Potential of computational models in personalized treatment of obstructive sleep apnea: a patient-specific 3-d finite element study

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 3-D finite element models based on patient-specific CT-scans are generated. The pharyngeal wall, the soft palate, the tongue, and their interactions are aimed at. Anatomic and physiologic operations are then conducted on the generated models to reflect commonly employed surgical techniques. Our results showed that maxillo-mandibular advancement(MAD) surgery of just 1 cm improved the critical closing pressure by atleast 212.2%. Following MAD, 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 which 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.