate mean values. Statistical analyses using SPSS v24 software included paired t tests, nonparametric Wilcoxon rank test, Friedman test with Bonferroni correction, and Spearman's correlation coefficients (p < 0.05).MATERIAL AND METHODA retrospective cohort with 20 subjects and mean age of 29.6 ± 8 years who completed DOME at Stanford University from September 2014 to April 2016. Subjects were included if polysomnography, airway morphology, and rhinomanometry were available for use. From the CBCT data, 3D nasal and pharyngeal airway model were generated. Numeric CFD simulation of the airway models were analyzed under the following conditions: (1) the volume of air was flowing at a velocity of 300 cm3/s, (2) the wall surface was not slippery, and (3) the simulations were repeated 1000 times to calculate mean values. Statistical analyses using SPSS v24 software included paired t tests, nonparametric Wilcoxon rank test, Friedman test with Bonferroni correction, and Spearman's correlation coefficients (p < 0.05).Mean AHI improved from 17.8 ± 17.6 to 7.8 ± 7.1 events per hour (p < 0.001). Mean lowest oxygen saturation improved from 88.2 ± 7.2 to 90.9 ± 4.2% (p < 0.05). Mean airflow velocity within the nasal airway decreased from 15.6 ± 7.3 to 7.4 ± 2.1 m/s (p < 0.001) after DOME. Mean negative pressure of the nasal airway, retropalatal airway, oropharyngeal airway, and hypopharyngeal airway is reduced from - 158.4 ± 115.3 to - 48.6 ± 28.7 Pa, from - 174.8 ± 119.9 to - 52.5 ± 31.3 Pa, from - 177.0 ± 118.4 to - 54.9 ± 31.8 Pa and from - 177.9 ± 117.9 to - 56.9 ± 32.1 Pa (p < 0.001), respectively. AHI positively correlated with nasal flow velocity (p < 0.05) and negatively correlated with pharyngeal airway pressure (p < 0.05). ODI was positively correlated with nasal velocity (p < 0.05) and negatively correlated with nasal airway pressure (p < 0.05), retropalatal airway pressure (p < 0.001), oropharyngeal airway pressure (p < 0.001), and hypopharyngeal airway pressure (p < 0.05).RESULTSMean AHI improved from 17.8 ± 17.6 to 7.8 ± 7.1 events per hour (p < 0.001). Mean lowest oxygen saturation improved from 88.2 ± 7.2 to 90.9 ± 4.2% (p < 0.05). Mean airflow velocity within the nasal airway decreased from 15.6 ± 7.3 to 7.4 ± 2.1 m/s (p < 0.001) after DOME. Mean negative pressure of the nasal airway, retropalatal airway, oropharyngeal airway, and hypopharyngeal airway is reduced from - 158.4 ± 115.3 to - 48.6 ± 28.7 Pa, from - 174.8 ± 119.9 to - 52.5 ± 31.3 Pa, from - 177.0 ± 118.4 to - 54.9 ± 31.8 Pa and from - 177.9 ± 117.9 to - 56.9 ± 32.1 Pa (p < 0.001), respectively. AHI positively correlated with nasal flow velocity (p < 0.05) and negatively correlated with pharyngeal airway pressure (p < 0.05). ODI was positively correlated with nasal velocity (p < 0.05) and negatively correlated with nasal airway pressure (p < 0.05), retropalatal airway pressure (p < 0.001), oropharyngeal airway pressure (p < 0.001), and hypopharyngeal airway pressure (p < 0.05).Anatomic expansion of the nasal floor with widening of the hard palatal vault from DOME is associated with reduction of nasal airflow velocity and downstream reduction of negative pressure in the pharyngeal airway. This dynamic interaction correlates with a reduction in the apnea-hypopnea index (AHI) and Oxygen Desaturation Index (ODI).CONCLUSIONAnatomic expansion of the nasal floor with widening of the hard palatal vault from DOME is associated with reduction of nasal airflow velocity and downstream reduction of negative pressure in the pharyngeal airway. This dynamic interaction correlates with a reduction in the apnea-hypopnea index (AHI) and Oxygen Desaturation Index (ODI). Distraction osteogenesis maxillary expansion (DOME) is a reliable method to expand the nasal floor and hard palatal vault in adults with obstructive sleep apnea (OSA). DOME results in a reduction in the apnea-hypopnea index (AHI) and subjective report of improved nasal breathing. Using rhinomanometry augmented computational fluid dynamic (CFD) modeling, we propose a mechanism of how DOME reduces upper airway pharyngeal collapse in adults with OSA. A retrospective cohort with 20 subjects and mean age of 29.6 ± 8 years who completed DOME at Stanford University from September 2014 to April 2016. Subjects were included if polysomnography, airway morphology, and rhinomanometry were available for use. From the CBCT data, 3D nasal and pharyngeal airway model were generated. Numeric CFD simulation of the airway models were analyzed under the following conditions: (1) the volume of air was flowing at a velocity of 300 cm /s, (2) the wall surface was not slippery, and (3) the simulations were repeated 1000 times to calculate mean values. Statistical analyses using SPSS v24 software included paired t tests, nonparametric Wilcoxon rank test, Friedman test with Bonferroni correction, and Spearman's correlation coefficients (p < 0.05). Mean AHI improved from 17.8 ± 17.6 to 7.8 ± 7.1 events per hour (p < 0.001). Mean lowest oxygen saturation improved from 88.2 ± 7.2 to 90.9 ± 4.2% (p < 0.05). Mean airflow velocity within the nasal airway decreased from 15.6 ± 7.3 to 7.4 ± 2.1 m/s (p < 0.001) after DOME. Mean negative pressure of the nasal airway, retropalatal airway, oropharyngeal airway, and hypopharyngeal airway is reduced from - 158.4 ± 115.3 to - 48.6 ± 28.7 Pa, from - 174.8 ± 119.9 to - 52.5 ± 31.3 Pa, from - 177.0 ± 118.4 to - 54.9 ± 31.8 Pa and from - 177.9 ± 117.9 to - 56.9 ± 32.1 Pa (p < 0.001), respectively. AHI positively correlated with nasal flow velocity (p < 0.05) and negatively correlated with pharyngeal airway pressure (p < 0.05). ODI was positively correlated with nasal velocity (p < 0.05) and negatively correlated with nasal airway pressure (p < 0.05), retropalatal airway pressure (p < 0.001), oropharyngeal airway pressure (p < 0.001), and hypopharyngeal airway pressure (p < 0.05). Anatomic expansion of the nasal floor with widening of the hard palatal vault from DOME is associated with reduction of nasal airflow velocity and downstream reduction of negative pressure in the pharyngeal airway. This dynamic interaction correlates with a reduction in the apnea-hypopnea index (AHI) and Oxygen Desaturation Index (ODI). ObjectiveDistraction osteogenesis maxillary expansion (DOME) is a reliable method to expand the nasal floor and hard palatal vault in adults with obstructive sleep apnea (OSA). DOME results in a reduction in the apnea-hypopnea index (AHI) and subjective report of improved nasal breathing. Using rhinomanometry augmented computational fluid dynamic (CFD) modeling, we propose a mechanism of how DOME reduces upper airway pharyngeal collapse in adults with OSA.Material and methodA retrospective cohort with 20 subjects and mean age of 29.6 ± 8 years who completed DOME at Stanford University from September 2014 to April 2016. Subjects were included if polysomnography, airway morphology, and rhinomanometry were available for use. From the CBCT data, 3D nasal and pharyngeal airway model were generated. Numeric CFD simulation of the airway models were analyzed under the following conditions: (1) the volume of air was flowing at a velocity of 300 cm3/s, (2) the wall surface was not slippery, and (3) the simulations were repeated 1000 times to calculate mean values. Statistical analyses using SPSS v24 software included paired t tests, nonparametric Wilcoxon rank test, Friedman test with Bonferroni correction, and Spearman’s correlation coefficients (p < 0.05).ResultsMean AHI improved from 17.8 ± 17.6 to 7.8 ± 7.1 events per hour (p < 0.001). Mean lowest oxygen saturation improved from 88.2 ± 7.2 to 90.9 ± 4.2% (p < 0.05). Mean airflow velocity within the nasal airway decreased from 15.6 ± 7.3 to 7.4 ± 2.1 m/s (p < 0.001) after DOME. Mean negative pressure of the nasal airway, retropalatal airway, oropharyngeal airway, and hypopharyngeal airway is reduced from − 158.4 ± 115.3 to − 48.6 ± 28.7 Pa, from − 174.8 ± 119.9 to − 52.5 ± 31.3 Pa, from − 177.0 ± 118.4 to − 54.9 ± 31.8 Pa and from − 177.9 ± 117.9 to − 56.9 ± 32.1 Pa (p < 0.001), respectively. AHI positively correlated with nasal flow velocity (p < 0.05) and negatively correlated with pharyngeal airway pressure (p < 0.05). ODI was positively correlated with nasal velocity (p < 0.05) and negatively correlated with nasal airway pressure (p < 0.05), retropalatal airway pressure (p < 0.001), oropharyngeal airway pressure (p < 0.001), and hypopharyngeal airway pressure (p < 0.05).ConclusionAnatomic expansion of the nasal floor with widening of the hard palatal vault from DOME is associated with reduction of nasal airflow velocity and downstream reduction of negative pressure in the pharyngeal airway. This dynamic interaction correlates with a reduction in the apnea-hypopnea index (AHI) and Oxygen Desaturation Index (ODI). Objective Distraction osteogenesis maxillary expansion (DOME) is a reliable method to expand the nasal floor and hard palatal vault in adults with obstructive sleep apnea (OSA). DOME results in a reduction in the apnea-hypopnea index (AHI) and subjective report of improved nasal breathing. Using rhinomanometry augmented computational fluid dynamic (CFD) modeling, we propose a mechanism of how DOME reduces upper airway pharyngeal collapse in adults with OSA. Material and method A retrospective cohort with 20 subjects and mean age of 29.6 ± 8 years who completed DOME at Stanford University from September 2014 to April 2016. Subjects were included if polysomnography, airway morphology, and rhinomanometry were available for use. From the CBCT data, 3D nasal and pharyngeal airway model were generated. Numeric CFD simulation of the airway models were analyzed under the following conditions: (1) the volume of air was flowing at a velocity of 300 cm 3 /s, (2) the wall surface was not slippery, and (3) the simulations were repeated 1000 times to calculate mean values. Statistical analyses using SPSS v24 software included paired t tests, nonparametric Wilcoxon rank test, Friedman test with Bonferroni correction, and Spearman’s correlation coefficients ( p < 0.05). Results Mean AHI improved from 17.8 ± 17.6 to 7.8 ± 7.1 events per hour ( p < 0.001). Mean lowest oxygen saturation improved from 88.2 ± 7.2 to 90.9 ± 4.2% ( p < 0.05). Mean airflow velocity within the nasal airway decreased from 15.6 ± 7.3 to 7.4 ± 2.1 m/s ( p < 0.001) after DOME. Mean negative pressure of the nasal airway, retropalatal airway, oropharyngeal airway, and hypopharyngeal airway is reduced from − 158.4 ± 115.3 to − 48.6 ± 28.7 Pa, from − 174.8 ± 119.9 to − 52.5 ± 31.3 Pa, from − 177.0 ± 118.4 to − 54.9 ± 31.8 Pa and from − 177.9 ± 117.9 to − 56.9 ± 32.1 Pa ( p < 0.001), respectively. AHI positively correlated with nasal flow velocity ( p < 0.05) and negatively correlated with pharyngeal airway pressure ( p < 0.05). ODI was positively correlated with nasal velocity ( p < 0.05) and negatively correlated with nasal airway pressure ( p < 0.05), retropalatal airway pressure ( p < 0.001), oropharyngeal airway pressure ( p < 0.001), and hypopharyngeal airway pressure ( p < 0.05). Conclusion Anatomic expansion of the nasal floor with widening of the hard palatal vault from DOME is associated with reduction of nasal airflow velocity and downstream reduction of negative pressure in the pharyngeal airway. This dynamic interaction correlates with a reduction in the apnea-hypopnea index (AHI) and Oxygen Desaturation Index (ODI). |
| Author | Iwasaki, Tomonori Guilleminault, Christian Liu, Stanley Yung Yoon, Audrey Yamasaki, Youichi |
| Author_xml | – sequence: 1 givenname: Tomonori surname: Iwasaki fullname: Iwasaki, Tomonori organization: Pediatric Dentistry, Graduate School of Medical and Dental Sciences, Kagoshima University – sequence: 2 givenname: Audrey surname: Yoon fullname: Yoon, Audrey organization: Sections of Pediatric Dentistry and Orthodontics, Division of Growth and Developments, UCLA School of Dentistry – sequence: 3 givenname: Christian surname: Guilleminault fullname: Guilleminault, Christian organization: Sleep Medicine Division, Department of Psychiatry, Stanford Health Care – sequence: 4 givenname: Youichi surname: Yamasaki fullname: Yamasaki, Youichi organization: Pediatric Dentistry, Graduate School of Medical and Dental Sciences, Kagoshima University – sequence: 5 givenname: Stanley Yung surname: Liu fullname: Liu, Stanley Yung email: ycliu@stanford.edu organization: Division of Sleep Surgery, Department of Otolaryngology-Head & Neck Surgery, School of Medicine, Stanford University |
| BackLink | https://www.ncbi.nlm.nih.gov/pubmed/31823220$$D View this record in MEDLINE/PubMed |
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| Keywords | Rhinomanometry Pharyngeal negative pressure DOME Adult maxillary expansion Nasal airflow velocity Sleep apnea Distraction osteogenesis maxillary expansion Computational fluid dynamic Nasal obstruction OSA Snoring |
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| References_xml | – volume: 78 start-page: 1258 issue: 8 year: 2014 end-page: 1264 ident: CR11 article-title: The effect of rapid maxillary expansion on pharyngeal airway pressure during inspiration evaluated using computational fluid dynamics publication-title: Int J Pediatr Otorhinolaryngol doi: 10.1016/j.ijporl.2014.05.004 – volume: 148 start-page: 599 issue: 4 year: 2015 end-page: 607 ident: CR9 article-title: Comparison of transverse changes during maxillary expansion with 4-point bone-borne and tooth-borne maxillary expanders publication-title: Am J Orthod Dentofac Orthop doi: 10.1016/j.ajodo.2015.04.040 – volume: 116 start-page: 104 issue: 1 year: 2014 end-page: 112 ident: CR17 article-title: Computational fluid dynamics endpoints to characterize obstructive sleep apnea syndrome in children publication-title: J Appl Physiol (1985) doi: 10.1152/japplphysiol.00746.2013 – ident: CR16 – volume: 273 start-page: 4021 issue: 11 year: 2016 end-page: 4026 ident: CR20 article-title: 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Distraction osteogenesis maxillary expansion (DOME) is a reliable method to expand the nasal floor and hard palatal vault in adults with obstructive... Distraction osteogenesis maxillary expansion (DOME) is a reliable method to expand the nasal floor and hard palatal vault in adults with obstructive sleep... ObjectiveDistraction osteogenesis maxillary expansion (DOME) is a reliable method to expand the nasal floor and hard palatal vault in adults with obstructive... |
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| SubjectTerms | Adult Apnea Cohort Studies Computer applications Computer Simulation Dentistry Distraction osteogenesis ENT • Original Article Female Flow velocity Humans Hydrodynamics Internal Medicine Male Maxilla Medicine Medicine & Public Health Neurology Osteogenesis, Distraction - methods Otorhinolaryngology Oxygen Oxygen - blood Palatal Expansion Technique Pediatrics Pharynx Pneumology/Respiratory System Polysomnography Pressure Pulmonary Ventilation - physiology Respiratory tract Retrospective Studies Rhinomanometry Sleep Sleep apnea Sleep Apnea, Obstructive - diagnosis Sleep Apnea, Obstructive - physiopathology Sleep Apnea, Obstructive - surgery Sleep disorders Statistical analysis Treatment Outcome Young Adult |
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| Title | How does distraction osteogenesis maxillary expansion (DOME) reduce severity of obstructive sleep apnea? |
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