Mandible behaviour interpretation during wakefulness, sleep and sleep‐disordered breathing

Abstract

SUMMARYThe mandible movement (MM) signal provides information on mandible activity. It can be read visually to assess sleep-wake state and respiratory events. This study aimed to assess (1) the training of independent scorers to recognize the signal specificities; (2) intrascorer reproducibility and (3) interscorer variability. MM was collected in the mid-sagittal plane of the face of 40 patients. The typical MM was extracted and classified into seven distinct pattern classes: active wakefulness (AW), quiet wakefulness or quiet sleep (QW/S), sleep snoring (SS), sleep obstructive events (OAH), sleep mixed apnea (MA), respiratory related arousal (RERA) and sleep central events (CAH). Four scorers were trained; their diagnostic capacities were assessed on two reading sessions. The intra-and interscorer agreements were assessed using Cohen's j. Intrascorer reproducibility for the two sessions ranged from 0.68 [95% confidence interval (CI): 0.59-0.77] to 0.88 (95% CI: 0.82-0.94), while the between-scorer agreement amounted to 0.68 (95% CI: 0.65-0.71) and 0.74 (95% CI: 0.72-0.77), respectively. The overall accuracy of the scorers was 75.2% (range: 72.4-80.7%). CAH MMs were the most difficult to discern (overall accuracy 65.6%). For the two sessions, the recognition rate of abnormal respiratory events (OAH, CAH, MA and RERA) was excellent: the interscorer mean agreement was 90.7% (Cohen's j: 0.83; 95% CI: 0.79-0.88). The discrimination of OAH, CAH, MA characteristics was good, with an interscorer agreement of 80.8% (Cohen's j: 0.65; 95% CI: 0.62-0.68). Visual analysis of isolated MMs can successfully diagnose sleep-wake state, normal and abnormal respiration and recognize the presence of respiratory effort. IN TROD UCTI ONMouth opening is a common observation during sleep in patients suffering from sleep-disordered breathing (SDB) (Miyamoto et al., 1999). The conjunction of sleep (and sleep stage) and neuro-anatomical factors of the upper respiratory airway will contribute in varying proportions to the occurrence of the obstructive event. Many factors influence the upper airway (UA) resistance and the occurrence of SDB. Inability to prevent UA obstruction during sleep is a feature of obstructive sleep apnea patients, inducing a cyclical phenomenon with persistent breathing effort. In the complex mechanisms leading to UA obstruction, the inferior jaw position (and linked structures including pharyngeal dilator muscles) is both influenced by and participates in pharyngeal patency. Mandible lowering during sleep is thought to be related to UA patency, as it is associated with both reduced cross-sectional area of the lumen and increased collapsibility of the UA (secondary to an inferior-posterior movement of the mandible) (Isono et al., 2004;Kuna and Remmers, 1985), and may contribute to sleep-related breathing abnormalities.The hypothetical mechanism explaining the mandible behaviour during sleep is postulated as follows.In normal conditions, the central respiratory drive commands the phasic inspiratory contraction of the...

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