The effects of non-continuous positive airway pressure (non-CPAP) therapies on the aerodynamic characteristics of the upper airway of obstructive sleep apnea patients: a systematic review

Publication date: Available online 24 February 2018
Source:Journal of Oral and Maxillofacial Surgery
Author(s): Hui Chen, Ghizlane Aarab, Jan de Lange, Paul van der Stelt, Frank Lobbezoo
PurposeThe effects of non-continuous positive airway pressure (non-CPAP) therapies on the airflow in the upper airway in obstructive sleep apnea (OSA) patients are not completely clear yet. Therefore, the primary aim of this systematic review was to determine the effects of various non-CPAP therapies on the aerodynamic characteristics of the upper airway in OSA patients.MethodsA PICO (population/patient, intervention, comparison, outcome) search strategy, focusing on the effects of various non-CPAP therapies on the aerodynamic characteristics of the upper airway (viz., velocity, wall shear stress, wall static pressure, airway resistance, pressure drop, and pressure effort) of OSA patients, was conducted in the following databases: Medline (Pubmed), Excerpta medica database (EMBASE), and Web of Science. In this systematic review, inclusion criteria were: (1) adults diagnosed with OSA by polysomnography (PSG) recordings; (2) treatment outcome assessed by a second PSG recording; and (3) computational fluid dynamic (CFD) was applied.ResultsOf 51 retrieved unique studies, nine studies fulfilled the criteria for this systematic review. Seven studies were on maxillomandibular advancement (MMA) surgery, and two studies were on mandibular advancement device (MAD) therapy. The aerodynamic characteristics of the upper airway improved in OSA patients who underwent MMA surgery. However, the studies on MMA surgery included only responders to MMA surgery. In the responders to MAD therapy, the velocity, wall static pressure, and airway resistance of the upper airway decreased. In non-responders to MAD therapy, the wall static pressure and airway resistance of the upper airway increased.ConclusionThis systematic review suggests that MMA surgery and MAD therapy may improve several aerodynamic characteristics of the upper airway in OSA patients by CFD analysis. However, due to limitations of the selected studies, there is not enough evidence yet to support CFD analysis as a routine tool to predict treatment outcome in OSA patients.



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