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How does distraction osteogenesis maxillary expansion (DOME) reduce severity of obstructive sleep apnea?

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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 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).

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).

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Abbreviations

3D:

three-dimensional

AHI:

apnea-hypopnea index

AI:

apnea index

CFD:

computational fluid dynamic

D:

depth

DOME:

distraction osteogenesis maxillary expansion

EB plane:

a plane parallel to the hard plate passing through the base of the epiglottis

HA:

hypopharyngeal airway

LOS:

lowest oxygen saturation

OA:

oropharyngeal airway

ODI:

oxygen desaturation index

OSA:

obstructive sleep apnea

PL plane:

a plane passing through the hard plate

RA:

retropalatal airway

W:

width

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Authors and Affiliations

  1. Pediatric Dentistry, Graduate School of Medical and Dental Sciences, Kagoshima University, Kogoshima, Japan

    Tomonori Iwasaki & Youichi Yamasaki

  2. Sections of Pediatric Dentistry and Orthodontics, Division of Growth and Developments, UCLA School of Dentistry, Los Angeles, CA, 90095, USA

    Audrey Yoon

  3. Sleep Medicine Division, Department of Psychiatry, Stanford Health Care, Redwood City, CA, 94063, USA

    Christian Guilleminault

  4. Division of Sleep Surgery, Department of Otolaryngology-Head & Neck Surgery, School of Medicine, Stanford University, 801 Welch Road, Stanford, CA, 94304, USA

    Stanley Yung Liu

Authors
  1. Tomonori Iwasaki
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  2. Audrey Yoon
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  3. Christian Guilleminault
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  4. Youichi Yamasaki
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  5. Stanley Yung Liu
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Correspondence to Stanley Yung Liu.

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The authors declare that they have no conflict of interest.

Ethical approval

This study was approved by the Institutional Review Board of Stanford University (Protocol 36385, IRB 6208) and the ethics committee of the Graduate School of Medical and Dental Sciences of Kagoshima University, Kagoshima, Japan. This study complied with the 1964 Helsinki Declaration and its later amendments.

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Informed consent was obtained from all individual participants included in the study.

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Iwasaki, T., Yoon, A., Guilleminault, C. et al. How does distraction osteogenesis maxillary expansion (DOME) reduce severity of obstructive sleep apnea?. Sleep Breath 24, 287–296 (2020). https://doi.org/10.1007/s11325-019-01948-7

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  • DOI: https://doi.org/10.1007/s11325-019-01948-7

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