Simulation of upper airway occlusion without and with mandibular advancement in obstructive sleep apnea using fluid-structure interaction

Abstract

Obstructive Sleep Apnea (OSA) is a common sleep disorder characterized by repetitive collapse of the upper airway (UA). One treatment option is a mandibular advancement splint (MAS) which protrudes the lower jaw, stabilizing the airway. However not all patients respond to MAS therapy and individual effects are not well understood. Simulations of airway behavior may represent a non-invasive means to understand OSA and individual treatment responses. Our aims were (1) to analyze UA occlusion and flow dynamics in OSA using the fluid structure interaction (FSI) method, and (2) to observe changes with MAS. Magnetic resonance imaging (MRI) scans were obtained at baseline and with MAS in a known treatment responder. Computational models of the patients' UA geometry were reconstructed for both conditions. The FSI model demonstrated full collapse of the UA (maximum 5.83mm) pre-treatment (without MAS). The UA collapse was located at the oropharynx with low oropharyngeal pressure (-51.18Pa to -39.08Pa) induced by velopharyngeal jet flow (maximum 10.0m/s). By comparison, simulation results from the UA with MAS, showed smaller deformation (maximum 2.03mm), matching the known clinical response. Our FSI modeling method was validated by physical experiment on a 1:1 flexible UA model fabricated using 3D steriolithography. This is the first study of airflow dynamics in a deformable UA structure and inspiratory flow. These results expand on previous UA models using computational fluid dynamics (CFD), and lay a platform for application of computational models to study biomechanical properties of the UA in the pathogenesis and treatment of OSA.

Keywords: Airway occlusion; CFD; FSI; MAS; MRI; OSA; Upper airway.