Use of Chest Wall Electromyography to Detect Respiratory Effort during Polysomnography

Abstract

Study Objectives: To evaluate the ability of chest wall EMG (CW-EMG) using surface electrodes to classify apneas as obstructive, mixed, or central compared to classification using dual channel uncalibrated respiratory inductance plethysmography (RIP). Methods: CW-EMG was recorded from electrodes in the eighth intercostal space at the right mid-axillary line. Consecutive adult clinical sleep studies were retrospectively reviewed, and the first 60 studies with at least 10 obstructive and 10 mixed or central apneas and technically adequate tracings were selected. Four obstructive and six central or mixed apneas (as classified by previous clinical scoring) were randomly selected. A blinded experienced scorer classified the apneas on the basis of tracings showing either RIP channels or the CW-EMG channel. The agreement using the two classification methods was determined by kappa analysis and intraclass correlation. Results: The percentage agreement was 89.5%, the kappa statistic was 0.83 (95% confidence interval 0.79 to 0.87), and the intraclass correlation was 0.83, showing good agreement. Of the 249 apneas classified as central by RIP, 26 were classified as obstructive (10.4%) and 7 as mixed (2.8%) by CW-EMG. Of the 229 events classified as central by CW-EMG, 7 (3.1%) were classified as obstructive and 6 (2.6%) as mixed by RIP. Conclusions: Monitoring CW-EMG may provide a clinically useful method of detection of respiratory effort when used with RIP and can prevent false classification of apneas as central. RIP can rarely detect respiratory effort not easily discernible by CW-EMG and the combination of the two methods is more likely to avoid apnea misclassification. Keywords: apnea, diaphragmatic EMG, polysomnography, respiratory effort Citation: Berry RB, Ryals S, Girdhar A, Wagner MH. Use of chest wall electromyography to detect respiratory effort during polysomnography.

Quantitative assessment of nocturnal neural respiratory drive in children with and without obstructive sleep apnoea using surface EMG

“…Neural respiratory drive of the diaphragm and parasternal intercostal muscle during sleep has previously been evaluated mainly in adults (Berry et al., ; Gauda, Miller, Carlo, DiFiore, & Martin, ; Luo et al., , ; Praud, D'Allest, Delaperche, Bobin, & Gaultier, ; Steier et al., , ; Steier, Jolley, Polkey, & Moxham, ; Tabachnik, Muller, Bryan, & Levison, ; Tabachnik, Muller, Levison, & Bryan, ). Oesophageal catheter‐mounted electrodes were the main technique used to assess EMGdi to minimize the potential of cross‐talk signal from muscles surrounding the diaphragm (Luo et al., , ; Steier et al., , ).…”

“…We did not have a control group of healthy children without a history of snoring; future work should include obtaining reference ranges of sEMGcw in healthy non‐snoring children. We also excluded nearly 20% of the studies reviewed owing to the poor quality of the RIP and/or sEMGcw signals, similar to a previous adult study (Berry et al., ). We did not have a standardized calibration procedure to check the quality of sEMGcw signals before commencement of PSG recording.…”

“…Neural respiratory drive of the diaphragm and parasternal intercostal muscle during sleep has previously been evaluated mainly in adults (Berry et al, 2016;Gauda, Miller, Carlo, DiFiore, & Martin, 1989;Luo et al, 2008Luo et al, , 2009Praud, D'Allest, Delaperche, Bobin, & Gaultier, 1988;Steier et al, 2008Steier et al, , 2010Steier, Jolley, Polkey, & Moxham, 2011;Tabachnik, Muller, Bryan, & Levison, 1981a;Tabachnik, Muller, Levison, & Bryan, 1981b Steier et al, 2008Steier et al, , 2010. However, oesophageal catheters have major limitations, including increased arousals during sleep, reduced stage N2 and REM sleep and reduced total sleep time, and are poorly accepted by children and their carers (Chervin & Aldrich, 1997;Chervin et al, 2003;Luo et al, 2008).…”

Influence of Parameter Selection in Fixed Sample Entropy of Surface Diaphragm Electromyography for Estimating Respiratory Activity

“…Assessment of respiratory muscle function provides valuable information for the diagnosis and treatment capabilities of patients with respiratory muscle weakness [1], for instance, in specialties such as respiratory medicine [2][3][4][5], intensive care [6,7], and sleep medicine [8][9][10][11][12][13]. Analyzing electromyographic signals of the respiratory muscles in routine clinical studies can provide useful complementary information for measuring respiratory effort [1].…”

“…Nevertheless, this technique is unpleasant for patients and of limited use in clinical practice [2]. Instead, surface electromyography has been used for the non-invasive assessment of respiratory muscle function [1,4,[10][11][12][13][14]. It is possible to record surface EMGdi signals with electrodes placed on the chest wall surface, near the zone of apposition of the diaphragm, as described in [15].…”