Mandibular movements identify respiratory effort in pediatric obstructive sleep apnea
Jean-Benoît Martinot, Fréderic Senny, Stéphane Denison, Valérie Cuthbert, Emmanuelle Gueulette, Hervé Guénard, Jean-Louis Pépin, Jean-Benoît Martinot, Fréderic Senny, Stéphane Denison, Valérie Cuthbert, Emmanuelle Gueulette, Hervé Guénard, Jean-Louis Pépin
Abstract
Study objectives: Obstructive sleep apnea-hypopnea (OAH) diagnosis in children is based on the quantification of flow and respiratory effort (RE). Pulse transit time (PTT) is one validated tool to recognize RE. Pattern analysis of mandibular movements (MM) might be an alternative method to detect RE. We compared several patterns of MM to concomittant changes in PTT during OAH in children with adenotonsillar hypertrophy.
Participants: 33 consecutive children with snoring and symptoms/signs of OAH.
Measurements: MMs were measured during polysomnography with a magnetometer device (Brizzy Nomics, Liege, Belgium) placed on the chin and forehead. Patterns of MM were evaluated representing peak to peak fluctuations > 0.3 mm in mandibular excursion (MML), mandibular opening (MMO), and sharp MM (MMS), which closed the mouth on cortical arousal (CAr).
Results: The median (95% CI) hourly rate of at least 1 MM (MML, or MMO, or MMS) was 18.1 (13.2-36.3) and strongly correlated with OAHI (p = 0.003) but not with central apnea-hypopnea index (CAHI; p = 0.292). The durations when the MM amplitude was > 0.4 mm and PTT > 15 ms were strongly correlated (p < 0.001). The mean (SD) of MM peak to peak amplitude was larger during OAH than CAH (0.9 ± 0.7 mm and 0.2 ± 0.3 mm; p < 0.001, respectively). MMS at the termination of OAH had larger amplitude compared to MMS with CAH (1.5 ± 0.9 mm and 0.5 ± 0.7 mm, respectively, p < 0.001).
Conclusions: MM > 0.4 mm occurred frequently during periods of OAH and were frequently terminated by MMS corresponding to mouth closure on CAr. The MM findings strongly correlated with changes in PTT. MM analysis could be a simple and accurate promising tool for RE characterization and optimization of OAH diagnosis in children.
Keywords: mandibular movements; pediatric obstructive sleep apnea; pulse transit time; respiratory effort.
© 2015 American Academy of Sleep Medicine.
Figures
![Figure 1. A midsagittal mandibular movement magnetic…](https://www.ncbi.nlm.nih.gov/pmc/articles/instance/4410931/bin/jcsm.11.5.567a.jpg)
![Figure 2. Schematic representation of the mandibular…](https://www.ncbi.nlm.nih.gov/pmc/articles/instance/4410931/bin/jcsm.11.5.567b.jpg)
![Figure 3A. Polysomnographic tracing of 4-min of…](https://www.ncbi.nlm.nih.gov/pmc/articles/instance/4410931/bin/jcsm.11.5.567c.jpg)
Figure 3B. Magnified traces of a single…
Figure 3B. Magnified traces of a single OAH event.
The abbreviations are the same as…
Figure 4. Box and whisker plots of…
Figure 4. Box and whisker plots of the mean envelop of mandibular movements during the…
Figure 5. Relationship between the period of…
Figure 5. Relationship between the period of NREM sleep times (minutes) during which PTT changes…
![Figure 3B. Magnified traces of a single…](https://www.ncbi.nlm.nih.gov/pmc/articles/instance/4410931/bin/jcsm.11.5.567d.jpg)
![Figure 4. Box and whisker plots of…](https://www.ncbi.nlm.nih.gov/pmc/articles/instance/4410931/bin/jcsm.11.5.567e.jpg)
![Figure 5. Relationship between the period of…](https://www.ncbi.nlm.nih.gov/pmc/articles/instance/4410931/bin/jcsm.11.5.567f.jpg)
Source: PubMed