Clinical and Physiological Relevance of Computational Studies of Obstructive Sleep Apnea: A Systematic Literature Review

Abstract Introduction Structural interventions for obstructive sleep apnea (OSA) have unpredictable success rates. Anatomically accurate computer simulations of airflow and soft tissue dynamics may be used in future virtual intervention planning tools to identify the optimal patient interventions. The objective of this study is to review the existing literature on the correlation between computer-derived biomechanical variables and clinical measures of OSA severity. Methods Scientific papers written in English that correlated the apnea-hypopnea index (AHI) with computer-derived biomechanical variables were identified by searching on the PubMed and SCOPUS databases the search phrase “sleep apnea” AND “computational fluid dynamics” OR "finite element” OR “fluid structure interaction”. Results A total of 19 articles were identified that reported correlations between computer-derived biomechanical variables and AHI, which was the metric of OSA severity reported in most studies. These studies demonstrated that several anatomic and physiologic variables correlate with OSA severity, including airspace cross-sectional areas, airspace volumes, and airflow resistance. No studies were found that correlated computer-derived dynamic measures of upper airway mechanical stability, such as tissue compliance, to OSA severity. Conclusion Computer-derived anatomic and physiologic variables may serve as useful predictors of surgical outcome or mandibular device treatment response in OSA patients. Further research is needed to test the hypothesis that virtual surgery planning based on computer-derived measures of upper airway stability can improve outcomes of OSA interventions. Support (If Any) This project was funded in part by the Advancing a Healthier Wisconsin Endowment.