Abstract
BackgroundThe patterns of mandibular movements (MM) during sleep can be used to identify increased respiratory effort periodic large-amplitude MM (LPM), and cortical arousals associated with “sharp” large-amplitude MM (SPM). We hypothesized that Cheyne Stokes breathing (CSB) may be identified by periodic abnormal MM patterns. The present study aims to evaluate prospectively the concordance between CSB detected by periodic MM and polysomnography (PSG) as gold-standard.The present study aims to evaluate prospectively the concordance between CSB detected by periodic MM and polysomnography (PSG) as gold-standard.MethodsIn 573 consecutive patients attending an in-laboratory PSG for suspected sleep disordered breathing (SDB), MM signals were acquired using magnetometry and scored manually while blinded from the PSG signal. Data analysis aimed to verify the concordance between the CSB identified by PSG and the presence of LPM or SPM. The data were randomly divided into training and validation sets (985 5-min segments/set) and concordance was evaluated using 2 classification models.ResultsIn PSG, 22 patients (mean age ± SD: 65.9 ± 15.0 with a sex ratio M/F of 17/5) had CSB (mean central apnea hourly indice ± SD: 17.5 ± 6.2) from a total of 573 patients with suspected SDB. When tested on independent subset, the classification of CSB based on LPM and SPM is highly accurate (Balanced-accuracy = 0.922, sensitivity = 0.922, specificity = 0.921 and error-rate = 0.078). Logistic models based odds-ratios for CSB in presence of SPM or LPM were 172.43 (95% CI: 88.23–365.04; p < 0.001) and 186.79 (95% CI: 100.48–379.93; p < 0.001), respectively.ConclusionCSB in patients with sleep disordered breathing could be accurately identified by a simple magnetometer device recording mandibular movements.
Highlights
The patterns of mandibular movements (MM) during sleep can be used to identify increased respiratory effort periodic large-amplitude MM (LPM), and cortical arousals associated with “sharp” large-amplitude MM (SPM)
We have previously showed that respiratory effort are well characterized by an increase in the amplitude of mandibular movements (MM) > 0.3 mm during episodes of OSA [8, 9]
A group of 22 patients was identified with Cheyne Stokes breathing (CSB) in 573 consecutive recorded subjects; in this group, a total of 1,970 3min sleep segments were evaluated (CSB was confirmed in 1,060 fragments)
Summary
The patterns of mandibular movements (MM) during sleep can be used to identify increased respiratory effort periodic large-amplitude MM (LPM), and cortical arousals associated with “sharp” large-amplitude MM (SPM). We hypothesized that Cheyne Stokes breathing (CSB) may be identified by periodic abnormal MM patterns. Central apnea/hypopnea assuming the pattern of Cheyne Stokes breathing (CSB) is an independent risk condition. The International Classification of Sleep Diseases diagnostic criteria for CSB requires 10 central apneas per hour of sleep. Recurrent arousals occur usually at ventilation peaks, promote ventilatory instability, and perpetuate CSB breathing patterns [4, 7]. The diagnosis requires expensive and poorly accessible type 1 or 2 polysomnography but could be addressed with a portable monitoring in a high pre-test probability population of CSB for early detection and intervention
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