Obstructive sleep apnea (OSA) occurs in 50-100% of patients with Down syndrome and can significantly cause and exacerbate medical problems in these patients. Current surgical management in these children is imperfect. There are variable surgical success rates for both first line surgery [palatine tonsillectomy and adenoidectomy (T&A)] as well as secondary surgeries performed if and when T&A fails. There is a critical need for a diagnostic modality that takes into account airway anatomy, tissue compliance, and collapsibility to be able to predict surgical outcome and improve surgical planning in these patients. Our central hypothesis is that upper airway flow-structure interaction (FSI) modeling using three-dimensional (3-D) computational simulations from dynamic MRI data can be used to predict surgical outcome for children with Down syndrome who have OSA despite previous T&A. The long-term goal is to improve surgical outcome of children with Down syndrome and OSA by creating an accurate FSI predictive model. Such a diagnostic tool would help tailor surgical procedures to be more effective as well as identify and avoid unnecessary (or unhelpful) surgical procedures. These created models then can also be adjusted and applied to other populations with OSA.
Our specific aims i nclude: 1) In children with Down syndrome with persistent OSA despite previous T&A, collect data characterizing upper airway anatomy, tissue compliance, and collapsibility;2) Generate and validate individualized dynamic FSI models for each child in specific aim 1;and 3) Using the validated dynamic computational models, predict the success of surgical treatment on children with Down syndrome who have persistent OSA despite previous T&A. This work is innovative as it uses dynamic rather than static MR imaging data and applies a unique computational model that accurately captures the unsteadiness of the flow and accounts for the interaction between the airflow and the surrounding airway flexible structures.
The proposed research is relevant to public health because it seeks to create a diagnostic tool that will better predict the need and effectiveness of specific surgical procedures in the treatment of obstructive sleep apnea (OSA) in children with Down syndrome. Such a diagnostic tool would help tailor surgical procedures to be more effective as well as identify and avoid unnecessary (or unhelpful) surgical procedures. The creation of this diagnostic tool is important in children with Down syndrome because of the very high rate and refractory nature of OSA in these children but also the creation of the tool may also be applied and benefit other populations of children and adults with OSA, which constitutes a major health problem in the USA.
|Fleck, Robert J; Shott, Sally R; Mahmoud, Mohamed et al. (2018) Magnetic resonance imaging of obstructive sleep apnea in children. Pediatr Radiol 48:1223-1233|
|Subramaniam, Dhananjay Radhakrishnan; Arens, Raanan; Wagshul, Mark E et al. (2018) Biomechanics of the soft-palate in sleep apnea patients with polycystic ovarian syndrome. J Biomech 76:8-15|
|Subramaniam, Dhananjay Radhakrishnan; Mylavarapu, Goutham; Fleck, Robert J et al. (2017) Effect of airflow and material models on tissue displacement for surgical planning of pharyngeal airways in pediatric down syndrome patients. J Mech Behav Biomed Mater 71:122-135|
|Subramaniam, Dhananjay Radhakrishnan; Mylavarapu, Goutham; McConnell, Keith et al. (2016) Compliance Measurements of the Upper Airway in Pediatric Down Syndrome Sleep Apnea Patients. Ann Biomed Eng 44:873-85|
|Mylavarapu, Goutham; Subramaniam, Dhananjay; Jonnagiri, Raghuvir et al. (2016) Computational Modeling of Airway Obstruction in Sleep Apnea in Down Syndrome: A Feasibility Study. Otolaryngol Head Neck Surg 155:184-7|
|Subramaniam, Dhananjay Radhakrishnan; Mylavarapu, Goutham; McConnell, Keith et al. (2016) Upper Airway Elasticity Estimation in Pediatric Down Syndrome Sleep Apnea Patients Using Collapsible Tube Theory. Ann Biomed Eng 44:1538-52|
|Fleck, Robert J; Amin, Raouf S; Shott, Sally R et al. (2014) MRI sleep studies: use of positive airway pressure support in patients with severe obstructive sleep apnea. Int J Pediatr Otorhinolaryngol 78:1163-6|
|Chen, Jie; Gutmark, Ephraim (2014) Numerical investigation of airflow in an idealized human extra-thoracic airway: a comparison study. Biomech Model Mechanobiol 13:205-14|
|Nayak, Khrishna S; Fleck, Robert J (2014) Seeing sleep: dynamic imaging of upper airway collapse and collapsibility in children. IEEE Pulse 5:40-4|
|Fleck Jr, Robert J; Mahmoud, Mohamed; McConnell, Keith et al. (2013) An adverse effect of positive airway pressure on the upper airway documented with magnetic resonance imaging. JAMA Otolaryngol Head Neck Surg 139:636-8|