Abstract
Obstructive sleep apnea syndrome (OSAS) is characterized by recurrent collapses of the upper airway, which lead to repetitive transient hypoxia, arousals and finally sleep fragmentation. Both anatomical and neuromuscular factors may play key roles in the pathophysiology of OSAS. The purpose of this paper was to study the control mechanism of OSAS from the mechanical point of view. A three-dimensional finite element model was developed, which not only reconstructed the realistic anatomical structure of the human upper airway, but also included surrounding structures such as the skull, neck, hyoid, cartilage and soft tissues. The respiration process during the normal and apnea states was simulated with the fluid-structure interaction method (FSI) and the computational fluid dynamics method (CFD). The airflow and deformation of the upper airway obtained from the FSI and the CFD method were compared and the results obtained under large negative pressure during an apnea episode were analyzed. The simulation results show that the FSI method is more feasible and effective than the CFD method. The concave configuration of the upper airway may accelerate the collapse of the upper airway in a positive feedback mechanism, which supplies meaningful information for clinical treatment and further research of OSAS.
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Lan Z, Itoi A, Takashima M, et al. Difference of pharyngeal morphology and mechanical property between OSAHS patients and normal subjects. Auris Nasus Larynx 2006, 33: 433–439
Ryan C M, Bradley T D. Pathogenesis of obstructive sleep apnea. J Appl Physiol, 2005, 99: 2440–2450
White D P. Pathogenesis of obstructive and central sleep apnea. Am J Respir Crit Care Med, 2005, 172: 1363–1370
Steier J, Jolley C J, Seymour J, et al. Increased load on the respiratory muscles in obstructive sleep apnea. Respir Physiol Neurobiol, 2010, 171: 54–60
Horner R L. The neuropharmacology of upper airway motor control in the awake and asleep states: implications for obstructive sleep apnoea. Respir Res, 2001, 2: 286–294
Huang L, Quinn S J, Ellis P D M, et al. Biomechanics of snoring. Endeavour, 1995, 19: 96–100
Farrè R, Rigau J, Montserrat J M, et al. Static and dynamic upper airway obstruction in sleep apnea. Am J Respir Crit Care Med, 2003, 168: 659–663
Luo X Y, Pedley T J. Multiple solutions and flow limitation in collapsible channel flows. J Fluid Mech, 2000, 420: 301–324
Huang L, Williams J E F. Neuromechanical interaction in human snoring and upper airway obstruction. J Appl Physiol, 1999, 86: 1759–1763
Fodil R, Ribreau C, Louis B. Interaction between steady flow and individualized compliant segment: application to upper airways. Med Biol Eng Comput, 1997, 35: 638–648
Lazopoulos K, Lazopoulos K A, Palassopoulos G. On the stability of the upper airways system. Nonlinear Analysis. Real World Appl, 2011, 12: 1323–1337
Saksono P H, Nithiarasu P, Sazonov I, et al. Computational flow studies in a subject-specific human upper airway using a one-equation turbulence model. Influence of the nasal cavity. Int J Numer Meth Eng, 2011, 87: 96–114
Sittitavornwong S, Waite P D, Shih A M, et al. Evaluation of obstructive sleep apnea syndrome by computational fluid dynamics. Sem Orthod, 2009, 15: 105–131
Mylavarapu G, Murugappan S, Mihaescu M, et al. Validation of computational fluid dynamics methodology used for human upper airway flow simulations. J Biomech, 2009, 42: 1553–1559
Mihaescu M, Murugappan S. Large Eddy simulation and Reynolds-averaged Navier-Stokes modeling of flow in a realistic pharyngeal airway model: an investigation of obstructive sleep apnea. J Biomech, 2008, 41: 2279–2288
Zhang J, Liu Y, Sun X. Computational fluid dynamics simulations of respiratory airflow in human nasal cavity and its characteristic dimension study. Acta Mech Sin, 2008, 24: 223–228
Liu Y, Yu C, Sun X, et al. 3D FE model reconstruction and numerical simulation of airflow for the upper airway. World J Model Simul, 2006, 2: 190–195
Xu C, Sin S H, McDonough J M, et al. Computational fluid dynamics modeling of the upper airway of children with obstructive sleep apnea syndrome in steady flow. J Biomech, 2006, 39: 2043–2054
Malvè M, del Palomar A P, López-Villalobos J L, et al. FSI analysis of the coughing mechanism in a human trachea. Ann Biomed Eng, 2010, 38: 1556–1565
Xu C, Brennick M J, Dougherty L. Modeling upper airway collapse by a finite element model with regional tissue properties. Med Eng Phys, 2009, 31: 1343–1348
Chouly F, Van Hirtum A, Lagrée P Y, et al. Numerical and experimental study of expiratory flow in the case of major upper airway obstructions with fluid-structure interaction. J Fluids Struct, 2008, 24: 250–269
Sun X, Yu C, Wang Y, et al. Numerical simulation of soft palate movement and airflow in human upper airway by fluid-structure interaction method. Acta Mech Sin, 2007, 23: 359–367
Payan Y, Pelorson X. Physical modeling of airflow-walls interactions to understand the sleep apnea syndrome. Lect Note Comput Sci, 2003, 2673: 261–269
Liu Y, Bao Y, Liu W, et al. An analysis of pharyngeal respiratory pressure before and after onset of obstruction in respiratory obstructive sleep apnea hypopnea syndrome. Chin J Intern Med, 2006, 45: 914–917
Ronchi P, Novelli G, Colombo L S, et al. Effectiveness of maxilla-mandibular advancement in obstructive sleep apnea patients with and without skeletal anomalies. Int J Oral Maxil Surg, 2010, 39: 541–547
Holty J E C, Guilleminault C. Maxillomandibular advancement for the treatment of obstructive sleep apnea: a systematic review and meta-analysis. Sleep Med Rev, 2010, 14: 287–297
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Huang, R., Li, X. & Rong, Q. Control mechanism for the upper airway collapse in patients with obstructive sleep apnea syndrome: a finite element study. Sci. China Life Sci. 56, 366–372 (2013). https://doi.org/10.1007/s11427-013-4448-6
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DOI: https://doi.org/10.1007/s11427-013-4448-6