Improving Outcomes in Pediatric Obstructive Sleep Apnea

This study aims to improve how doctors choose surgery for children aged 3 to 18 with obstructive sleep apnea (OSA). OSA is when breathing repeatedly stops and starts during sleep. While removing tonsils and adenoids is a common first step, it doesn't always work. This study uses a special type of MRI with inhaled 129-Xe (Xenon gas) to create computer models of a child's airway. These models will help predict which surgical option will be most successful in reducing OSA, measured by changes in their obstructive apnea-hypopnea index (oAHI) 90 days after surgery. The goal is to find a better way to decide on surgery for each child.

Study design
This interventional study plans to enroll 120 participants. It is not specified if it is randomized or blinded.
What's involved
Not specified in the trial record.
Compensation
Not stated in the trial record.
Follow-up
Participants' surgical outcomes will be measured 90 days after surgery.

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NCT04991389

Improving Outcomes in Pediatric Obstructive Sleep Apnea With Computational Fluid Dynamics

Recruiting
PHASE4Ages 3–18InterventionalDiagnostic
Children's Hospital Medical Center, Cincinnati
~120 participants
Updated 2026-01-07 on ClinicalTrials.gov
What's tested:129-Xe

At a glance

Recruiting sites
1 of 1 listed site is recruiting right now
RecruitingSuspended, closed, or not yet open
What they're measuring
Predict the surgical option with the most successful outcome with patient-specific validation computational fluid dynamics (CFD) airflow simulations of respiratory upper airways of children with DS and OSA using inhaled Xenon gas phase-contrast MRI.
Measured over 90 days
+1 more outcome measured
Obstructive Sleep Apnea
1 sites across 1 states
Ohio1
  • Alister Bates, PhD · PRINCIPAL_INVESTIGATOR · Children's Hospital Medical Center, Cincinnati

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Eligibility criteria

Inclusion

Male or Female
Subjects between the ages of 5 to 18 only for Aim 1 and xenon use
Subjects 3-18 years of age for Aims 2 and 3
Subjects with persistent moderate or severe OSA after adenotonsillectomy. - -- Persistent moderate or severe OSA will be defined as an oAHI \> 5 per hour of sleep.
Clinical indication or suspicion of upper-airway obstruction. Examples include but not limited to hypertrophy of the lingual tonsils, disproportionately large tongue, or micrognathia.
Subjects who have failed a trial of CPAP.
Subjects whose parents elect to pursue surgery without a trial of CPAP.
Subjects who require a surgical procedure for OSA based on the clinical assessment of the surgeon (otolaryngologist or plastic surgeon).

Exclusion

Children adequately treated with CPAP.
Children with braces/metal rods.
Children who have a contraindication to sedative.
  • Predict the surgical option with the most successful outcome with patient-specific validation computational fluid dynamics (CFD) airflow simulations of respiratory upper airways of children with DS and OSA using inhaled Xenon gas phase-contrast MRI.90 days

    To solve the equations governing flow (the Navier-Stokes Equations), the airway model will be divided into 3-5 million cells using Star-CCM+ (Siemens PLM Software, Plano, TX). The inlet flow boundary condition for CFD simulations will be the respiratory flow rate as measured by an MRI-compatible pneumotach,83 which records flow rates synchronously with MRI. The flow solver (also Star-CCM+) will compute the pressure and velocity fields down to the resolution of the cells. The influence of flow features smaller than the cells will be calculated using the large eddy simulation (LES) turbulence model.46,69,84 The duration of the breath will be divided into time-steps lasting 0.1 ms, and the flow solution calculated for each timestep. In between each time-step, the airway model will be moved according to the results of the image registration.18 The result will be temporal and spatial maps of the air flow velocity and pressure throughout the breath.

  • Measure changes in geometric analysis of airway, airway resistance, and pressure forces with surgical outcome as measured by changes in oAHI (obstructive apnea-hypopnea index)90 days

    Surgical interventions aimed at reducing the oAHI in patients with persistent OSA post-T\&A have variable success rates. Airway obstruction in each child can be characterized by geometric analysis of the airway, airway resistance, pressure forces, and the cause of airway collapse (either due to air pressure forces or neuromuscular control). Comparing the changes in these characteristics with the actual surgical outcome, measured by change in the oAHI, will reveal which characteristics determine surgical success.