The comparison of spectral analyses and flow features in upper airways with obstructive sleep apnea (OSA) between successful and failed surgeries

TL;DR

This study combines experimental measurements and numerical simulations to analyze flow features in upper airways of OSA patients, revealing key signals and flow patterns that distinguish successful from failed surgeries, offering new surgical planning insights.

Contribution

It introduces a combined experimental and simulation approach to identify flow features and spectral signals associated with surgical outcomes in OSA treatment.

Findings

Dominant 3-5 Hz signal correlates with breathing quality.

Successful surgeries show specific recirculation downstream of the minimum cross-section.

A strong correlation exists between AHI and the area ratio of airway cross-sections.

Abstract

Obstructive sleep apnea (OSA) is a common sleep disorder and widening the upper airway is often used in clinical practice. However, the success rate of this surgery is limited; the failed surgery would even make the situation worse, indicating the widened airway is not the unique criterion to evaluate the breathing quality. Therefore, we carried out both experimental measurement and numerical simulation on OSA upper airways and found that there existed an intrinsic dominant 3-5 Hz signal and the signal-to-noise ratio (SNR) at 3-5 Hz is inversely correlated with apnea-hypopnea index (AHI). Firstly, to validate the suitability of simulation methods, we carried out Laser Doppler measurement in 3D-printing OSA upper airway models, and found excellent agreement between the measured and calculated velocity profiles in two upper airway models for the first time. Then we carried out large eddy simulation (LES) to investigate four pairs of OSA upper airway models with 8 different AHI values for both pre- and post-surgery; among them, three surgeries were successful and one failed. The decreased the pressure drop for failed case, proving that only widening airway cannot guarantee to improve OSA. In our analysis, it is indicating that a dominant recirculation downstream of the minimum cross-section should be a main feature of a successful surgery, and the strength of 3-5 Hz signal induced by flow separation in the upper airway plays an important role in appraising breathing quality. This provides a new guideline for surgery planning. Furthermore, we found a strong correlation between AHI and the area ratio of minimum cross-section near the retro-palate to the maximum cross-section behind the tongue base, and this correlation is highly significant, r = - 0.833, p = 0.01 < 0.05.