Mandibular Movements As Accurate Reporters of Respiratory Effort during Sleep: Validation against Diaphragmatic Electromyography

Abstract

ContextMandibular movements (MM) are considered as reliable reporters of respiratory effort (RE) during sleep and sleep disordered breathing (SDB), but MM accuracy has never been validated against the gold standard diaphragmatic electromyography (EMG-d).ObjectivesTo assess the degree of agreement between MM and EMG-d signals during different sleep stages and abnormal respiratory events.MethodsTwenty-five consecutive adult patients with SDB were studied by polysomnography (PSG) that also included multipair esophageal diaphragm electromyography and a magnetometer to record MM. EMG-d activity (microvolt) and MM (millimeter) amplitudes were extracted by envelope processing. Agreement between signals amplitudes was evaluated by mixed linear regression and cross-correlation function and in segments of PSG including event-free and SDB periods.ResultsThe average total sleep time was 370 ± 18 min and the apnea hypopnea index was 24.8 ± 5.2 events/h. MM and EMG-d amplitudes were significantly cross-correlated: median r (95% CI): 0.67 (0.23–0.96). A mixed linear model showed that for each 10 µV of increase in EMG-d activity, MM amplitude increased by 0.28 mm. The variations in MM amplitudes (median range: 0.11–0.84 mm) between normal breathing, respiratory effort-related arousal, obstructive, mixed, and central apnea periods closely corresponded to those observed with EMG-d activity (median range: 2.11–8.23 µV).ConclusionMM amplitudes change proportionally to diaphragmatic EMG activity and accurately identify variations of RE during normal sleep and SDB.

Bruxism Relieved Under CPAP Treatment in a Patient With OSA Syndrome

“…This is known to typically indicate an underlying exaggerated respiratory effort. 4,5 The spectral analysis comparison between masseteric and limb EMG during the episode of bruxism shows that contractions of jaw muscles are not nonspecific motor phenomena in response to arousals. 9 By closing the mouth and stretching the upper airways muscles, mandibular motion contributes to airflow restoration.…”

“…During respiratory effort, this amplitude increases to > 0.3 mm, a finding which was validated by measurement of pulse transit time 4 or electromyographic activity of the diaphragm. 5 Cortical arousals are marked by large abrupt MMs.…”

Assessment of Mandibular Movement Monitoring With Machine Learning Analysis for the Diagnosis of Obstructive Sleep Apnea

“…Mandibular movement analysis has been validated as an accurate measurement modality of respiratory effort during sleep, providing information on the obstructive or central nature of respiratory events. 24 Compared with other simplified diagnostic techniques, MM also provides reliable estimation of TST and unbiased identification of microarousals. 26,27 Correct TST calculation prevents RDI underestimation (relative to the total recording time), and microarousal identification ensures recognition of respiratory effort-related arousals.…”

The prevalence of sleep-disordered breathing in Northwest Russia: The ARKHsleep study

“… 24 Several studies have shown that jaw movement analysis is a reliable method for distinguishing sleep-wake status and thus can be used as an alternative to actigraphy. 25 – 27 The device can recognize the nature of SDB: central or obstructive. Supplemental Appendix 2 presents the Somnolter® device appearance and a screenshot of recorded signals.…”

“…We relied on the Jawac signal to estimate sleep-wake status and arousals. 25,26 Another limitation was that HSAT was performed only for one night, and night-to-night variability can also cause some misclassification.…”