Mandibular jaw movements as a non-invasive measure of respiratory effort during sleep: application in clinical practice

Assessment of respiratory effort (RE) is key for characterization of respiratory events. The discrimination between central and obstructive events is important because these events are caused by different physio-pathological mechanisms and require different treatment approaches. Many of the currently available options for home sleep apnea testing either do not measure RE, or RE signal recording is not always reliable. This is due to a variety of factors, including for instance wrong placement of the respiratory inductance plethysmography (RIP) sensors leading to artifacts or signal loss. Monitoring of mandibular jaw movements (MJM) provides the ability to accurately measure RE through a single point of contact sensor placed on the patient's chin. The inertial unit included in the capturing technology and overnight positional stability of the sensor provide a robust MJM bio-signal to detect sleep-disordered breathing (SDB). Many of the pharyngeal muscles are attached to the mandible directly, or indirectly via the hyoid bone. The motor trigeminal nerve impulses to contract or relax these muscles generate discrete MJM that reflect changes in RE during sleep. Indeed, the central drive utilizes the lower jaw as a fine-tuning lever to stiffen the upper airway musculature and safeguard the patency of the pharynx. Associations between the MJM bio-signal properties and both physiological and pathological breathing patterns during sleep have been extensively studied. These show a close relationship between changes in the MJM bio-signal as a function of RE that is similar to levels of RE measured simultaneously by the reference bio-signals such as esophageal pressure or crural diaphragmatic electromyography. Specific waveforms, frequencies, and amplitudes of these discrete MJM are seen across a variety of breathing disturbances that are recommended to be scored by the American Academy of Sleep Medicine. Moreover, MJM monitoring provides information about sleep/wake states and arousals, which enables total sleep time measurement for accurate calculation of conventional hourly indices. The MJM bio-signal can be interpreted and its automatic analysis using a dedicated machine learning algorithm delivers a comprehensive and clinically informative study report that provides physicians with the necessary information to aid in the diagnosis of SDB.