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, 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

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.

Conflict of interest statement

Conflict of Interests The authors have no conflict of interests to declare.

Brazilian Sleep Association. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. ( https://creativecommons.org/licenses/by-nc-nd/4.0/ ).

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