Midsagittal Jaw Movement Analysis for the Scoring of Sleep Apneas and Hypopneas

Abstract

Given the importance of the detection and classification of sleep apneas and hypopneas (SAHs) in the diagnosis and the characterization of the SAH syndrome, there is a need for a reliable non-invasive technique measuring respiratory effort. This paper proposes a new method for the scoring of SAHs based on the recording of the midsagittal jaw motion (mouth opening) and on a dedicated automatic analysis of this signal. Continuous wavelet transform is used to quantize respiratory effort from the jaw motion, to detect salient mandibular movements related to SAHs and to delineate events which are likely to contain the respiratory events. The classification of the delimited events is performed using multi-layer perceptrons which were trained and tested on sleep data from 34 recordings. Compared with SAHs scored manually by an expert, the sensitivity and specificity of the detection were 86.1% and 87.4% respectively. Moreover, the overall classification agreement in the recognition of obstructive, central and mixed respiratory events between the manual and automatic scorings was 73.1%. The midsagittal jaw motion signal is hence a reliable marker of respiratory effort and allows an accurate detection and classification of SAHs.

Mandibular Movements Identify Respiratory Effort in Pediatric Obstructive Sleep Apnea

“…Data published in adults 19 and visual analysis of the traces in this study indicate that MM can be analyzed in 4 different ways depending on their amplitude and duration as shown in Table 1 and Figures 2, 3, and S1 (supplemental material).…”

“…19 Moreover the peak-topeak amplitude of mandibular movement (excursion) during a respiratory cycle (inspiration and expiration) was measured by grayscale mathematical morphology. 22,23 This mathematical computation creates an envelope around each mandibular …”

Nasal obstruction and male gender contribute to the persistence of mouth opening during sleep in CPAP‐treated obstructive sleep apnoea

“…Mandible behaviour has been shown as a reliable marker of respiratory effort during sleep. 19 An automatic analysis of mandible movement has been previously developed for the scoring of apnoea-hypopnoea events, 9,20,21 the scoring of sleep/wake phases 22,23 as well as micro-arousals. 21 In the present study, the automatic analysis of this signal was used to assess (i) the mean value of mouth opening over the entire sleep period and (ii) the mean amplitude of the mandible oscillation.…”

“…During an obstructive respiratory event, respiratory effort increases and recruitment of supra-hyoid muscles, mylohyoid, geniohyoid and genioglossus cause mouth opening, which is not compensated by the jaw closing muscles, masseter, internal pterygoid and temporalis. 8,9 Mouth opening in turn induces mandibular retrusion, decreases pharyngeal diameter, 10 reduces the mechanical efficiency of the pharyngeal dilator muscles 11 and increases pharyngeal resistance and collapsibility. 12 CPAP treatment with a nasal mask, by alleviating pharyngeal obstructions, reduces sleep time spent in mouth breathing 13,14 as well as the amplitude of mouth opening movements.…”

Portable monitoring in sleep apnea

“…One other approach is the recording of midsagittal jaw movements based on magnetic distance determination [27]. A magnetic sensor on the chin and one on the forehead allow to determine continuously the relative jaw movements.…”