Computational fluid dynamics analysis of H-uvulopalatopharyngoplasty in obstructive sleep apnea syndrome

To explore the impact of H-uvulopalatopharyngoplasty (H-UPPP) in obstructive sleep apnea syndrome (OSAS) and gain insights into the potential mechanism underlying improvement by H-UPPP.

In a cohort of 11 OSAS patients, computational fluid dynamics (CFD) models of the upper airway were obtained using commercial software from computed tomography (CT) datasets before and after H-UPPP. Morphological and numerical parameters were respectively computed and compared during the peak tidal inspiratory flow. The correlations among polysomnography endpoints, airway dimensions, and pre- and post-operative airflow properties were analyzed with Spearman's rank correlation.

The preoperative minimum cross-sectional area was significantly increased by 89.56% (p < .05), with a positive correlation to the apnea hypoapnea index (AHI) (r = 0.974). However, the capacity of all pharyngeal regions was not significantly altered (p > .05). Following H-UPPP, we observed a significant increase in pressure and reduction of velocity (p < .05) in the previously constricted areas. The change in pressure and velocity were significantly correlated with AHI (r = 0.922 and r = 0.946, respectively). In addition, the pressure drop in the constricted area, oropharynx, and hypopharynx were also significantly decreased (p < .05).

H-UPPP is capable of expanding the constricted region of the velopharynx and can decrease the airway resistance which will in turn decrease the workload necessary for breathing and facilitate inspiration.