Publications

• What are the criteria for selecting a continuous positive airway pressure interface in the treatment of the obstructive sleep apnea syndrome

  Borel JC, Chaudot C, Bresse C, Clot F, DeschauxC, des équipes paramédicales et techniques d’AGIR à dom – 2013

  Continuous positive airway pressure (CPAP) is the first line therapy for moderate to severe obstructive sleep apnea syndrome (OSAS). In spite of technical innovations regarding the masks, more than 50% of the patients exhibit adverse effects and particularly non-intentional leaks. In this context, the choice of the right interface is crucial. Few studies have assessed the effects of different interfaces on upper airway mechanical properties, CPAP efficacy and compliance. Indeed, only one Cochrane review, including four studies and 132 patients, concluded that the optimum type of interface remained unclear but nasal mask should be considered as the first line interface. Recent studies have addressed this problem of interfaces and give new clinical and physiological insights for helping clinicians in the choice of mask: Functional and/or anatomical problems that increase nasal resistances have to be assessed and treated when possible. If there are no such problems, a nasal mask is the first option to initiate CPAP. Nasal pillows give the opportunity to reduce mask size in case of cutaneous problems or ocular irritation. Finally, oronasal masks are proposed as an alternative to respond to sleep-related mouth leaks that reduce CPAP efficacy or tolerance. However, patients on oronasal mask should be carefully followed.

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• Evolving technologies to study sleep and respiration : finding the dream

  Buyers' guide to respiratory care products. Verbraecken J – 2013

  Nocturnal polysomnography (PSG) is the most important laboratory technique in the management of sleep-wake disturbances and is considered the ‘‘gold standard’’. The term ‘‘polysomnography’’ was introduced in 1974, and refers to the continuous monitoring of multiple neurophysiological and cardiorespiratory variables, usually over the course of a night, to study normal and disturbed sleep for diagnostic purposes and for the assessment of treatment effects. New sensor technologies are entering the field, and rapid development in telecommunications and mobile technology has accelerated the introduction of telemedicine as a viable and reliable option. The present broad review is an amalgam of the current knowledge with proposed new sensors and remote control. The reader should note that not all of the techniques discussed here have strong clinical validation, and this should be considered when purchasing equipment.

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• Added Value of a Mandible Movement Automated Analysis in the Screening of Obstructive Sleep Apnea: Is there a Gender Influence?

  Journal of Sleep Disorders: Treatment & Care. Maury G, Cambron L, Jamart J, Marchand E, Senny F and Poirrier R – 2013

  Abstract
  We previously demonstrated the added value of mandible movement automated analysis (MMAA) to a portable device for the screening of obstructive sleep apnea (OSA). In the present study, we aimed at investigating its respective value in the two genders. Several sleep monitoring equipments have been developed for the screening of OSA but few have been assessed in the female population. In a Systematic Review of the literature on portable devices published in 2003, the authors recommend that studies include more diversified populations, among them women. We prospectively compared in-laboratory polysomnography to simultaneous recording with a portable device with MMAA in 570 patients. The portable device included 3 signals: SpO2, NAF and MMAA. Two respiratory disorder indexes (RDI) were automatically calculated in each gender: RDI (without MMAA) and SMM-RDI (with MMAA). The added value of the MM study was assessed in each group and compared to each other. The population was studied according to gender (men: 381; age: 50 ± 13; BMI: 30 ± 6 kg/m² and women: 189; age: 49 ± 13; BMI: 27 ± 6 kg/m²). Correlations between apnea hypopnea index (AHI) derived from PSG and SMM-RDI were excellent both in men (r: 0.95; p<0.001) and women (r: 0.94; p<0.001) and better (p<0.001 for both) than AHI with RDI (respectively r: 0.93; p<0.001 and r: 0.91; p<0.001). By adding the MMAA, the sensitivity improved significantly in both genders. The sensitivity of SMM-RDI was lower in women for the detection of both mild to severe (AHI ≥5/h) (p=0.005) and moderate to severe (AHI ≥15/h) disease (p<0.001). These differences disappeared for severe disease. This study demonstrated a significant added value of MMAA to a portable device in the screening of OSA in both genders, although the SMM-RDI had a lower sensitivity in women for the diagnosis of mild and moderate OSA.

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• Analyse avant et après tonsillectomie des mouvements de la mandibule au cours du sommeil de l’enfant souffrant d’hypertrophie tonsillaire

  Poster. Martinot J B, Denison S J, Cuthbert V S, Gueulette E, Senny F H, Guenard H – 2013

  Introduction : L’hypertrophie tonsillaire s’accompagne volontiers d’une respiration buccale. Elle peut constituer un véritable obstacle sur les voies aériennes et être à l’origine d’un effort respiratoire (ER).  Celui-ci peut être dépisté par les changements du temps de transit du pouls (PPT). Le rehaussement brutal et de grande amplitude de la mandibule est connu pour accompagner la réaction d’éveil qui termine l’épisode obstructif et ferme la bouche. Nous analysons ici le profil des mouvements mandibulaires (MO) qui accompagnent l’effort respiratoire (ER) précédant la réaction d’éveil par comparaison aux changements du PTT. L’effet de la tonsillectomie sur ces MO est analysé.

  Conclusion : L’analyse de la position de la mandibule permet de repérer les périodes d’effort respiratoire ainsi que les activations corticales qui les accompagnent au cours du sommeil de l’enfant souffrant d’hypertrophie tonsillaire.

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• Mandible Behavior in Obstructive Sleep Apnea Patients Under CPAP Treatment

  The Open Sleep Journal. Senny F, Maury G, Cambron L, Leroux A, Destiné J and Poirrier R – 2012

  Aim: To investigate whether obstructive sleep apnea (OSA) patients present different behaviors of mandible movements before and under CPAP therapy.

  Conclusions: When an efficient CPAP pressure is applied, the mouth is less open and presents fewer broad sharp closure movements, and oscillating mandible movements are absent or very small.

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• Added value of a mandible movement automated analysis in the screening of obstructive sleep apnea

  Journal of Sleep Research. Maury G, Cambron L, Jamart J, Marchand E, Senny F and Poirrier R – 2012

  SUMMARY
  In-laboratory polysomnography is the gold standard for diagnosing obstructive sleep apnea syndrome, but is time consuming and costly, with long waiting lists in many sleep laboratories. Therefore, the search for alternative methods to detect respiratory events is growing. In this prospective study, we compared attended polysomnography with two other methods, with or without mandible movement automated analysis provided by a distance-meter and added to airflow and oxygen saturation analysis for the detection of respiratory events. The mandible movement automated analysis allows for the detection of salient mandible movement, which is a surrogate for arousal. All parameters were recorded simultaneously in 570 consecutive patients (M ⁄ F: 381 ⁄ 189; age: 50 ± 14 years; body mass index: 29 ± 7 kg m)2) visiting a sleep laboratory. The most frequent main diagnoses were: obstructive sleep apnea (344; 60%); insomnia ⁄ anxiety ⁄ depression (75; 13%); and upper airway resistance syndrome (25; 4%). The correlation between polysomnography and the method with mandible movement automated analysis was excellent (r: 0.95; P < 0.001). Accuracy characteristics of the methods showed a statistical improvement in sensitivity and negative predictive value with the addition of mandible movement automated analysis. This was true for different diagnostic thresholds of obstructive sleep severity, with an excellent efficiency for moderate to severe index (apnea–hypopnea index ‡15 h)1). A Bland & Altman plot corroborated the analysis. The addition of mandible movement automated analysis significantly improves the respiratory index calculation accuracy compared with an airflow and oxygen saturation analysis. This is an attractive method for the screening of obstructive sleep apnea syndrome, increasing the ability to detect hypopnea thanks to the salient mandible movement as a marker of arousals.

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• Mandibular movements recorded during child’s sleep apnea hypopnea syndrome could provide useful surrogate markers for cortical arousals

  Poster. Centre du Sommeil et de la Vigilance. Martinot J-B, Denison S, Cuthbert V, Senny F, Guénard H – 2012

  Introduction : Mouth opening and oral breathing are common clinical features during the childhood sleep in the presence of adenotonsillar hypertrophy. In adults, lowering of the mandible often indicates respiratory inspiratory effort during the obstructive sleep apnea hypopnea syndrome. We examined here the movements of the mandible in a group of 21 consecutive children referred for polysomnography before tonsillectomy. Mandibular movements patterns were analysed in relationship to the occurrence of obstructive apnea or hypopnea with or without cortical arousals.

  Conclusion : The sudden and sharp movement of the mandible (MOS) is a good marker of the occurrence of apnea or hypopnea during the sleep of children suffering from upper airway obstruction due to tonsillar hypertrophy. This movement is also associated with cortical arousal.The movement variability (MOV) preceding MOS is presumed to be linked to respiratory effort. Whether mandible movements analysis could be a surrogate for airflow limitations with or without respiratory effort related arousals is still under investigation.

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• The Relationship between Mouth Opening and Sleep Stage-Related Sleep Disordered Breathing

  Journal of Clinical Sleep Medicine. Tsuda H, Lowe A A, Chen H, Fleetham J A, Ayas N T, Almeida F R – 2011

  Study Objectives : To evaluate mouth opening during sleep and the possible correlations between mouth opening and specific patient characteristics.

  Conclusions : The ND patients opened their mouths wider than the RD patients during most sleep stages. The relationship between REM-dependent AHI and the amout of mouth opening may be a factor in the pathogenesis of OSA.

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• The sleep/wake state scoring from mandible movement signal

  Sleep and Breathing. International Journal of the Science and Practice of Sleep Medicine. Senny F, Maury G, Cambron L, Leroux A, Destiné J and Poirrier R – 2011

  Purpose : Estimating the total sleep time in home recording devices is necessary to avoid underestimation of the indices reflecting sleep apnea and hypopnea syndrome severity, e.g., the apnea–hypopnea index (AHI). A new method to distinguish sleep from wake using jaw movement signal processing is assessed.

  Conclusions : Mandible movement recording and its dedicated signal processing for sleep/wake recognition improve sleep disorder index accuracy by assessing the total sleep time. Such a feature is welcome in home screening methods.

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• Obstructive sleep apnoea syndrome: Comparison between polysomnography and portable sleep monitoring based on jaw recordings

  Neurophysiologie Clinique/Clinical Neurophysiology. Cheliout-Heraut F, Senny F, Djouadic F, Ouayound M, Bour F – 2011

  Introduction : Obstructive sleep apnoea syndrome (OSAS) constitutes a new major public health problem because of its several pathophysiologic consequences such as cognitive disorders, excessive daytime sleepiness with risks of traffic accidents, cardiovascular implications, and decrease of quality of life. The necessity of a gold-standard polysomnography to ensure an accurate diagnosis implies an expensive, technical and time-consuming examination. Thus, it seems logical to develop new systems so as to diagnose SAS and to make it possible to detect apnoeas/hypopnoeas easily during sleep even at home.

  Conclusion : The dedicated automatic analysis based on mandibular movements presents a good potential for the diagnosis of OSAS. The AHI computed by the automatic method is correlated with the AHI-PSG and the Somnolter could easily be used both in hospital, and in ambulatory settings.

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