Mandibular position and movements: Suitability for diagnosis of sleep apnoea. Issue 3 (6th November 2016)

• Record Type: Journal Article
• Authors: Martinot, Jean‐Benoit; Borel, Jean‐Christian; Cuthbert, Valérie; Guénard, Hervé Jean‐Pierre; Denison, Stéphane; Silkoff, Philip E.; Gozal, David; Pepin, Jean‐Louis
• Is Part Of: Respirology. Volume 22:Issue 3(2017)
• Page Start: 567
• Page End: 574
• Publication Date: 2016-11-06
• Subjects: obstructive sleep apnoea syndrome -- portable monitor device -- respiratory effort -- sleep mandibular movements; Respiratory organs -- Diseases -- Periodicals; Respiratory organs -- Periodicals; 612.2
• DOI: 10.1111/resp.12929
• Languages: English
• ISSNs: 1323-7799

Abstract

ABSTRACT: Background and objective: Mandibular movements (MMs) and position during sleep reflect respiratory efforts related to increases in upper airway resistance and micro‐arousals. The study objective was to assess whether MM identifies sleep‐disordered breathing (SDB) in patients with moderate to high pre‐test probability. Methods: This was a prospective study of 87 consecutive patients referred for an in‐laboratory sleep test. Magnetometer‐derived MM signals were incorporated into standard polysomnography (PSG). Respiratory events detected with MM analysis were compared with PSG for respiratory disturbance index (RDI) with a blinded scoring. All records were scored manually according to American Academy of Sleep Medicine rules. Primary outcome was to rule‐in obstructive sleep apnoea syndrome (OSAS) defined as RDI cut‐off value ≥5 or 15/h total sleep time (TST). Results: High concordance emerged between MM and PSG‐derived RDI with high temporal coincidence between events (R 2 = 0.906; P < 0.001). The mean diagnostic accuracy of MM for OSAS using RDI MM cut‐off values of 5.9 and 13.5 was 0.935 (0.86–0.97) and 0.913 (0.84–0.95), with a mean positive likelihood ratio (LLR+) of 3.73 (2.7–20.4) and 8.46 (2.3–31.5), respectively. Receiver operating characteristic (ROC) curves at PSG cut‐off values of 5 and 15/h TST had areas under the curve (AUC) of 0.96 (95% CI: 0.89–0.99) and 0.97 (95% CI: 0.91–0.99) ( P < 0.001), respectively. MM analysis accurately identified SDB at different levels of severity. Conclusion: RDI assessed by MM is highly concordant with PSG, suggesting a role of ambulatory MM recordings to screen for SDB in patients with moderate to high pre‐test probability. Abstract : The study aims to score blindly the mandibular movements (MMs) compared with the respiratory disordered events during an in‐laboratory polysomnography in patients with obstructive sleep apnoea. High agreement was found between both scorings. A simple recording of the MMs could be explored for home diagnosis of sleep‐disordered breathing. See article, page 418