Physiological and geometrical effects in the upper airways with and without mandibular advance device for sleep apnea treatment

Adela Martínez, Alfonso López Muñiz, Eduardo Soudah, Juan Calvo, Alberto Álvarez Suárez, Juan Cobo, Teresa Cobo, Adela Martínez, Alfonso López Muñiz, Eduardo Soudah, Juan Calvo, Alberto Álvarez Suárez, Juan Cobo, Teresa Cobo

Abstract

Sleep apnea is a sleep disorder that occurs when the breathing of a person is interrupted during the sleep. This interruption occurs because of the patient has narrowed airways and the upper airways muscles relax, closes in and blocks the airway. Therefore, any forces or reaction originated by the air flow dynamics over the relaxed upper airways muscles could make to close the upper airways, and consequently the air could not flow into your lungs, provoking sleep apnea. Fully describing the dynamic behavior of the airflow in this area is a severe challenge for the physicians. In this paper we explore the dynamic behavior of airflow in the upper airways of 6 patients suffering obstructive sleep apnea with/without a mandibular advancement device using computational fluid dynamics. The development of flow unsteadiness from a laminar state at entry to the pharynx through to the turbulent character in the soft palate area is resolved using an accurate numerical model. Combining the airflow solution with a geometrical analysis of the upper airways reveals the positive effects of mandibular advance device in the air flow behavior (pressure drop). Improved modeling of airflow and positioning of mandibular advance device could be applied to improve diagnosis and treatment of obstructive sleep apnea.

Conflict of interest statement

The authors declare no competing interests.

Figures

Figure 1
Figure 1
Front and lateral views of one patient. Left: without MAD; Right: with MAD (mandibular antepulsion).
Figure 2
Figure 2
Sagittal view of upper airway mesh and details: (a) section in the sagittal plane above the pharynx, (b) detail of boundary layer, (c) section in the axial plane in the bottom part of the soft palate.
Figure 3
Figure 3
Schematic representation of the geometrical factor to characterize the pharynx.
Figure 4
Figure 4
Cross-sectional area of the minimum area for the 6 patients (with and without MAD) analyzed.
Figure 5
Figure 5
Computational fluid dynamics simulation result of patient 3 during peak inspiration (right, pressure gradient; left: pressure distribution along the centerline).
Figure 6
Figure 6
Computational fluid dynamics simulation result of patient 3 during peak inspiration (right, velocity distribution; left: velocity distribution along the centerline).
Figure 7
Figure 7
MAD Pressure index.

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Source: PubMed

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