Rationale: Mandibular position and motion during sleep rely on the balance between mandibular elevators and depressors. We hypothesized that vertical mandibular position (VMP) modulates airflow amplitude during sleep.
Conclusion: Elevation and lowering of the mandible were associated with changes in masseteric EMG activity modulating airflow amplitude during sleep.
BACKGROUND: Unintentional leaks (ULs) are frequent adverse effects in CPAP-treated patients. We previously published a novel methodology for analyzing the determinants of UL using polysomnography. We now propose a simplified recording system using a type 3 polygraphic device (Somnolter; Nomics S.A.).
INTERPRETATION: The use of type 3 polygraphy for characterizing leak determinants in patients treated with nasal automatic-CPAP is feasible in routine practice. Leak determinants are patient specific. Interrater concordance for determining individual leak management strategies demonstrated a “fair” level of agreement.
RATIONALE: The respiratory effort index derived from vertical mandibular movements (MM-REI) is a potential marker of increased respiratory effort during sleep. We evaluated the effectiveness of mandibular advancement splint therapy using MM-REI, in comparison with the apnea-hypopnea index (AHI) and oxygen desaturation index (ODI).
CONCLUSIONS: The reduction of vertical respiratory mandibular movements estimated by MM-REI and sleep respiratory effort duration accompanied the decrease in obstructive hypopneas, AHI, and ODI when snoring resolved in subjects with OSA treated with an optimally titrated mandibular advancement splint.
BACKGROUND: Unintentional leakage from the mouth or around the mask may lead to cessation of CPAP treatment; however, the causes of unintentional leaks are poorly understood. The objectives of this study were to identify determining factors of unintentional leakage and to determine the effect of the type of mask (nasal/oronasal) used on unintentional leakage.
CONCLUSIONS: Mouth opening, CPAP level, sleep position, and REM sleep independently contribute to unintentional leakage. These results provide a strong rationale for the definition of phenotypes and the individual management of leaks during CPAP treatment.
Noninvasive application of nasal or oronasal CPAP requires a mask port that leaks continuously and allows the patient to expire against continuous positive pressure generated by an intelligent blower. The built-in intentional leak is variable and depends on several factors, including mask port size, CPAP level, and phase of the respiratory cycle. The blower is designed to compensate not only for the variable intentional leak but also for an additional wide range of unintentional leak. The unintentional leak originates from either the mouth or around the mask. An unintentional leak is estimated by subtracting the total leak from the intentional leak. The device built-in algorithm for such leak estimation is specific to each manufacturer and is not clearly disclosed. In addition, each CPAP manufacturer reports unintentional leak using different metrics and defines excessive leak using different criteria. The lack of a standard definition of how to measure and report CPAP unintentional leak may have contributed to the lack of studies focusing on unintentional leak. Nevertheless, unintentional leak is an important complication of CPAP treatment for OSA that frequently affects patient comfort and is associated with lower adherence.
Sleep apnoea syndrome (SAS) is a common sleep disorder with a prevalence ranging from 5.9% to 79.2% in the European general population over 40 years of age, depending on the clinical symptoms and apnoea hypopnoea scoring criteria used [1]. Despite its frequency, the fact that it is a significant risk factor for many common diseases, and a recent meta-analysis demonstrating that available treatments are effective, SAS remains underdiagnosed. Indeed, patients with sleep apnoea presenting with concomitant cardiovascular diseases often have no typical presentation pointing towards obstructive SAS [3]. In various locations around the world, suspected SAS patients may find that accessing diagnostic examinations can be challenging. The average waiting time for a sleep study can vary from 2 to 48 months in industrialised countries. Nevertheless, in-lab full-night polysomnography (PSG) remains the ‘gold-standard’ for the diagnosis of SAS, despite the fact that it is time consuming, expensive and often not widely available [5]. In certain countries, PSG is obligatory in the diagnostic work-up for SAS. Thus, targeting the patient population that is most likely to benefit from PSG would help to optimise the limited resources at hand. Recent studies have suggested that mandibular movements (MM) can be considered a surrogate for the measurement of respiratory effort during sleep and can estimate total sleep time (eTST), as well as sleep fragmentation. Thus, MM can be used to identify sleep-disordered breathing. In their study, MARTINOT et al. compared the respiratory disturbance index measured by MM (MM-RDI) and the usual respiratory disturbance index measured by PSG (PSG-RDI). They reported that the MM-RDI is highly concordant with the PSG-RDI: in patients with a moderate-to-high pre-test probability for obstructive SAS, a MM-RDI >13.5 per h has a false positive rate of 4.72–18.49% (95% CI) when detecting a PSG-RDI ⩾15 per h, and a false negative rate of 0.0–16.82% (95% CI). Our objective was therefore to assess the feasibility of use of the MM-RDI as a screening tool in an ambulatory setting for PSG candidates. In order to address this question, we report herein the results of a preliminary study based on the retrospective analysis of a large, anonymous patient database in Belgium.
Study Objectives: To evaluate the changes that are brought about by continuous use of an orthodontic activator for the betterment of sleep-breathing in a child.
Conclusions: The Andresen activator not only is a useful and long-trusted orthodontic appliance used for the betterment of maxillary protrusion, it also has a positive effect on other aspects of child development by improving the sleep-breathing patterns of children who undergo orthodontic therapy with this appliance.
Background: 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. 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.
Conclusion: CSB in patients with sleep disordered breathing could be accurately identified by a simple magnetometer device recording mandibular movements.
Context : Mandibular Movements (MM) are considered as reliable reporters of respiratory effort (RE) during sleep disordered breathing (SDB), but MM accuracy has never been validated against the gold standard diaphragmatic electromyography (EMG-d)
Conclusion : MM amplitudes change proportionally to giaphragmatic EMG activity and accurately identify variations of RE during normal sleep and SDB.
Objectives: Adenotonsillectomy (AT) markedly improves but does not necessarily normalize polysomnographic findings in children with adenotonsillar hypertrophy and related sleep-disordered breathing (SDB). Adenotonsillectomy efficacy should be evaluated by follow-up polysomnography (PSG), but this method may underestimate persistent respiratory effort (RE). Mandibular movement (MMas) monitoring is an innovative measurement that readily identifies RE during upper airway obstruction. We hypothesized that MMas indices would decrease in parallel of PSG indices and that children with persistent RE more reliably could be identified with MMas.
Conclusion: Adenotonsillectomy significantly reduced AHI. However, persistent RERA were apparent in a significant proportion of children, and this was reflected by the remaining abnormal MMas pattern. Follow-up of children after AT can be recommended and readily achieved by monitoring MMas to identify persistent RE.