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(Chest. 2005;128:1324-1330.)
© 2005 American College of Chest Physicians

The Impact of Anatomic Manipulations on Pharyngeal Collapse*

Results From a Computational Model of the Normal Human Upper Airway

Yaqi Huang, PhD; David P. White, MD and Atul Malhotra, MD

* From the Sleep Medicine Division and Pulmonary/Critical Care Division, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA.

Correspondence to: Atul Malhotra, MD, Assistant Professor of Medicine, Sleep Disorders Research Program@BIDMC, Sleep Medicine Division and Pulmonary/Critical Care Division, Brigham and Women’s Hospital and Harvard Medical School, 75 Francis St, Boston, MA, 02115; e-mail: amalhotra1{at}partners.org

Obstructive sleep apnea (OSA) is a common disease with important neurocognitive and cardiovascular sequelae. Existing therapies are unsatisfactory, leading investigators to seek alternative forms of anatomic manipulation to influence pharyngeal mechanics. We have developed a two-dimensional computational model of the normal human upper airway based on signal averaging of MRI. Using the finite element method, we can perform various anatomic perturbations on the structure in order to assess the impact of these manipulations on pharyngeal mechanics and collapse. By design, the normal sleeping upper airway model collapses at – 13 cm H2O. This closing pressure becomes more negative (ie, less collapsible) when we perform mandibular advancement (– 21 cm H2O), palatal resection (– 18 cm H2O), or palatal stiffening (– 17 cm H2O). Where clinical data are available in the literature, the results of our model correspond reasonably well. Furthermore, our model provides information regarding the site of obstruction and provides hypotheses for clinical studies that can be undertaken in the future (eg, combination therapies). We believe that, in the future, finite element modeling will provide a useful tool to help advance our understanding of OSA and its response to various therapies.

Key Words: breathing • computational model • lung • MRI • obstructive sleep apnea • pharyngeal collapse






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