阻塞性睡眠呼吸暂停（OSA）手术成功与失败患者上气道频谱分析及血流特征的比较
The comparison of spectral analyses and flow features in upper airways with obstructive sleep apnea (OSA) between successful and failed surgeries
摘要：
阻塞性睡眠呼吸暂停（OSA）是一种常见的睡眠障碍，在临床实践中经常使用上气道扩张。然而，这种手术的成功率是有限的，手术失败甚至会使情况变得更糟，表明气道增宽并不是评价呼吸质量的唯一标准。因此，我们对阻塞性睡眠呼吸暂停（OSA）患者上气道进行了实验测量和数值模拟，发现OSA患者上气道存在一个固有的优势3-5 Hz信号，且3-5 Hz的信噪比（SNR）与呼吸暂停低通气指数（AHI）呈负相关。首先，为了验证模拟方法的适用性，我们在3D打印OSA上气道模型中进行了激光多普勒测量，并首次发现两个上气道模型中测量和计算的速度分布之间具有良好的一致性。然后，我们进行了大涡模拟（LES）研究了4对OSA上气道模型，8个不同的AHI值的手术前后，其中3个手术成功，1个失败。失败病例的压力降降低，证明单纯扩大气道并不能保证改善OSA。在我们的分析中，这是表明，占主导地位的再循环下游的最小横截面应该是一个成功的手术的主要特征，在上气道中的流动分离诱导的3-5 Hz信号的强度在评价呼吸质量中起着重要的作用。这为手术计划提供了新的指导。腭后最小横截面面积与舌根后最大横截面面积之比与AHI呈显著正相关（r =-0.833，p = 0.01 < 0.05）。
英文摘要：
Obstructive sleep apnea (OSA) is a common sleep disorder and widening the upper airway is often used in clinical practice. However, the success rate of this surgery is limited; the failed surgery would even make the situation worse, indicating the widened airway is not the unique criterion to evaluate the breathing quality. Therefore, we carried out both experimental measurement and numerical simulation on OSA upper airways and found that there existed an intrinsic dominant 3-5 Hz signal and the signal-to-noise ratio (SNR) at 3-5 Hz is inversely correlated with apnea-hypopnea index (AHI). Firstly, to validate the suitability of simulation methods, we carried out Laser Doppler measurement in 3D-printing OSA upper airway models, and found excellent agreement between the measured and calculated velocity profiles in two upper airway models for the first time. Then we carried out large eddy simulation (LES) to investigate four pairs of OSA upper airway models with 8 different AHI values for both pre- and post-surgery; among them, three surgeries were successful and one failed. The decreased the pressure drop for failed case, proving that only widening airway cannot guarantee to improve OSA. In our analysis, it is indicating that a dominant recirculation downstream of the minimum cross-section should be a main feature of a successful surgery, and the strength of 3-5 Hz signal induced by flow separation in the upper airway plays an important role in appraising breathing quality. This provides a new guideline for surgery planning. Furthermore, we found a strong correlation between AHI and the area ratio of minimum cross-section near the retro-palate to the maximum cross-section behind the tongue base, and this correlation is highly significant, r = - 0.833, p = 0.01 < 0.05.
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