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Mandibular position and movements: Suitability for diagnosis of sleep apnoea
Author(s) -
Martinot JeanBenoit,
Borel JeanChristian,
Cuthbert Valérie,
Guénard Hervé JeanPierre,
Denison Stéphane,
Silkoff Philip E.,
Gozal David,
Pepin JeanLouis
Publication year - 2017
Publication title -
respirology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.857
H-Index - 85
eISSN - 1440-1843
pISSN - 1323-7799
DOI - 10.1111/resp.12929
Subject(s) - medicine , polysomnography , respiratory disturbance index , receiver operating characteristic , concordance , area under the curve , sleep (system call) , respiratory system , prospective cohort study , likelihood ratios in diagnostic testing , nuclear medicine , anesthesia , apnea , computer science , operating system
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.