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The effect of nasal and oral breathing on airway collapsibility in patients with obstructive sleep apnea: Computational fluid dynamics analyses.

ABSTRACT: OBJECTIVE:The purpose of this study was to investigate the effect of breathing route on the collapsibility of the pharyngeal airway in patients with obstructive sleep apnea by using computational fluid dynamics technology. METHODS:This study examined Japanese men with obstructive sleep apnea. Computed tomography scans of the nose and pharynx were taken during nasal breathing with closed mouth, nasal breathing with open mouth, and oral breathing while they were awake. Three-dimensional reconstructed stereolithography models and digital unstructured grid models were created and airflow simulations were performed using computational fluid dynamics software. RESULTS:Airflow velocity was significantly higher during oral breathing than during nasal breathing with open or closed mouth. No significant difference in maximum velocity was noted between nasal breathing with closed and open mouth. However, airflow during nasal breathing with open mouth was slow but rapidly sped up at the lower level of the velopharynx, and then spread and became a disturbed, unsteady stream. In contrast, airflow during nasal breathing with closed mouth gradually sped up at the oropharyngeal level without spreading or disturbance. Negative static pressure during oral breathing was significantly decreased; however, there were no significant differences between nasal breathing with closed or open mouth. CONCLUSIONS:Computational fluid dynamics results during nasal and oral breathing revealed that oral breathing is the primary condition leading to pharyngeal airway collapse based on the concept of the Starling Resistor model. Airflow throughout the entirety of the breathing route was smoother during nasal breathing with closed mouth than that with open mouth.

SUBMITTER: Suzuki M

PROVIDER: S-EPMC7153879 | biostudies-literature | 2020

REPOSITORIES: biostudies-literature

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The effect of nasal and oral breathing on airway collapsibility in patients with obstructive sleep apnea: Computational fluid dynamics analyses.

Suzuki Masaaki M Tanuma Tadashi T

PloS one 20200413 4

<h4>Objective</h4>The purpose of this study was to investigate the effect of breathing route on the collapsibility of the pharyngeal airway in patients with obstructive sleep apnea by using computational fluid dynamics technology.<h4>Methods</h4>This study examined Japanese men with obstructive sleep apnea. Computed tomography scans of the nose and pharynx were taken during nasal breathing with closed mouth, nasal breathing with open mouth, and oral breathing while they were awake. Three-dimensi ...[more]

PMID: 32282859

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Project description:Study objectivesObstructive sleep apnea is associated with neurobehavioral dysfunction, but the relationship between disease severity as measured by the apnea-hypopnea index and neurobehavioral morbidity is unclear. The objective of our study is to compare the neurobehavioral morbidity of mild sleep-disordered breathing versus obstructive sleep apnea.MethodsChildren 3-12 years old recruited for mild sleep-disordered breathing (snoring with obstructive apnea-hypopnea index < 3) into the Pediatric Adenotonsillectomy Trial for Snoring were compared to children 5-9 years old recruited for obstructive sleep apnea (obstructive apnea-hypopnea 2-30) into the Childhood Adenotonsillectomy Trial. Baseline demographic, polysomnographic, and neurobehavioral outcomes were compared using univariable and multivariable analysis.ResultsThe sample included 453 participants with obstructive sleep apnea (median obstructive apnea-hypopnea index 5.7) and 459 participants with mild sleep-disordered breathing (median obstructive apnea-hypopnea index 0.5). By polysomnography, participants with obstructive sleep apnea had poorer sleep efficiency and more arousals. Children with mild sleep-disordered breathing had more abnormal executive function scores (adjusted odds ratio 1.96, 95% CI 1.30-2.94) compared to children with obstructive sleep apnea. There were also elevated Conners scores for inattention (adjusted odds ratio 3.16, CI 1.98-5.02) and hyperactivity (adjusted odds ratio 2.82, CI 1.83-4.34) in children recruited for mild sleep-disordered breathing.ConclusionsAbnormal executive function, inattention, and hyperactivity were more common in symptomatic children recruited into a trial for mild sleep-disordered breathing compared to children recruited into a trial for obstructive sleep apnea. Young, snoring children with only minimally elevated apnea-hypopnea levels may still be at risk for deficits in executive function and attention.Trial registrationPediatric Adenotonsillectomy for Snoring (PATS), NCT02562040; Childhood Adenotonsillectomy Trial (CHAT), NCT00560859.

Project description:Study objectivesObstructive sleep apnea (OSA) results from the interaction of several physiological traits; specifically a compromised upper airway anatomy and muscle function, and two key non-anatomical deficits: elevated loop gain and a low arousal threshold. Although continuous positive airway pressure (CPAP) is an efficacious treatment, it is often poorly tolerated. An alternative approach could involve administering therapies targeting the non-anatomic causes. However, therapies (oxygen or hypnotics) targeting these traits in isolation typically improve, but rarely resolve OSA. Therefore, our aim was to determine how the combination of oxygen and eszopiclone alters the phenotypic traits and OSA severity and to assess the baseline phenotypic characteristics of responders/nonresponders to combination therapy.MethodsIn a single-blinded randomized crossover study, 20 OSA patients received combination therapy (3 mg eszopiclone and 40% oxygen) versus placebo/sham air, with 1 w between conditions. Under each condition, we assessed the effects on OSA severity (clinical polysomnography) and the phenotypic traits causing OSA using CPAP manipulations (research polysomnography).ResultsCombination therapy reduced the apnea-hypopnea index (51.9 ± 6.2 vs. 29.5 ± 5.3 events/h; P < 0.001), lowered both the ventilation associated with arousal (5.7 ± 0.3 vs. 5.2 ± 0.3 L/min; P = 0.05) and loop gain (3.3 ± 0.5 vs. 2.2 ± 0.3; P = 0.025). Responders to therapy (apnea-hypopnea index reduced by > 50% to below 15 events/h; n = 9/20) had less severe OSA (P = 0.001), a less collapsible upper airway (P = 0.01) and greater upper airway muscle effectiveness (P = 0.002).ConclusionsThe combination of lowering loop gain and raising the arousal threshold is an effective therapy in patients whose anatomy is not severely compromised. Our work demonstrates that combining therapies that target multiple traits can resolve OSA in selected individuals.Clinical trial registrationClinicalTrials.gov, ID: NCT01633827.

Dataset Information

The effect of nasal and oral breathing on airway collapsibility in patients with obstructive sleep apnea: Computational fluid dynamics analyses.

Publications

The effect of nasal and oral breathing on airway collapsibility in patients with obstructive sleep apnea: Computational fluid dynamics analyses.

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