Computational Fluid Dynamic Study on Obstructive Sleep Apnea Syndrome Treated With Maxillomandibular Advancement

Maxillomandibular advancement is one of the treatments available for obstructive sleep apnea. The influence of this surgery on the upper airway and its mechanism are not fully understood. The present research simulates the flow fields of narrowed upper airways of 2 patients with obstructive sleep apnea treated with maxillomandibular advancement. The geometry of the upper airway was reconstructed from computed tomographic images taken before and after surgery. The consequent three-dimensional surface model was rendered for measurement and computational fluid dynamics simulation. Patients showed clinical improvement 6 months after surgery. The cross-sectional area of the narrowest part of the upper airway was increased in all dimensions. The simulated results showed a less constricted upper airway, with less velocity change and a decreased pressure gradient across the whole conduit during passage of air. Less breathing effort is therefore expected to achieve equivalent ventilation with the postoperative airway. This study demonstrates the possibility of computational fluid dynamics in providing information for understanding the pathogenesis of OSA and the effects of its treatment.

[1]  W. Stanford,et al.  Cine CT in obstructive sleep apnea. , 1988, AJR. American journal of roentgenology.

[2]  Y. Chan,et al.  Quantitative computer-assisted digital-imaging upper airway analysis for obstructive sleep apnoea. , 2004, Clinical otolaryngology and allied sciences.

[3]  C. Guilleminault,et al.  Maxillofacial Surgery and Obstructive Sleep Apnea: A Review of 80 Patients , 1989, Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery.

[4]  P. Parizel,et al.  Functional imaging using computational fluid dynamics to predict treatment success of mandibular advancement devices in sleep-disordered breathing. , 2007, Journal of Biomechanics.

[5]  C. Guilleminault,et al.  Obstructive sleep apnea and maxillomandibular advancement: an assessment of airway changes using radiographic and nasopharyngoscopic examinations. , 2002, Journal of oral and maxillofacial surgery : official journal of the American Association of Oral and Maxillofacial Surgeons.

[6]  Peretz Lavie,et al.  Effect of sleep apnea on cognition and mood , 2005, International review of psychiatry.

[7]  J. Remmers,et al.  Pathogenesis of upper airway occlusion during sleep. , 1978, Journal of applied physiology: respiratory, environmental and exercise physiology.

[8]  J. Leiter,et al.  Upper airway shape: Is it important in the pathogenesis of obstructive sleep apnea? , 1996, American journal of respiratory and critical care medicine.

[9]  Soo-Jin Jeong,et al.  Numerical investigation on the flow characteristics and aerodynamic force of the upper airway of patient with obstructive sleep apnea using computational fluid dynamics. , 2007, Medical engineering & physics.

[10]  Y. Goh,et al.  Modified Maxillomandibular Advancement for the Treatment of Obstructive Sleep Apnea: A Preliminary Report , 2003, The Laryngoscope.

[11]  N. Zamel,et al.  Pharyngeal size in snorers, nonsnorers, and patients with obstructive sleep apnea. , 1986, The New England journal of medicine.

[12]  J. Stradling,et al.  Predictors and prevalence of obstructive sleep apnoea and snoring in 1001 middle aged men. , 1991, Thorax.

[13]  J. Curé,et al.  Three-dimensional changes in upper airways of patients with obstructive sleep apnea following maxillomandibular advancement. , 2007, Journal of oral and maxillofacial surgery : official journal of the American Association of Oral and Maxillofacial Surgeons.

[14]  J. Udupa,et al.  Computational fluid dynamics modeling of the upper airway of children with obstructive sleep apnea syndrome in steady flow. , 2006, Journal of biomechanics.

[15]  P. Parizel,et al.  Correlation between severity of sleep apnea and upper airway morphology based on advanced anatomical and functional imaging. , 2007, Journal of biomechanics.

[16]  M. Hernán,et al.  CT in the evaluation of the upper airway in healthy subjects and in patients with obstructive sleep apnea syndrome. , 1998, Chest.

[17]  J R Galvin,et al.  Obstructive sleep apnea: diagnosis with ultrafast CT. , 1989, Radiology.

[18]  C. Guilleminault,et al.  Overview of Phase I Surgery for Obstructive Sleep Apnea Syndrome , 1999, Ear, nose, & throat journal.

[19]  M. Tafti,et al.  Why don't all heavy snorers have obstructive sleep apnea? , 1991, The American review of respiratory disease.

[20]  N. Punjabi,et al.  Demographics and diagnosis of obstructive sleep apnea. , 2005, Anesthesiology clinics of North America.

[21]  A. Malhotra,et al.  Sleep · 2: Pathophysiology of obstructive sleep apnoea/hypopnoea syndrome , 2004, Thorax.

[22]  C. Guilleminault,et al.  Overview of Phase II Surgery for Obstructive Sleep Apnea Syndrome , 1999, Ear, nose, & throat journal.