Synchronized mandibular movement and capnography: a novel approach to obstructive airway detection during procedural sedation—a post hoc analysis of a prospective study

Abstract

Perioperative complications related to obstructive sleep apnea still occur despite the use of partial pressure end-tidal CO 2 P ETCO 2 and pulse oximetry. Airway obstruction can complicate propofol sedation and a novel monitor combining mandibular movement analysis with capnography may facilitate its detection. Patients scheduled for sleep endoscopy were recruited and monitored with standard monitoring, P ETCO 2 , and Jaw Activity (JAWAC) mandibular movement sensors. A post hoc analysis investigated airway obstruction prediction using a Respiratory Effort Sequential Detection Algorithm (RESDA) based on P ETCO 2 and mandibular movement signals. 21 patients were recruited and 54 episodes of airway obstruction occurred. RESDA detected obstructive apnea [mean ± SD (median)] 29 ± 29 (21) s, p < 0.0001, before P ETCO 2 alone. This prolonged the time between obstructive apnea detection and decrease to 90% oxygen saturation 64 ± 38 ( 54) versus 38 ± 20 (35) s, p < 0.0001. It predicted airway obstruction with a sensitivity and specificity of 81% and 93%, respectively. The RESDA algorithm, which is based on the combination of capnography with mandibular movement assessment of respiratory effort, can more rapidly alarm anesthetists of airway obstruction during propofol sedation than P ETCO 2 alone. However, P ETCO 2 , pulse oximetry, and clinical monitoring are still required. Trial Registry numbers: ClinicalTrial.gov (NCT02909309) https ://clini caltr ials.gov/ct2/show/NCT02 90930 9.

Journal of Clinical Monitoring and Computing 2018–2019 end of year summary: respiration

“…Ponthieu et al [33] reported on a pilot study on the performance of an airway obstruction prediction algorithm (RESDA) on 21 adult patients with suspected obstructive sleep apnea who were scheduled for endoscopy. The RESDA algorithm inputs include end-tidal CO 2 and mandibular movement pattern and amplitude from sensors positioned on the patients' chin and forehead.…”