Abstract
Mandibular 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). To assess the degree of agreement between MM and EMG-d signals during different sleep stages and abnormal respiratory events. Twenty-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. The 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). MM amplitudes change proportionally to diaphragmatic EMG activity and accurately identify variations of RE during normal sleep and SDB.
Highlights
Assessing respiratory effort (RE) is a critically important factor in the context of identifying obstructive and central events in sleep breathing disorders (SDB)
Excursions in the thorax or abdominal belts can vary with body position, and there is a risk of misclassification of obstructive apneas [1, 8]
MM and EMG-d amplitudes were significantly crosscorrelated in the 28,211 randomized PSG segments with a median correlation coefficient of 0.63 and a median lag of 0.0 s
Summary
Assessing respiratory effort (RE) is a critically important factor in the context of identifying obstructive and central events in sleep breathing disorders (SDB). The American Academy of Sleep Medicine (AASM) recommends as gold standard the use of esophageal manometry that directly and quantitatively reflects variations in intrathoracic pressures [1]. This measurement is considered as the reference standard for assessing RE but is under the influence of the thoracic volume, and a range of other potential masking factors such as chest wall dynamics, airway resistance, lung compliance, and respiratory muscle activity [2,3,4]. Respiratory inductive plethysmography (RIP) measures the temporal coordination of thoracic and abdominal movements. Less invasive, more practical, reliable, and more cost-effective techniques for investigating patients with suspected SDB are sorely needed [9]
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
