Interpreting the mandibular jaw movement signal in pediatric obstructive sleep apnea diagnosis: A technical and practical review.

Pediatric obstructive sleep apnea (OSA) is a common yet often underdiagnosed condition, partly due to limited access to polysomnography. Mandibular jaw movement (MJM) analysis offers a promising alternative to conventional home sleep apnea testing in children, capturing the dynamic interactions between respiratory drive and upper airway musculature, enabling accurate identification of, and critical insights into, sleep-disordered breathing events. This technical and practical review provides a structured framework for understanding and interpreting MJM signals during sleep in pediatric patients.

Exploring the Dose-Response Relationship between Mandibular Protrusion and Respiratory Effort Burden in Oral Appliance Therapy for Obstructive Sleep Apnea.

Increased respiratory effort (RE) is a critical feature of obstructive sleep apnea (OSA). Although prior studies have established the efficacy of mandibular advancement device (MAD) therapy in reducing the apnea-hypopnea index (AHI), the impact of MAD therapy on RE burden remains unexplored. In this study, we used a validated mandibular jaw movement (MJM) monitoring technology to determine the dose-response relationship between MAD protrusion levels and RE burden measured as the percentage of total sleep time (TST) spent in elevated respiratory effort (REMOV) during MAD titration.

Assessment of Craniofacial Growth Pattern Relative to Respiratory Mandibular Movement and Sleep Characteristics: A Pilot Study.

Objectives:  The primary objective was to evaluate the influence of sagittal skeletal pattern on mandibular movement (MM) during sleep in growing orthodontic populations. The secondary objective was to compare MM according to obstructive sleep apnea (OSA) status.

Materials And Methods:  This cross-sectional study included subjects between 6 and 17 years old, presenting with class I, II, and III skeletal patterns and no previous history of orthodontic treatment.

Enhancing artificial intelligence-driven sleep apnea diagnosis: The critical importance of input signal proficiency with a focus on mandibular jaw movements.

Purpose: This review aims to highlight the pivotal role of the mandibular jaw movement (MJM) signal in advancing artificial intelligence (AI)-powered technologies for diagnosing obstructive sleep apnea (OSA).

Methods: A scoping review was conducted to evaluate various aspects of the MJM signal and their contribution to improving signal proficiency for users.

Results: The comprehensive literature analysis is structured into four key sections, each addressing factors essential to signal proficiency.

Air leak phenotyping by mandibular jaw movement analysis in CPAP therapy: Key insights for practitioners.

Monitoring unintentional air leaks in continuous positive airway pressure (CPAP) treatment for obstructive sleep apnea (OSA) is essential for therapy success. While leaks are often attributed to improperly sealed masks, mouth openings may also cause them, requiring interventions. Recent studies demonstrated distinctive mandibular jaw movement (MJM) signal patterns during sleep related to respiratory events and sleep stages.

Mandibular Jaw Movement Automated Analysis for Oral Appliance Monitoring in Obstructive Sleep Apnea: A Prospective Cohort Study.

Oral appliances are second-line treatments after continuous positive airway pressure for obstructive sleep apnea (OSA) management. However, the need for oral appliance titration limits their use as a result of monitoring challenges to assess the treatment effect on OSA. To assess the validity of mandibular jaw movement (MJM) automated analysis compared with polysomnography (PSG) and polygraphy (PG) in evaluating the effect of oral appliance treatment and the effectiveness of MJM monitoring for oral appliance titration at home in patients with OSA.

Insights on mandibular jaw movements during polysomnography in obstructive sleep apnea.

Unlabelled: A strong and specific comprehensive physiological association has been documented between mandibular jaw movements and related periods of normal or disturbed breathing across different sleep stages. The mandibular jaw movement biosignal can be incorporated in the polysomnography, displayed on the screen as a function of time like any standard polysomnography signal (eg, airflow, oxygen saturation, respiratory inductance plethysmography bands) and interpreted in the context of the target period of breathing and its associated respiratory effort level. Overall, the mandibular jaw movement biosignal that depicts the muscular trigeminal respiratory drive is a highly effective tool for differentiating between central and obstructive sleep episodes including hypopneas and for providing clinicians with valuable insights into wake/sleep states, arousals, and sleep stages.

Determinants of apnea-hypopnea index variability during home sleep testing.

Background: A single-night attended in-laboratory polysomnography or home sleep testing are common approaches for obstructive sleep apnea (OSA) diagnosis. However, internight variability in apnea-hypopnea index value is common, and may result in misclassification of OSA severity and inapropriate treatment decisions.

Objective: To investigate factors determining short-term apnea-hypopnea index variability using multi-night automated home sleep testing, and to determine how this variability impacts clinical decisions.

Remote Monitoring of Positive Airway Pressure Data: Challenges, Pitfalls, and Strategies to Consider for Optimal Data Science Applications.

Over recent years, positive airway pressure (PAP) remote monitoring has transformed the management of OSA and produced a large amount of data. Accumulated PAP data provide valuable and objective information regarding patient treatment adherence and efficiency. However, the majority of studies that have analyzed longitudinal PAP remote monitoring have summarized data trajectories in static and simplistic metrics for PAP adherence and the residual apnea-hypopnea index by the use of mean or median values.

Respiratory effort during sleep and prevalent hypertension in obstructive sleep apnoea.

Background: Mechanisms underlying blood pressure changes in obstructive sleep apnoea (OSA) are incompletely understood. Increased respiratory effort is one of the main features of OSA and is associated with sympathetic overactivity, leading to increased vascular wall stiffness and remodelling. This study investigated associations between a new measure of respiratory effort (percentage of total sleep time spent with increased respiratory effort based on measurement of mandibular jaw movements (MJM): REMOV, %TST) and prevalent hypertension in adults referred for evaluation of suspected OSA.

Mandibular Movements are a Reliable Noninvasive Alternative to Esophageal Pressure for Measuring Respiratory Effort in Patients with Sleep Apnea Syndrome.

Purpose: Differentiation between obstructive and central apneas and hypopneas requires quantitative measurement of respiratory effort (RE) using esophageal pressure (PES), which is rarely implemented. This study investigated whether the sleep mandibular movements (MM) signal recorded with a tri-axial gyroscopic chin sensor (Sunrise, Namur, Belgium) is a reliable surrogate of PES in patients with suspected obstructive sleep apnea (OSA).

Patients And Methods: In-laboratory polysomnography (PSG) with PES and concurrent MM monitoring was performed.

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.

Azithromycin for treatment of hospitalised COVID-19 patients: a randomised, multicentre, open-label clinical trial (DAWn-AZITHRO).

Background And Objectives: Azithromycin was rapidly adopted as a repurposed drug to treat coronavirus disease 2019 (COVID-19) early in the pandemic. We aimed to evaluate its efficacy in patients hospitalised for COVID-19.

Methods: In a series of randomised, open-label, phase 2 proof-of-concept, multicentre clinical trials (Direct Antivirals Working against the novel coronavirus (DAWn)), several treatments were compared with standard of care.

Detecting COVID-19 and other respiratory infections in obstructive sleep apnoea patients through CPAP device telemonitoring.

Objective: The earliest possible detection of individuals with COVID-19 has been essential to curb the spread of infection. Existing digital tools have been scaled up to address this issue. Every night telemonitoring data on continuous positive airway pressure (CPAP) device use, the first-line therapy for obstructive sleep apnoea (OSA), is collected worldwide.

AKR1B10, One of the Triggers of Cytokine Storm in SARS-CoV2 Severe Acute Respiratory Syndrome.

Preventing the cytokine storm observed in COVID-19 is a crucial goal for reducing the occurrence of severe acute respiratory failure and improving outcomes. Here, we identify Aldo-Keto Reductase 1B10 (AKR1B10) as a key enzyme involved in the expression of pro-inflammatory cytokines. The analysis of transcriptomic data from lung samples of patients who died from COVID-19 demonstrates an increased expression of the gene encoding AKR1B10.