This study demonstrated the high reliability of mandibular movement as a surrogate of the gold-standard esophageal pressure signal for measuring respiratory effort associated with obstructive, central or mixed apneas and/or hypopneas during sleep.
Congratulations to the authors: Jean-Louis Pepin, Nhat-Nam Le-Dong, Valérie Cuthbert, Nathalie Coumans, Renaud Tamisier, Atul Malhotra and Jean-Benoit Martinot.
Objective
To assess whether Sunrise is a reliable surrogate of esophageal pressure (PES) in patients with suspected OSA.
Methods
- Patients underwent overnight in-laboratory PSG with PES measurement and simultaneous MM recordings using Sunrise.
- PSG data was manually and independently scored by 2 sleep experts in accordance with the recommended criteria established by the AASM.
- A total of 8,042 signal sequences were extracted from the PES and MM recordings from 38 patients.
- Evaluation of the similarity and linear correlation between PES and MM was done using the longest common subsequence (LCSS) algorithm and Pearson’s coefficient; description of signal amplitudes; estimation of the marginal effect for crossing from normal breathing (NB) to a respiratory disturbance for a given change in MM signal using a mixed linear regression.
Results
- MM showed a high level of synchronization with concurrent PES signals. Distribution of MM amplitude differed significantly between event types: median (95% confidence interval) values of 0.60 (0.16–2.43) for central apneas, 0.83 (0.23–4.71) for central hypopneas, 1.93 (0.46–12.43) for mixed apneas, 3.23 (0.72–18.09) for obstructive hypopneas, and 6.42 (0.88–26.81) for obstructive apneas.
- Mixed regression indicated that crossing from NB to central events would decrease MM signal amplitude by –1.23 (central hypopneas) and –2.04 (central apneas) units, while obstructive events would increase MM amplitude by +3.27 (obstructive hypopneas) and +6.79 (obstructive apneas) units (all p<10-6).
Conclusion
- In OSA patients, MM signals facilitated the measurement of specific levels of respiratory effort associated with obstructive, central or mixed apneas and/or hypopneas.
- A high degree of similarity was observed with the PES gold-standard signal and recorded MM.
Key Takeaways
Non-invasively recorded MM signals are a reliable noninvasive alternative to esophageal pressure for measuring respiratory effort in patients with OSA.
Fig 3. Distribution of esophageal pressure (PES; A), gyroscope mandibular jaw movement (MM-Gyr; B) and accelerometer mandibular jaw movement (MM-Acc; C) signal amplitudes during normal breathing and different respiratory disturbances.
