Validation of a quantitative method to measure neural respiratory drive in children during sleep

Chuang, Sandra; Teng, Arthur; Butler, Jane E.; Gandevia, Simon C.; Selvadurai, Hiran; Jaffé, Adam

doi:10.1016/j.resp.2017.02.004

Cited by 3 publications

(9 citation statements)

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“…The major strength of our study is the use of sEMGcw recorded by commercial polysomnographic equipment in a real‐world setting, allowing potential introduction of sEMGcw measurements into clinical practice. Reliable sEMGcw recordings and analyses are achievable with standardized techniques (Chuang et al., ; Maarsingh et al., 2000). Based on our previous validation (Chuang et al., ), we were confident that the narrower EMG filter settings recommended by the AASM (Iber et al., ) were suitable for quantitative evaluation of sEMGcw, although a filter range of at least 20–450 Hz is the recommended setting for assessing respiratory muscle EMG (Stegeman & Hermens, ).…”

Section: Discussionmentioning

confidence: 99%

“…In each participant, two excerpts of 60 s epochs exhibiting a stable breathing pattern in one sleeping position (supine, right lateral, left lateral or prone) from each of the three sleep stages [light sleep (N2), deep sleep (N3) and random eye movement (REM) sleep] were exported to Spike2 (Cambridge Electronic Design, Cambridge, UK) data acquisition and analysis system for offline manual waveform analysis. Segments of sEMGcw contaminated with electrical activity of the heart (QRS complex) were removed from sEMGcw traces using a customized script (Figure ; Chuang et al., ). The gated EMG signals were converted to a root mean square (RMS) signal with a time constant of 100 ms, moving average.…”

Section: Methodsmentioning

confidence: 99%

“…These are based on a number of factors, which include video observation of the child's respiratory effort and visual evaluation of sEMGcw magnitude. We have previously demonstrated that quantitative evaluation of sEMGcw recorded in children using a clinical polysomnography set‐up is achievable (Chuang et al., ). The aim of this study was to determine whether tidal non‐normalized sEMGcw can differentiate children with OSA from those without.…”

Section: Introductionmentioning

confidence: 99%

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

Chuang

Teng

Butler

et al. 2019

Experimental Physiology

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New Findings What is the central question of this study?Recent studies have suggested potential utility of non‐normalized respiratory muscle EMG as an index of neural respiratory drive (NRD). Whether NRD measured using non‐normalized surface EMG of the lateral chest wall overlying the diaphragm (sEMGcw) recorded during nocturnal clinical polysomnography can differentiate children with and without obstructive sleep apnoea (OSA) is not known. What is the main finding and its importance?Non‐normalized sEMGcw was increased in children with OSA and an additional group of snoring children without OSA but subjectively increased respiratory effort compared with primary snorers. The sEMGcw has potential clinical utility in evaluation of children with sleep‐disordered breathing as an objective, non‐invasive, non‐volitional marker of NRD. Abstract Our aim was to investigate whether neural respiratory drive measured by non‐normalized surface EMG recorded from the chest wall overlying the diaphragm (sEMGcw) differentiates children with and without obstructive sleep apnoea (OSA). Polysomnography data of children aged 0–18 years were divided into the following three groups: (i) primary snorers (PS); (ii) snoring children without OSA but with increased work of breathing (incWOB; subjective physician report of increased respiratory effort during sleep); and (iii) children with OSA [obstructive apnoea–hypopnoea index (OAHI) >1 h−1]. Excerpts of sEMGcw obtained during tidal unobstructed breathing from light, deep and rapid eye movement sleep were exported for quantitative analysis. Overnight polysomnography data from 45 PS [median age 4.4 years (interquartile range 3.0–7.7 years), OAHI 0 h−1 (0.0–0.2 h−1)], 19 children with incWOB [age 2.8 years (2.4–5.7 years), OAHI 0.1 h−1 (0.0–0.4 h−1)] and 27 children with OSA [age 3.6 years (2.6–6.2 years), OAHI 3.7 h−1 (2.3–6.9 h−1)] were analysed. The sEMGcw was higher in those with OSA [8.47 μV (5.98–13.07 μV); P < 0.0001] and incWOB [8.97 μV (5.94–13.43 μV); P < 0.001] compared with PS [4.633 μV (2.98–6.76 μV)]. There was no significant difference in the sEMGcw between children with incWOB and OSA (P = 0.78). Log sEMGcw remained greater in children with OSA and incWOB compared with PS after age, body mass index centiles, sleep stages and sleep positions were included in the mixed linear models (P < 0.0001). The correlation between sEMGcw and OAHI in children without OSA was small (rs = 0.254, P = 0.04). The sEMGcw is increased in children with OSA and incWOB compared with PS.

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Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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

Chuang

Teng

Butler

et al. 2019

Experimental Physiology

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“…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].…”

Section: Introductionmentioning

confidence: 99%

“…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].…”

Section: Introductionmentioning

confidence: 99%

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

Estrada

Torres

Sarlabous

et al. 2017

Entropy

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Fixed sample entropy (fSampEn) is a robust technique that allows the evaluation of inspiratory effort in diaphragm electromyography (EMGdi) signals, and has potential utility in sleep studies. To appropriately estimate respiratory effort, fSampEn requires the adjustment of several parameters. The aims of the present study were to evaluate the influence of the embedding dimension m, the tolerance value r, the size of the moving window, and the sampling frequency, and to establish recommendations for estimating the respiratory activity when using the fSampEn on surface EMGdi recorded for different inspiratory efforts. Values of m equal to 1 and r ranging from 0.1 to 0.64, and m equal to 2 and r ranging from 0.13 to 0.45, were found to be suitable for evaluating respiratory activity. fSampEn was less affected by window size than classical amplitude parameters. Finally, variations in sampling frequency could influence fSampEn results. In conclusion, the findings suggest the potential utility of fSampEn for estimating muscle respiratory effort in further sleep studies.

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ERS statement on respiratory muscle testing at rest and during exercise

et al. 2019

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Assessing respiratory mechanics and muscle function is critical for both clinical practice and research purposes. Several methodological developments over the past two decades have enhanced our understanding of respiratory muscle function and responses to interventions across the spectrum of health and disease. They are especially useful in diagnosing, phenotyping and assessing treatment efficacy in patients with respiratory symptoms and neuromuscular diseases. Considerable research has been undertaken over the past 17 years, since the publication of the previous American Thoracic Society (ATS)/European Respiratory Society (ERS) statement on respiratory muscle testing in 2002. Key advances have been made in the field of mechanics of breathing, respiratory muscle neurophysiology (electromyography, electroencephalography and transcranial magnetic stimulation) and on respiratory muscle imaging (ultrasound, optoelectronic plethysmography and structured light plethysmography). Accordingly, this ERS task force reviewed the field of respiratory muscle testing in health and disease, with particular reference to data obtained since the previous ATS/ERS statement. It summarises the most recent scientific and methodological developments regarding respiratory mechanics and respiratory muscle assessment by addressing the validity, precision, reproducibility, prognostic value and responsiveness to interventions of various methods. A particular emphasis is placed on assessment during exercise, which is a useful condition to stress the respiratory system.

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Validation of a quantitative method to measure neural respiratory drive in children during sleep

Cited by 3 publications

References 30 publications

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

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

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

ERS statement on respiratory muscle testing at rest and during exercise

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