Upper Airway Flow Dynamics in Obstructive Sleep Apnea Patients with Various Apnea-Hypopnea Index

Background and aim: This study evaluates the upper airway flow characteristics, anatomical features and analyzes their correlations with AHI in patients with varied degrees of OSA severity seeking for discernments of the underlying pathophysiological profile. Materials and Methods: Patient-specific computational fluid dynamics models were reconstructed from high-resolution cone-beam computed tomography images for 4 OSA patients classified as minimal, mild, moderate, and severe according to AHI. Results: The parameters, minimal cross-sectional area (MCA), and the pharyngeal airway volume did not show clear correlations with the OSA severity defined according to AHI. No correlations were found between the classically defined resistance of the airway in terms of pressure drop and AHI. The flow analysis further showed that the fluid mechanisms likely to cause airway collapse are associated with the degree of narrowing in the pharyngeal airway rather than AHI. Results also suggested that some patients classified as severe OSA according to the AHI can show less susceptibility to airway collapse than patients with relatively lower AHI values and vice versa. Conclusions: The relative contribution of anatomical and non-anatomical causes to the OSA severity can significantly vary between patients. AHI alone is inadequate to be used as a marker of the pathophysiological profile of OSA. Combining airflow analysis with AHI in diagnosing OSA severity may provide additional details about the underlying pathophysiology, subsequently improving the individualized clinical outcomes.