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Compliance Measurements of the Upper Airway in Pediatric Down Syndrome Sleep Apnea Patients

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Abstract

Compliance of soft tissue and muscle supporting the upper airway are two of several factors contributing to pharyngeal airway collapse. We present a novel, minimally invasive method of estimating regional variations in pharyngeal elasticity. Magnetic resonance images for pediatric sleep apnea patients with Down syndrome [9.5 ± 4.3 years (mean age ± standard deviation)] were analyzed to segment airways corresponding to baseline (no mask pressure) and two positive pressures. A three dimensional map was created to evaluate axial and circumferential variation in radial displacements of the airway, dilated by the positive pressures. The displacements were then normalized with respect to the appropriate transmural pressure and radius of an equivalent circle to obtain a measure of airway compliance. The resulting elasticity maps indicated the least and most compliant regions of the pharynx. Airway stiffness of the most compliant region [403 ± 204 (mean ± standard deviation) Pa] decreased with severity of obstructive sleep apnea. The non-linear response of the airway wall to continuous positive airway pressure was patient specific and varied between anatomical locations. We identified two distinct elasticity phenotypes. Patient phenotyping based on airway elasticity can potentially assist clinical practitioners in decision making on the treatments needed to improve airway patency.

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Acknowledgements

This study was supported by National Institutes of Health Grant RO1HL105206-01. The authors would like to thank Dr. Jie Chen for useful discussions and Dr. Mohamed A. Mahmoud for his contributions to the MRI sleep studies.

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Authors and Affiliations

  1. Department of Aerospace Engineering and Engineering Mechanics, CEAS, University of Cincinnati, Cincinnati, OH, 45221-0070, USA

    Dhananjay Radhakrishnan Subramaniam, Goutham Mylavarapu & Ephraim J. Gutmark

  2. Division of Pulmonary Biology, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA

    Keith McConnell

  3. Division of Pediatric Radiology, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA

    Robert J. Fleck

  4. Department of Pediatric Otolaryngology, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA

    Sally R. Shott

  5. Division of Pulmonary Medicine, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA

    Raouf S. Amin

  6. Department of Pediatrics, College of Medicine, University of Cincinnati, Cincinnati, OH, USA

    Raouf S. Amin

  7. UC Department of Otolaryngology-Head and Neck Surgery, Cincinnati, OH, USA

    Ephraim J. Gutmark

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  1. Dhananjay Radhakrishnan Subramaniam
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Correspondence to Ephraim J. Gutmark.

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Associate Editor Zahra Moussavi oversaw the review of this article.

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Subramaniam, D.R., Mylavarapu, G., McConnell, K. et al. Compliance Measurements of the Upper Airway in Pediatric Down Syndrome Sleep Apnea Patients. Ann Biomed Eng 44, 873–885 (2016). https://doi.org/10.1007/s10439-015-1392-6

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  • DOI: https://doi.org/10.1007/s10439-015-1392-6

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