Laurent Cambron

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 ± 14 years; body mass index: 29 ± 7 kg m−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 < 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 ≥15 h−1). A Bland & 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.

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 Cohens 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% (Cohens 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% (Cohens 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.

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.

Comparison of clinical scores in their ability to detect hypoxemic severe OSA patients

Background Severe obstructive sleep apnea (sOSA) and preoperative hypoxemia are risk factors of postoperative complications. Patients exhibiting the combination of both factors are probably at higher perioperative risk. Four scores (STOP-Bang, P-SAP, OSA50, and DES-OSA) are currently used to detect OSA patients preoperatively. This study compared their ability to specifically detect hypoxemic sOSA patients. Methods One hundred and fifty-nine patients scheduled for an overnight polysomnography (PSG) were prospectively enrolled. The ability of the four scores to predict the occurrence of hypoxemic episodes in sOSA patients was compared using sensitivity (Se), specificity (Sp), Youden Index, Cohen kappa coefficient, and the area under ROC curve (AUROC) analyses. Results OSA50 elicited the highest Se [95% CI] at detecting hypoxemic sOSA patients (1 [0.89–1]) and was significantly more sensitive than STOP-Bang in that respect. DES-OSA was significantly more specific (0.58 [0.49–0.66]) than the three other scores. The Youden Index of DES-OSA (1.45 [1.33–1.58]) was significantly higher than those of STOP-Bang, P-SAP, and OSA50. The AUROC of DES-OSA (0.8 [0.71–0.89]) was significantly the largest. The highest Kappa value was obtained for DES-OSA (0.33 [0.21–0.45]) and was significantly higher than those of STOP-Bang, and OSA50. Conclusions In our population, DES-OSA appears to be more effective than the three other scores to specifically detect hypoxemic sOSA patients. However prospective studies are needed to confirm these findings in a perioperative setting. Clinical trial registration ClinicalTrials.gov: NCT02050685.

Development and Validation of a Morphological Preoperative Obstructive Sleep Apnea Prediction Score: The DES-OSA Score

SESSION TITLE: OSA Posters SESSION TYPE: Poster Presentations PRESENTED ON: Saturday, March 22, 2014 at 01:15 PM 02:15 PM PURPOSE: Obstructive Sleep Apnea (OSA) increases the perioperative risk. We develop a preoperative prediction score based on morphological characteristics. METHODS: Following IRB approvals and informed consent, we included 149 patients scheduled for an overnight polysomnography (OPS). Before OPS, we measured several morphological metrics of their body, face, and neck. According to their value, each of them received a 1, 2 or 3 point(s) score. After the OPS, the AHI (Apnea Hypopnea Index: number of apnea and hypopnea per hour) was collected. Different combinations of morphological metric scores were then summed and tested for their ability to predict a severe OSA (AHI>30). This ability was calculated using ROC curve analysis and prediction probability (PK). A two-tailed P value lower than 0.05 was considered significant. RESULTS: 10 patients were excluded. The best prediction score take account of four parameters: the Mallampati score, the distance between the thyroid and the chin (DTC), the body mass index (BMI) and the neck circumference (NC). According to their value, the parameters were weighted as following (1 point, 2 points, 3 points): Mallampati (Class I, Class II, Class III et IV), DTC in cm (>6, 5-6, 28, >39, >41), NC in cm (>37, >42, >48). The PK for an AHI>30 was 0.868 (95% CI: 0.81-0.92). The area under the curve was 0.83 (95% CI: 0.735-0.926). Sensitivity (Se) and Specificity (Sp), expressed in %, were 100 (Se) and 28.1 (Sp) for a summed score > 3, 73.1 (Se) and 78.9 (Sp) for a summed score >5, and 53.8 (Se) and 94.7 (Sp) for a summed score >6, respectively. CONCLUSIONS: Our study defines a simple morphological score for detecting OSA patients. A score > 3 presents a sensitivity of 100% and a score > 6 presents a specificity of 94.7% to identify an OSA patient with an AHI > 30. CLINICAL IMPLICATIONS: Anesthesiologists could use the DES-OSA score in order to detect OSA patients. The best clinical threshold is a score higher to 5 points. DISCLOSURE: The following authors have nothing to disclose: Eric Deflandre, Vincent Bonhomme, Stephanie Degey, Laurent Cambron, Robert Poirrier, Jean-Francois Brichant, Pol Hans No Product/Research Disclosure Information Copyright

Added Value of a Mandible Movement Automated Analysis in the Screening of Obstructive Sleep Apnea: Is there a Gender Influence?

Added Value of a Mandible Movement Automated Analysis in the Screening of Obstructive Sleep Apnea: Is there a Gender Influence? We previously demonstrated the added value of mandible movement automated analysis (MMAA) to a portable device for the screening of obstructive sleep apnea (OSA). In the present study, we aimed at investigating its respective value in the two genders. Several sleep monitoring equipments have been developed for the screening of OSA but few have been assessed in the female population. In a Systematic Review of the literature on portable devices published in 2003, the authors recommend that studies include more diversified populations, among them women.

Comportement de la mandibule chez les patients souffrant d’un syndrome d’apnées obstructives sévère et traités sous CPAP

Adresse e-mail : remy.hurdiel@orange.fr (R. Hurdiel) Le développement et la validation d’appareils facilement utilisable et de faible coût enregistrant les paramètres du sommeil, sont d’un intérêt important pour la recherche et pour l’éducation à la santé. Objectif.— L’objectif était de comparer l’enregistrement des principales variables du sommeil obtenues par agenda électronique, actimètre et agenda de sommeil manuscrit. Méthode.— On note que 48 adultes répartis en deux groupes (A et B) ont accepté d’enregistrer les données de leur sommeil pendant 6 à 7 jours consécutifs (soit 123 et 126 nuits respectivement). Tous ont porté un actimètre et ont utilisé l’application Scextan® (ULCO, Dunkerque, France) durant toute la période d’étude (intervalle d’une minute). Les 19 participants du groupe B ont en supplément fourni des données à partir d’un agenda de sommeil manuscrit (intervalle de 15 minutes). Les variables analysées ont été : le temps total de sommeil (TTS), les éveils après endormissement (WASO), le nombre d’éveils nocturnes (NbE), l’efficacité du sommeil (SE). Également, la latence d’endormissement (LE) a été déterminée par l’actimètre et par l’agenda de sommeil électronique (référence de l’heure de coucher). Résultats.— Les analyses (Pearson et Bland et Altman) montrent une forte corrélation de la LE (r = 0,94), du TTS (r = 0,96) et un fort agrément entre l’actimètre et l’agenda électronique (Biais LE = 3,3 ± 13 minutes ; biais TTS = 8,7 ± 11 minutes). La mesure du TTS est moins bonne entre l’actimètre et l’agenda de sommeil manuscrit (r = 0,78 ; Biais = —3,7 ± 56 minutes). Toutefois, quel que soit le type d’agenda, les corrélations et agréments avec l’actimètre sont faibles pour les éveils nocturnes (WASO, NbE, SE ; corrélation systématiquement inférieure à 0,22). Conclusion.— L’agenda de sommeil électronique, tel que Scextan®, est une méthode valable pour la mesure des temps de sommeil et du rythme circadien du sommeil. De plus, la mesure est plus précise qu’avec un agenda de sommeil manuscrit. Même si ces évaluations doivent être complétées par l’utilisation d’un accéléromètre pour détecter les éveils nocturnes, l’agenda électronique installé sur un appareil mobile offre plus de facilités éducatives que l’agenda de sommeil manuscrit.