Development and validation of a computational finite element model of the rabbit upper airway: simulations of mandibular advancement and tracheal displacement

Amatoury, Jason; Kairaitis, Kristina; Wheatley, John R.; Amis, Terence C.; Bilston, Lynne E.

doi:10.1152/japplphysiol.00820.2015

Cited by 17 publications

(13 citation statements)

References 48 publications

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“…This effect occurs via a number of mechanisms related to transmission of forces from the chest wall to the peripharyngeal tissues (11,29). Longitudinal tracheal tension and passive stretch of muscles attached to the hyoid bone play important roles (1,3). Low lung volumes are associated with reduced tension transmission to peripharyngeal tissues, potentially resulting in failure of peripharyngeal tissue pressure to fall during inspiration, leading to a failure to stabilize and/or dilate the upper airway during inspiration.…”

Section: Discussionmentioning

confidence: 99%

Feedback modulation of surrounding pressure determines the onset of negative effort dependence in a collapsible tube bench model of the pharyngeal airway

Lambeth

Kolevski

Amis

et al. 2017

Journal of Applied Physiology

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Negative effort dependence (NED), decreased airflow despite increased driving pressure, has been proposed as a specific obstructive sleep apnea (OSA) phenotypic characteristic. We examined conditions under which NED occurs in a collapsible tube, pharyngeal airway bench model with the chamber enclosed, focusing on relationships with surrounding pressure levels and longitudinal strain. Using a vacuum source, graded airflows (V̇; 0-5 l/s) were generated through a thin-walled latex tube enclosed within a rigid, cylindrical chamber, sealed with initial chamber pressures (Pci) of 0-5 cmHO (separate runs), or opened to the atmosphere. Upstream minus downstream pressure (Pu - Pd), maximum airflow (V̇), and chamber pressure (Pc) were measured at 0-50% longitudinal strain. NED occurred across the range of Pci and strains studied but was most pronounced for the chamber open condition. With a sealed chamber, V̇ increased and Pc decreased with increasing Pu - Pd until the onset of NED at V̇ and a Pc value that was designated as critical (Pcc). Pcc was lowest (-17 cmH0) and V̇ was highest (~5 l/s) with chamber sealed: Pci = 0 cmHO and 12.5 to 25% strain. We conclude that for our collapsible tube model, the achievable V̇ before the onset of NED depends on both the initial conditions (Pci and strain) and the dynamics of feedback between driving pressure and chamber pressure (chamber sealed vs. open). NED-based phenotypic analyses for OSA may need to focus on potential feedback control mechanisms (eg lung volume change, muscle activity) that may link peripharyngeal tissue pressure levels to driving pressures for airflow. A collapsible tube, pharyngeal airway bench model was used to study the role of surrounding pressure and longitudinal wall strain at the onset of negative effort dependence (NED). NED occurred to varying degrees across all conditions tested, but maximum airflow was achieved with ) low initial surrounding pressure,) a feedback mechanism between surrounding pressure and driving pressure; and ) a moderate amount of strain applied. Potential impacts on OSA phenotypic analyses are discussed.

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Section: Discussionmentioning

confidence: 99%

Feedback modulation of surrounding pressure determines the onset of negative effort dependence in a collapsible tube bench model of the pharyngeal airway

Lambeth

Kolevski

Amis

et al. 2017

Journal of Applied Physiology

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“…In addition to the neurally mediated traction of the hyoid bone discussed above, floating hyoid bone within soft tissue could also be displaced by nonmuscular passive forces derived from surrounding soft tissue [15, 16]. Relatively excessive soft tissue within the maxilla–mandible bony structure could shift the hyoid bone caudally, as well as narrow the pharyngeal airway in people with OSA [6, 17].…”

Section: Introductionmentioning

confidence: 99%

Displacement of the hyoid bone by muscle paralysis and lung volume increase: the effects of obesity and obstructive sleep apnea

Kohno

Kitamura

Kato

et al. 2018

Sleep

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Study ObjectivesAnimal studies suggest a pivotal role of the hyoid bone in obstructive sleep apnea (OSA). We aimed to explore the role of the hyoid bone in humans by testing the hypotheses that muscle paralysis and lung volume (LV) changes displace the hyoid bone position particularly in people with obesity and/or OSA.MethodsFifty patients undergoing general anesthesia participated in this study (20 participants with nonobese, non-OSA; 8 people with nonobese OSA; and 22 people with obese OSA). Three lateral neck radiographs to assess the hyoid position (primary variable) and craniofacial structures were taken during wakefulness, complete muscle paralysis under general anesthesia, and LV increase under general anesthesia. LV was increased by negative extrathoracic pressure application and LV changes were measured with a spirometer. Analysis of covariance was used to identify statistical significance.ResultsMuscle paralysis under general anesthesia significantly displaced the hyoid bone posteriorly (95% CI: 1.7 to 4.6, 1.5 to 5.2, and 1.1 to 4.0 mm in nonobese non-OSA, nonobese OSA, and obese OSA groups, respectively), and this was more prominent in people with central obesity. LV increase significantly displaced the hyoid bone caudally in all groups (95% CI: 0.2 to 0.7, 0.02 to 0.6, and 0.2 to 0.6 mm/0.1 liter LV increase in nonobese non-OSA, nonobese OSA, and obese OSA groups, respectively). Waist–hip ratio was directly associated with the caudal displacement during LV increase.ConclusionsThe hyoid bone plays an important role in the pathophysiology of pharyngeal airway obstruction due to muscle paralysis and LV reduction, particularly in people with obesity.Clinical TrialUMIN Clinical Trial Registry, https://upload.umin.ac.jp/cgi-open-bin/ctr/ctr_view.cgi?recptno=cR000022635&language=E, UMIN000019578

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“…We trace these deviations back to special boundary conditions (such as tissue-bone sliding) and anisotropic properties of pharyngeal muscles that are not considered by our piecewise isotropic homogeneous soft tissue model. Consideration of anisotropic effects of pharyngeal muscles can also be studied on post-surgery relocation of the hyoid bones which is known to be a natural mediator and landmark of pharyngeal muscles action [ 32 ].…”

Section: Discussionmentioning

confidence: 99%

A combined planning approach for improved functional and esthetic outcome of bimaxillary rotation advancement for treatment of obstructive sleep apnea using 3D biomechanical modeling

Frey¹,

Gabrielova

Gladilin

2018

PLoS ONE

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In recent years, bimaxillary rotation advancement (BRA) has become the method of choice for surgical treatment of obstructive sleep apnea (OSA). As dislocation of the jaw bones affects both, airways and facial contours, surgeons are facing the challenge of finding an optimal jaw position that allows for the reestablishment of normal airway ventilation and esthetic surgical outcome. Owing to the complexity of the facial anatomy and its mechanical behavior, individual planning of surgical OSA treatment under consideration of functional and esthetic aspects presents a challenge that surgeons typically approach in a non-quantitative manner using subjective evaluation and clinical experience. This paper describes a framework for individual planning of OSA treatment using bimaxillary rotation advancement, which relies on computational modeling of hard and soft tissue mechanics. The described framework for simulation of functional and esthetic post-surgery outcome was used in 10 OSA patients. Comparison of the simulation results with post-surgery data reveals that biomechanical simulation provides a reliable estimate for post-surgery facial tissue behavior and antero-posterior airway extension, but fails to accurately describe a surprisingly large lateral stretch of the velopharyngeal region. This discrepancy is traced back to anisotropic effects of pharyngeal muscles. Possible approaches to improving the accuracy of model predictions and defining sharp criteria for optimizing combined OSA planning are discussed.

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Development and validation of a computational finite element model of the rabbit upper airway: simulations of mandibular advancement and tracheal displacement

Cited by 17 publications

References 48 publications

Feedback modulation of surrounding pressure determines the onset of negative effort dependence in a collapsible tube bench model of the pharyngeal airway

Feedback modulation of surrounding pressure determines the onset of negative effort dependence in a collapsible tube bench model of the pharyngeal airway

Displacement of the hyoid bone by muscle paralysis and lung volume increase: the effects of obesity and obstructive sleep apnea

A combined planning approach for improved functional and esthetic outcome of bimaxillary rotation advancement for treatment of obstructive sleep apnea using 3D biomechanical modeling

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