Abstract

The upper airway experiences mechanical loads during breathing. Obstructive sleep apnea is a very common sleep disorder, in which the normal function of the airway is compromised, enabling its collapse. Its treatment remains unsatisfactory with variable efficacy in the case of many surgeries. Finite element models of the upper airway to simulate the effects of various anatomic and physiologic manipulations on its mechanics could be helpful in predicting surgical success. Partial 3D finite element models based on patient-specific CT-scans were undertaken in a pilot study of 5 OSA patients. Upper airway soft tissues including the soft palate, hard palate, tongue, and pharyngeal wall were segmented around the midsagittal plane up to a width of 2.5 cm in the lateral direction. Simulations of surgical interventions such as Uvulopalatopharyngoplasty (UPPP), maxillo-mandibular advancement (MMA), palatal implants, and tongue implants have been performed. Our results showed that maxillo-mandibular advancement (MMA) surgery of 1 cm improved the critical closing pressure by at least 212.2%. Following MMA, the best improvement was seen via uvulopalatopharyngoplasty (UPPP), with an improvement of at least 19.12%. Palatal and tongue implants also offered a certain degree of improvement. Further, we observed possible interacting mechanisms that suggested simultaneous implementation of UPPP and tongue stiffening; and palatal and tongue stiffening could be beneficial. Our results suggest that computational modeling is a useful tool for analyzing the influence of anatomic and physiological manipulations on upper airway mechanics. The goal of personalized treatment in the case of OSA could be achieved with the use of computational modeling.

中文翻译：

---

计算模型在阻塞性睡眠呼吸暂停个性化治疗中的潜力：针对患者的部分 3D 有限元研究

摘要

呼吸期间上呼吸道承受机械负荷。阻塞性睡眠呼吸暂停是一种非常常见的睡眠障碍，气道的正常功能受到损害，导致气道塌陷。其治疗效果仍不理想，多次手术疗效参差不齐。上呼吸道的有限元模型可以模拟各种解剖和生理操作对其力学的影响，有助于预测手术的成功。在针对 5 名 OSA 患者的试点研究中，采用了基于患者特异性 CT 扫描的部分 3D 有限元模型。将包括软腭、硬腭、舌头和咽壁在内的上气道软组织围绕正中矢状面分割，横向宽度达2.5cm。已经进行了悬雍垂腭咽成形术 (UPPP)、上下颌前移 (MMA)、腭种植体和舌种植体等手术干预的模拟。我们的结果表明，上颌-下颌前移 (MMA) 1 厘米手术将临界闭合压力至少提高了 212.2%。 MMA 后，悬雍垂腭咽成形术 (UPPP) 的改善效果最好，至少改善了 19.12%。腭和舌头植入物也提供了一定程度的改善。此外，我们观察到了可能的相互作用机制，表明同时实施 UPPP 和舌头僵硬；腭和舌头僵硬可能是有益的。我们的结果表明，计算模型是分析解剖和生理操作对上气道力学影响的有用工具。 OSA 的个性化治疗目标可以通过使用计算模型来实现。