Effects of 3D Airway Geometry on the Airflow of Adults with Cleft Lip and Palate and Obstructive Sleep Apnea: A Functional Imaging Study

Leticia Dominguez Campos; Inge Elly Kiemle Trindade; Sergio Henrique Kiemle Trindade; Luiz André Freire Pimenta; Julia Kimbell; Amelia Drake; Maria Noel Marzano-Rodrigues; Ivy Kiemle Trindade-Suedam

doi:10.1055/s-0043-1776868

Sleep Science, Table of Contents

CC BY-NC-ND 4.0 · Sleep Sci 2023; 16(04): e430-e438
DOI: 10.1055/s-0043-1776868

Original Article

Effects of 3D Airway Geometry on the Airflow of Adults with Cleft Lip and Palate and Obstructive Sleep Apnea: A Functional Imaging Study

Leticia Dominguez Campos

¹Laboratory of Physiology, Hospital de Reabilitação de Anomalias Craniofaciais, Universidade de São Paulo, Bauru, SP, Brazil

,

Inge Elly Kiemle Trindade

¹Laboratory of Physiology, Hospital de Reabilitação de Anomalias Craniofaciais, Universidade de São Paulo, Bauru, SP, Brazil

²School of Dentistry, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States of America

³Department of Biological Sciences, School of Dentistry, Universidade de São Paulo, Bauru, SP, Brazil

,

Sergio Henrique Kiemle Trindade

¹Laboratory of Physiology, Hospital de Reabilitação de Anomalias Craniofaciais, Universidade de São Paulo, Bauru, SP, Brazil

⁴Department of Pediatric Dentistry, Orthodontics and Public Health, School of Medicine, Universidade de São Paulo, Bauru, SP, Brazil

,

Luiz André Freire Pimenta

³Department of Biological Sciences, School of Dentistry, Universidade de São Paulo, Bauru, SP, Brazil

,

Julia Kimbell

⁵School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States of America

,

Amelia Drake

⁵School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States of America

,

Maria Noel Marzano-Rodrigues

¹Laboratory of Physiology, Hospital de Reabilitação de Anomalias Craniofaciais, Universidade de São Paulo, Bauru, SP, Brazil

,

Ivy Kiemle Trindade-Suedam

¹Laboratory of Physiology, Hospital de Reabilitação de Anomalias Craniofaciais, Universidade de São Paulo, Bauru, SP, Brazil

²School of Dentistry, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States of America

³Department of Biological Sciences, School of Dentistry, Universidade de São Paulo, Bauru, SP, Brazil

› Author Affiliations

Abstract

Objective Individuals with cleft lip and palate (CLP) are at a high risk of developing obstructive sleep apnea (OSA). Hypothetically, the severity of OSA might be associated with the morphology of the upper airway (UAW) and the characteristics of the airflow. Thus, the present study aimed to assess and compare, in adults with CLP and skeletal class-III discrepancy, with or without OSA, simulations of airflow resistance and pressure according to the geometrical characteristics of the UAW and cephalometric parameters.

Materials and Methods According to the results of type-I polysomnography tests, the sample (n = 21) was allocated in 2 groups: 1) without OSA (N-OSA; n = 6); and 2) with OSA (OSA; n = 15). Cephalometric measurements were performed on the cone-beam computed tomography (CBCT) scans of the groups. After three-dimensional (3D) reconstructions, the volume (V) and minimal cross-sectional area (mCSA) of the UAW were generated. Computational fluid dynamics (CFD) simulations were used to assess key airflow characteristics. The results were presented at a significance level of 5%.

Results The UAW pressure values and airway resistance did not differ between the groups, but there was a tendency for more negative pressures (26%) and greater resistance (19%) in the OSA group. Volume and mCSA showed a moderate negative correlation with resistance and pressure. The more inferior the hyoid bone, the more negative the pressures generated on the pharyngeal walls.

Conclusion The position of the hyoid bone and the geometry of the UAW (V and mCSA) exerted effects on the airway-airflow resistance and pressure. However, key airflow characteristics did not differ among subjects with CLP, were they affected or not by OSA.

Keywords

congenital, hereditary, and neonatal diseases and abnormalities - diagnostic imaging - sleep apnea, obstructive

Full Text

References

References
1 Kapur VK, Auckley DH, Chowdhuri S. et al. Clinical Practice Guideline for Diagnostic Testing for Adult Obstructive Sleep Apnea: An American Academy of Sleep Medicine Clinical Practice Guideline. J Clin Sleep Med 2017; 13 (03) 479-504
2 Fernandes MBL, Salgueiro AGNS, Bighetti EJB, Trindade-Suedam IK, Trindade IEK. Symptoms of Obstructive sleep apnea, nasal obstruction, and enuresis in children with nonsyndromic cleft lip and palate: a prevalence study. Cleft Palate Craniofac J 2019; 56 (03) 307-313
3 Campos LD, Trindade I, Yatabe M. et al. Reduced pharyngeal dimensions and obstructive sleep apnea in adults with cleft lip/palate and Class III malocclusion. Cranio 2019; •••: 1-7
4 Görücü-Coşkuner H, Saglam-Aydinatay B, Aksu M, Ozgur FF, Taner T. Comparison of positive screening for obstructive sleep apnea in patients with and without cleft lip and palate. Cleft Palate Craniofac J 2020; 57 (03) 364-370
5 IPDTOC Working Group. Prevalence at birth of cleft lip with or without cleft palate: data from the International Perinatal Database of Typical Oral Clefts (IPDTOC). Cleft Palate Craniofac J 2011; 48 (01) 66-81
6 Freitas JA, das Neves LT, de Almeida AL. et al. Rehabilitative treatment of cleft lip and palate: experience of the Hospital for Rehabilitation of Craniofacial Anomalies/USP (HRAC/USP)–Part 1: overall aspects. J Appl Oral Sci 2012; 20 (01) 9-15
7 Trindade IE, Gomes Ade O, Fernandes Mde B, Trindade SH, Silva Filho OG. Nasal airway dimensions of children with repaired unilateral cleft lip and palate. Cleft Palate Craniofac J 2015; 52 (05) 512-516
8 Trindade-Suedam IK, Lima TF, Campos LD, Yaedú RYF, Filho HN, Trindade IEK. Tomographic pharyngeal dimensions in individuals with unilateral cleft lip/palate and class III malocclusion are reduced when compared with controls. Cleft Palate Craniofac J 2017; 54 (05) 502-508
9 Oosterkamp BC, Remmelink HJ, Pruim GJ, Hoekema A, Dijkstra PU. Craniofacial, craniocervical, and pharyngeal morphology in bilateral cleft lip and palate and obstructive sleep apnea patients. Cleft Palate Craniofac J 2007; 44 (01) 1-7
10 Freitas JA, Garib DG, Trindade-Suedam IK. et al. Rehabilitative treatment of cleft lip and palate: experience of the Hospital for Rehabilitation of Craniofacial Anomalies-USP (HRAC-USP)–part 3: oral and maxillofacial surgery. J Appl Oral Sci 2012; 20 (06) 673-679
11 Garcia GJ, Tewksbury EW, Wong BA, Kimbell JS. Interindividual variability in nasal filtration as a function of nasal cavity geometry. J Aerosol Med Pulm Drug Deliv 2009; 22 (02) 139-155
12 Mylavarapu G, Murugappan S, Mihaescu M, Kalra M, Khosla S, Gutmark E. Validation of computational fluid dynamics methodology used for human upper airway flow simulations. J Biomech 2009; 42 (10) 1553-1559
13 Lin EL, Bock JM, Zdanski CJ, Kimbell JS, Garcia GJM. Relationship between degree of obstruction and airflow limitation in subglottic stenosis. Laryngoscope 2018; 128 (07) 1551-1557
14 Kimbell JS, Basu S, Garcia GJM. et al. Upper airway reconstruction using long-range optical coherence tomography: Effects of airway curvature on airflow resistance. Lasers Surg Med 2019; 51 (02) 150-160
15 Faizal WM, Ghazali NNN, Khor CY. et al. Computational fluid dynamics modelling of human upper airway: A review. Comput Methods Programs Biomed 2020; 196: 105627
16 Cheng T, Carpenter D, Cohen S, Witsell D, Frank-Ito DO. Investigating the effects of laryngotracheal stenosis on upper airway aerodynamics. Laryngoscope 2018; 128 (04) E141-E149
17 Frank-Ito DO, Wofford M, Schroeter JD, Kimbell JS. Influence of Mesh Density on Airflow and Particle Deposition in Sinonasal Airway Modeling. J Aerosol Med Pulm Drug Deliv 2016; 29 (01) 46-56
18 Borojeni AAT, Garcia GJM, Moghaddam MG. et al. Normative ranges of nasal airflow variables in healthy adults. Int J CARS 2020; 15 (01) 87-98
19 Campbell DA, Moghaddam MG, Rhee JS, Garcia GJM. Narrowed Posterior Nasal Airway Limits Efficacy of Anterior Septoplasty. Facial Plast Surg Aesthet Med 2021; 23 (01) 13-20
20 Celikoglu M, Buyuk SK, Sekerci AE, Ucar FI, Cantekin K. Three-dimensional evaluation of the pharyngeal airway volumes in patients affected by unilateral cleft lip and palate. Am J Orthod Dentofacial Orthop 2014; 145 (06) 780-786
21 Genta PR, Eckert DJ, Gregorio MG. et al. Critical closing pressure during midazolam-induced sleep. J Appl Physiol 2011; 111 (05) 1315-1322
22 Ribeiro AA, Smith FJ, Nary Filho H, Trindade IEK, Tonello C, Trindade-Suedam IK. Three-Dimensional Upper Airway Assessment in Treacher Collins Syndrome. Cleft Palate Craniofac J 2020; 57 (03) 371-377
23 Campos LD, Trindade-Suedam IK, Sampaio-Teixeira AC. et al. Obstructive Sleep Apnea Following Pharyngeal Flap Surgery for Velopharyngeal Insufficiency: A Prospective Polysomnographic and Aerodynamic Study in Middle-Aged Adults. Cleft Palate Craniofac J 2016; 53 (03) e53-e59
24 Tufik S, Santos-Silva R, Taddei JA, Bittencourt LR. Obstructive sleep apnea syndrome in the Sao Paulo Epidemiologic Sleep Study. Sleep Med 2010; 11 (05) 441-446
25 Alwadei AH, Galang-Boquiren MTS, Kusnoto B. et al. Computerized measurement of the location and value of the minimum sagittal linear dimension of the upper airway on reconstructed lateral cephalograms compared with 3-dimensional values. Am J Orthod Dentofacial Orthop 2018; 154 (06) 780-787
26 Taherian S, Rahai H, Lopez S, Shin J, Jafari B. Evaluation of human obstructive sleep apnea using computational fluid dynamics. Commun Biol 2019; 2: 423-440
27 Campbell M, Sapra A. Physiology, Airflow Resistance. In: StatPearls. Treasure Island (FL): StatPearls Publishing; ; April 30, 2021
28 Pfitzner J. Poiseuille and his law. Anaesthesia 1976; 31 (02) 273-275
29 Dempsey JA, Veasey SC, Morgan BJ, O'Donnell CP. Pathophysiology of sleep apnea. Physiol Rev 2010; 90 (01) 47-112
30 Gurani SF, Di Carlo G, Cattaneo PM, Thorn JJ, Pinholt EM. Effect of head and tongue posture on the pharyngeal airway dimensions and morphology in three-dimensional imaging: a systematic review. J Oral Maxillofac Res 2016; 7 (01) e1
31 Subramaniam RP, Richardson RB, Morgan KT, Kimbell JS, Guilmette RA. Computational fluid dynamics simulations of inspiratory airflow in the human nose and nasopharynx. Inhal Toxicol 1998; 10: 91-120
32 Kimbell JS, Garcia GJ, Frank DO, Cannon DE, Pawar SS, Rhee JS. Computed nasal resistance compared with patient-reported symptoms in surgically treated nasal airway passages: a preliminary report. Am J Rhinol Allergy 2012; 26 (03) e94-e98