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

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 noninvasive technique measuring respiratory effort. This paper proposes a new method for the scoring of SAHs based on the recording of the midsagittal jaw motion (MJM, 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 multilayer 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 MJM signal is hence a reliable marker of respiratory effort and allows an accurate detection and classification of SAHs

Influence of premedication with alprazolam on the occurrence of obstructive apneas

peer reviewe

Sleep-disordered breathing and comorbidities: Role of the upper airway and craniofacial skeleton

Obstructive sleep-disordered breathing (SDB), which includes primary snoring through to obstructive sleep apnea syndrome (OSAS), may cause compromise of respiratory gas exchange during sleep, related to transient upper airway narrowing disrupting ventilation, and causing oxyhemoglobin desaturation and poor sleep quality. SDB is common in chronic disorders and has significant implications for health. With prevalence rates globally increas-ing, this condition is causing a substantial burden on health care costs. Certain populations, including people with sickle cell disease (SCD), exhibit a greater prevalence of OSAS. A review of the literature provides the available normal polysomnography and oximetry data for reference and documents the structural upper airway differences between those with and without OSAS, as well as between ethnicities and disease states. There may be differences in craniofacial development due to atypical growth trajectories or extramedullary hematopoiesis in anemias such as SCD. Studies involving MRI of the upper airway illustrated that OSAS populations tend to have a greater amount of lymphoid tissue, smaller airways, and smaller lower facial skeletons from measurements of the mandible and linear mental spine to clivus. Understanding the potential relationship between these anatomical landmarks and OSAS could help to stratify treatments, guiding choice towards those which most effectively resolve the obstruction. OSAS is relatively common in SCD populations, with hypoxia as a key manifestation, and sequelae including increased risk of stroke. Combatting any structural defects with appropriate interventions could reduce hypoxic exposure and consequently reduce the risk of comorbidities in those with SDB, warranting early treatment interventions

Diagnosis of sleep apnoea using a mandibular monitor and machine learning analysis: one-night agreement compared to in-home polysomnography

Background: The capacity to diagnose obstructive sleep apnoea (OSA) must be expanded to meet an estimated disease burden of nearly one billion people worldwide. Validated alternatives to the gold standard polysomnography (PSG) will improve access to testing and treatment. This study aimed to evaluate the diagnosis of OSA, using measurements of mandibular movement (MM) combined with automated machine learning analysis, compared to in-home PSG. Methods: 40 suspected OSA patients underwent single overnight in-home sleep testing with PSG (Nox A1, ResMed, Australia) and simultaneous MM monitoring (Sunrise, Sunrise SA, Belgium). PSG recordings were manually analysed by two expert sleep centres (Grenoble and London); MM analysis was automated. The Obstructive Respiratory Disturbance Index calculated from the MM monitoring (MM-ORDI) was compared to the PSG (PSG-ORDI) using intraclass correlation coefficient and Bland-Altman analysis. Receiver operating characteristic curves (ROC) were constructed to optimise the diagnostic performance of the MM monitor at different PSG-ORDI thresholds (5, 15, and 30 events/hour). Results: 31 patients were included in the analysis (58% men; mean (SD) age: 48 (15) years; BMI: 30.4 (7.6) kg/m2). Good agreement was observed between MM-ORDI and PSG-ORDI (median bias 0.00; 95% CI −23.25 to + 9.73 events/hour). However, for 15 patients with no or mild OSA, MM monitoring overestimated disease severity (PSG-ORDI 5–15: MM-ORDI overestimation + 3.70 (95% CI −0.53 to + 18.32) events/hour). In 16 patients with moderate-severe OSA (n = 9 with PSG-ORDI 15–30 events/h and n = 7 with a PSG-ORD > 30 events/h), there was an underestimation (PSG-ORDI > 15: MM-ORDI underestimation −8.70 (95% CI −28.46 to + 4.01) events/hour). ROC optimal cut-off values for PSG-ORDI thresholds of 5, 15, 30 events/hour were: 9.53, 12.65 and 24.81 events/hour, respectively. These cut-off values yielded a sensitivity of 88, 100 and 79%, and a specificity of 100, 75, 96%. The positive predictive values were: 100, 80, 95% and the negative predictive values 89, 100, 82%, respectively. Conclusion: The diagnosis of OSA, using MM with machine learning analysis, is comparable to manually scored in-home PSG. Therefore, this novel monitor could be a convenient diagnostic tool that can easily be used in the patients’ own home. Clinical Trial Registration: https://clinicaltrials.gov, identifier NCT0426255

Classification techniques on computerized systems to predict and/or to detect Apnea: A systematic review

Sleep apnea syndrome (SAS), which can significantly decrease the quality of life is associated with a major risk factor of health implications such as increased cardiovascular disease, sudden death, depression, irritability, hypertension, and learning difficulties. Thus, it is relevant and timely to present a systematic review describing significant applications in the framework of computational intelligence-based SAS, including its performance, beneficial and challenging effects, and modeling for the decision-making on multiple scenarios.info:eu-repo/semantics/publishedVersio

The role of upper airway morphology in obstructive sleep apnea

Obstructive sleep apnea (OSA) is a highly prevalent sleep-related breathing disorder, characterized by repetitive complete and/or partial obstructions of the upper airway during sleep. It is suggested that impaired upper airway morphology is a fundamental pathophysiological trait of OSA. However, the exact role of the upper airway morphology in the pathogenesis and treatment of OSA is still not well known. Therefore, the general aim of this thesis was to evaluate the role of upper airway morphology in the pathogenesis of different OSA phenotypes and in the effects of mandibular advancement device (MAD) therapy. Upper airway morphology was investigated by cone beam computed tomography (CBCT). No significant differences in the upper airway morphology between positional and non-positional OSA (chapter 2), nor between Dutch and Chinese patients with mild to moderate OSA (chapter 3) were found. Further, miniscrew-assisted orthodontic treatment with premolar extractions increased upper airway dimensions in young adults with Class II malocclusion (chapter 4). Finally, no significant differences in the changes in upper airway dimensions between two types of MADs in situ (chapter 5), nor between responders and non-responders (chapter 6) with mild to moderate OSA were found. Therefore, it was concluded that the upper airway morphology does not play a significant role in the pathogenesis of different OSA phenotypes and in the treatment effects of MADs. Future research involving both anatomical and non-anatomical factors is needed to better understand the pathogenesis and treatment outcomes of OSA

Craniofacial morphology and dental characteristics in children and adolescents with sleep disorders: a systematic review

PURPOSE: To systematically evaluate the available evidence regarding craniofacial morphology and dental characteristics in children and adolescents with sleep disorders. METHODS: A systematic electronic literature search was conducted on May 3, 2022. The Cochrane Library, MEDLINE (PubMed), Embase, CINAHL, Web of Science and Dentistry and Oral Sciences Source were accessed. Hand searching of reference lists and study inclusions were established. Data extraction and quality assessment were carried out for each included study. Significant findings of each study were reported. RESULTS: A total of 18,615 papers were identified, and 4 additional studies with manual searching. Fifty-two papers were included. Obstructive sleep apnea (OSA) was found to be associated with increased lower anterior facial height in 18/47 studies, mandibular retrusion in 16/47 studies, narrow maxilla in 9/47 studies, steep mandibular plane angle in 8/47 studies, cross bite in 8/47 studies, deep palatal height in 6/47 studies, inferior hyoid bone position in 5/47 studies, overjet in 4/47 studies, and longer or larger soft palate in 6/47 studies. Sleep bruxism (SB) was found to be associated with increased incisal overjet in 3/5 studies. CONCLUSION: Within the limitations of the studies included, the most common craniofacial morphologies found in association with OSA children were increased lower anterior facial height, mandibular retrusion, narrow maxilla and steep mandibular plane angle, while the most common dental characteristics found in association with OSA children were cross bite, deep palatal height, overjet and longer or larger soft palate

Treatment of obstructive sleep apnoea with oral appliances

The use of oral appliances for the treatment of obstructive sleep apnoea (OSA) has become an established treatment choice. To date, follow-up data on the effects of such treatment on the facial skeleton, pharynx and occlusion have been limited. A study has subsequently been designed to address these issues. One hundred consecutively treated medically referred patients (87 males, 13 females, mean age 49 years, SD 8.5), were reviewed cephalometrically in six month intervals (6-30 months) following treatment with mandibular advancement therapy. Reference points and planes were digitized with a reflex metrograph and their means converted to linear and angular measurements. The mean mandibular advancement was 6.8mm (SD 1.8). No relationship was found between occlusal changes, degree of mandibular advancement, skeletal classification, duration of treatment, age or sex (ANOVA). When all patients were compared (N 100) occlusal changes related to a reduction in overbite (-l.02mm p<0.0001) and overjet (1.06mm p<0.0001) this was associated with a retroclination of the upper anteriors (-1.9° p<0.0001) and a proclination of the lower anteriors (2.8° p<0.001). A reduction in maxillary arch length was also found (-0.47mm p<0.006). Skeletal differences included small statistically significant changes in SNA0 (p<0.023), ANB0 (p<0.013) and maxillary length (p<0.002). A change in the vertical position of the mandibular condyle was highly significant (p<0.0001). When the changes over time were determined, an increase in face height and reduction in overbite and overjet were evident at 6 months associated with a change in condylar position. Over-eruption of the maxillary first premolars and mandibular first molars, along with a proclination of the lower incisors were only evident at 24 months. Occlusal changes tended to be progressive with on-going treatment with the greatest changes occurring at the final review period (30 months). Significant positive correlations were found also between the amount of anterior opening by the appliances and changes in overbite at 24 and 30 months. Although changes were not evident in either hypopharyngeal width or hyoid bone position, long-term mandibular advancement does, however, have a demonstratable effect on both the oropharynx and velopharynx. Following 12 months of treatment, posterior airway space (PAS) increased from 10.7 to 12.0mm (p<0.009). Statistically significant changes in the velopharynx were observed as early as six months with a reduction in length of the soft palate of 1.5mm (p<0.0001 ). These changes were considered to be due to the loss of pharyngeal odema following the elimination of habitual snoring. A change in natural head position (NHP) from an extended to a more upright position was also significant . Cephalometric differentiation between patients with mild or moderate OSA and those diagnosed with non-apneic snoring have been limited. Of this sample (NlOO), 58 patients were referred for the treatment of mild to moderate OSA and 42 for the treatment of nonapnoeic snoring. No statistically significant differences were observed between the apnoeic and non-apnoeic patients in either their skeletal or cranial base dimensions. Nasopharyngeal depth was, however, reduced in the apnoeic group