Mandible Behavior in Obstructive Sleep Apnea Patients Under CPAP Treatment

Aim: To investigate whether obstructive sleep apnea (OSA) patients present different behaviors of mandible movements before and under CPAP therapy. Materials and Methodology: In this retrospective study, patients were selected according to inclusion criteria: both the diagnostic polysomnography recording showing an OSA with an apnea-hypopnea index (AHI) greater than 25 (n/h) and the related CPAP therapy control recordings were available, presence of mandible movement and mask pressure signals in the recordings, and tolerance to the applied positive pressure. Statistical analysis on four parameters, namely the apneahypopnea index (AHI), the arousal index (ArI), the average of the mandible lowering during sleep (aLOW), and the average amplitude of the oscillations of the mandible movement signal (aAMPL), was performed on two sets of recordings: OSA and CPAP therapy. Results: Thirty-four patients satisfied the inclusion criteria, thus both OSA and CPAP groups included thirty-four recordings each. Significant difference (p < 0.001) was found in the OSA group compared with the CPAP group when considering either the four parameters or only the two ones related to mandible movements. Conclusions: When an efficient CPAP pressure is applied, the mouth is less open and presents fewer broad sharp closure movements, and oscillating mandible movements are absent or very small.Peer reviewe

Quelques compétences de la Défense en matière de délits internationaux : criminalité maritime à l'étranger et piraterie dans le Code de la navigation

Les développements sont consacrés à quelques missions des navires de guerre belges prévues par le Code belge de la navigation . Nous analyserons d’abord les contours matériels des délits maritimes internationaux énumérés dans le Code (II), puis la procédure prévue ainsi que sa conformité à la Convention européenne des droits de l’homme (III). Les aspects matériels et procéduraux précités ne peuvent toutefois être développés en faisant l’impasse sur quelques notions élémentaires de droit de la mer, ni sur le contexte des missions de la Défense sur mer (I)

Added value of a mandible movement automated analysis in the screening of obstructive sleep apnea

In-laboratory polysomnography is the 'gold standard' for diagnosing obstructive sleep apnea syndrome, but is time consuming and costly, with long waiting lists in many sleep laboratories. Therefore, the search for alternative methods to detect respiratory events is growing. In this prospective study, we compared attended polysomnography with two other methods, with or without mandible movement automated analysis provided by a distance-meter and added to airflow and oxygen saturation analysis for the detection of respiratory events. The mandible movement automated analysis allows for the detection of salient mandible movement, which is a surrogate for arousal. All parameters were recorded simultaneously in 570 consecutive patients (M/F: 381/189; age: 50±14years; body mass index: 29±7kgm -2) visiting a sleep laboratory. The most frequent main diagnoses were: obstructive sleep apnea (344; 60%); insomnia/anxiety/depression (75; 13%); and upper airway resistance syndrome (25; 4%). The correlation between polysomnography and the method with mandible movement automated analysis was excellent (r: 0.95; P&lt;0.001). Accuracy characteristics of the methods showed a statistical improvement in sensitivity and negative predictive value with the addition of mandible movement automated analysis. This was true for different diagnostic thresholds of obstructive sleep severity, with an excellent efficiency for moderate to severe index (apnea-hypopnea index ≥15h -1). A Bland &amp; Altman plot corroborated the analysis. The addition of mandible movement automated analysis significantly improves the respiratory index calculation accuracy compared with an airflow and oxygen saturation analysis. This is an attractive method for the screening of obstructive sleep apnea syndrome, increasing the ability to detect hypopnea thanks to the salient mandible movement as a marker of arousals. © 2012 European Sleep Research Society

Mandible Behavior in Obstructive Sleep Apnea Patients Under CPAP Treatment

Aim: To investigate whether obstructive sleep apnea (OSA) patients present different behaviors of mandible movements before and under CPAP therapy. Materials and Methodology: In this retrospective study, patients were selected according to inclusion criteria: both the di-agnostic polysomnography recording showing an OSA with an apnea-hypopnea index (AHI) greater than 25 (n/h) and the related CPAP therapy control recordings were available, presence of mandible movement and mask pressure signals in the recordings, and tolerance to the applied positive pressure. Statistical analysis on four parameters, namely the apnea-hypopnea index (AHI), the arousal index (ArI), the average of the mandible lowering during sleep (aLOW), and the aver-age amplitude of the oscillations of the mandible movement signal (aAMPL), was performed on two sets of recordings: OSA and CPAP therapy. Results: Thirty-four patients satisfied the inclusion criteria, thus both OSA and CPAP groups included thirty-four record-ings each. Significant difference (p < 0.001) was found in the OSA group compared with the CPAP group when consider-ing either the four parameters or only the two ones related to mandible movements. Conclusions: When an efficient CPAP pressure is applied, the mouth is less open and presents fewer broad sharp closure movements, and oscillating mandible movements are absent or very small

Mandible behaviour interpretation during wakefulness, sleep and sleep-disordered breathing.

The mandible movement (MM) signal provides information on mandible activity. It can be read visually to assess sleep-wake state and respiratory events. This study aimed to assess (1) the training of independent scorers to recognize the signal specificities; (2) intrascorer reproducibility and (3) interscorer variability. MM was collected in the mid-sagittal plane of the face of 40 patients. The typical MM was extracted and classified into seven distinct pattern classes: active wakefulness (AW), quiet wakefulness or quiet sleep (QW/S), sleep snoring (SS), sleep obstructive events (OAH), sleep mixed apnea (MA), respiratory related arousal (RERA) and sleep central events (CAH). Four scorers were trained; their diagnostic capacities were assessed on two reading sessions. The intra- and interscorer agreements were assessed using Cohen's κ. Intrascorer reproducibility for the two sessions ranged from 0.68 [95% confidence interval (CI): 0.59-0.77] to 0.88 (95% CI: 0.82-0.94), while the between-scorer agreement amounted to 0.68 (95% CI: 0.65-0.71) and 0.74 (95% CI: 0.72-0.77), respectively. The overall accuracy of the scorers was 75.2% (range: 72.4-80.7%). CAH MMs were the most difficult to discern (overall accuracy 65.6%). For the two sessions, the recognition rate of abnormal respiratory events (OAH, CAH, MA and RERA) was excellent: the interscorer mean agreement was 90.7% (Cohen's κ: 0.83; 95% CI: 0.79-0.88). The discrimination of OAH, CAH, MA characteristics was good, with an interscorer agreement of 80.8% (Cohen's κ: 0.65; 95% CI: 0.62-0.68). Visual analysis of isolated MMs can successfully diagnose sleep-wake state, normal and abnormal respiration and recognize the presence of respiratory effort

Diagnostique du syndrome d’apnées et hypopnées obstructives du sommeil par l’analyse des mouvements de la mandibule

Les mouvements de la mandibule donnent une image des efforts respiratoires, particulièrement en période d’apnées et d’hypopnées du sommeil. Ils sont donc une alternative à la pression oesophagienne. Cette étude a mis en évidence le potentiel d’une analyse automatique des mouvements de la mâchoire pour le diagnostique du syndrome d’apnées et hypopnées obstructives du sommeil (SAHOS) par la mesure de l’indice d’apnées et d’hypopnées (IAH)

Validation des mouvements de la mandibule pour mesurer le sommeil par comparaison directe à la polysomnographie et à l’actimetrie

peer reviewe

Validation of midsagittal jaw movements to measure sleep in healthy adults by comparison with actigraphy and polysomnography.

OBJECTIVE: In a device based on midsagittal jaw movements analysis, we assessed a sleep-wake automatic detector as an objective method to measure sleep in healthy adults by comparison with wrist actigraphy against polysomnography (PSG). METHODS: Simultaneous and synchronized in-lab PSG, wrist actigraphy and jaw movements were carried out in 38 healthy participants. Epoch by epoch analysis was realized to assess the ability to sleep-wake distinction. Sleep parameters as measured by the three devices were compared. This included three regularly reported parameters: total sleep time, sleep onset latency, and wake after sleep onset. Also, two supplementary parameters, wake during sleep period and latency time, were added to measure quiet wakefulness state. RESULTS: The jaw movements showed sensitivity level equal to actigraphy 96% and higher specificity level (64% and 48% respectively). The level of agreement between the two devices was high (87%). The analysis of their disagreement by discrepant resolution analysis used PSG as resolver revealed that jaw movements was right (58.9%) more often than actigraphy (41%). In sleep parameters comparison, the coefficient correlation of jaw movements was higher than actigraphy in all parameters. Moreover, its ability to distinct sleep-wake state allowed for a more effective estimation of the parameters that measured the quiet wakefulness state. CONCLUSIONS: Midsagittal jaw movements analysis is a reliable method to measure sleep. In healthy adults, this device proved to be superior to actigraphy in terms of estimation of all sleep parameters and distinction of sleep-wake status

The sleep/wake state scoring from mandible movement signal.

Mandible movement recording and its dedicated signal processing for sleep/wake recognition improve sleep disorder index accuracy by assessing the total sleep time. Such a feature is welcome in home screening methods

Validation of midsagittal jaw movements to measure sleep in healthy adults by comparison with actigraphy and polysomnography

OBJECTIVE: In a device based on midsagittal jaw movements analysis, we assessed a sleep-wake automatic detector as an objective method to measure sleep in healthy adults by comparison with wrist actigraphy against polysomnography (PSG). METHODS: Simultaneous and synchronized in-lab PSG, wrist actigraphy and jaw movements were carried out in 38 healthy participants. Epoch by epoch analysis was realized to assess the ability to sleep-wake distinction. Sleep parameters as measured by the three devices were compared. This included three regularly reported parameters: total sleep time, sleep onset latency, and wake after sleep onset. Also, two supplementary parameters, wake during sleep period and latency time, were added to measure quiet wakefulness state. RESULTS: The jaw movements showed sensitivity level equal to actigraphy 96% and higher specificity level (64% and 48% respectively). The level of agreement between the two devices was high (87%). The analysis of their disagreement by discrepant resolution analysis used PSG as resolver revealed that jaw movements was right (58.9%) more often than actigraphy (41%). In sleep parameters comparison, the coefficient correlation of jaw movements was higher than actigraphy in all parameters. Moreover, its ability to distinct sleep-wake state allowed for a more effective estimation of the parameters that measured the quiet wakefulness state. CONCLUSIONS: Midsagittal jaw movements analysis is a reliable method to measure sleep. In healthy adults, this device proved to be superior to actigraphy in terms of estimation of all sleep parameters and distinction of sleep-wake status