[fr] [en] PURPOSE: Estimating the total sleep time in home recording devices is necessary to avoid underestimation of the indices reflecting sleep apnea and hypopnea syndrome severity, e.g., the apnea-hypopnea index (AHI). A new method to distinguish sleep from wake using jaw movement signal processing is assessed.
METHODS: In this prospective study, jaw movement signal was recorded using the Somnolter (SMN) portable monitoring device synchronously with polysomnography (PSG) in consecutive patients complaining about a lack of recovery sleep. The automated sleep/wake scoring method is based on frequency and complexity analysis of the jaw movement signal. This computed scoring was compared with the PSG hypnogram, the two total sleep times (TST(PSG) and TST(SMN)) as well.
RESULTS: The mean and standard deviation (in minutes) of TST(PSG) on the whole dataset (n = 124) were 407 ± 95.6, while these statistics were 394.2 ± 99.3 for TST(SMN). The Bland and Altman analysis of the difference between the two TST was 12.8 ± 57.3 min. The sensitivity and specificity (in percent) were 85.3 and 65.5 globally. The efficiency decreased slightly when AHI lies between 15 and 30, but remained similar for lower or greater AHI. In the 24 patients with insomnia/depression diagnosis, a mean difference in TST of -3.3 min, a standard deviation of 58.2 min, a sensitivity of 86.3%, and a specificity of 66.2% were found.
CONCLUSIONS: 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.
Disciplines :
Neurology
Author, co-author :
Senny, Frederic; Electronic Department, Montefiore Institute, University of Liège (ULg), Building B28, Grande Traverse, Sart-Tilman, B4000, Liège, Belgium. F.Senny@ulg.ac.be
Wickwire EM, Collop NA (2010) Insomnia and sleep-related breathing disorders. Chest 137(6):1449-1463
The American Association of Sleep Medicine Task Force (1999) Sleep-related breathing disorders in adults: recommendations for syndrome definition and measurement techniques in clinical research. Sleep 22(5):667-689
Rechtschaffen A, Kale A (1968) A manual of standardized terminology, techniques and scoring system for sleep stages of human subjects. National Institutes of Health, Washington
Flemons WW, Littner MR, Rowley JA (2000) Home diagnosis of sleep apnea: a systematic review of the literature: an evidence review cosponsored by the American Academy of Sleep Medicine, the American College of Chest Physicians, and the American Thoracic Society. Chest 124:1543-1579 (Pubitemid 37290070)
The American Thoracic Society, the American College of Chest Physicians, and the American Association of Sleep Medicine (2004) Executive summary on the systematic review and practice parameters for portable monitoring in the investigation of suspected sleep apnea in adults. Am J Respir Crit Care Med 169:1160-1163
Russo MB, Labutta A, Vo R, Black J, Campell W, Greene J, McGhee J, Redmond D (2005) Human biovibrations: assessment of human life signs, motor activity, and cognitive performance using wrist-mounted actigraphy. Aviat Space Environ Med 76(7):C64-C74 (Pubitemid 40934334)
American Sleep Disorders Association (1995) Practice parameters for the use of actigraphy in the clinical assessment of sleep disorders. Sleep 18(4):285-287
Sadeh A, Acebo C (2002) The role of actigraphy in sleep medicine. Sleep Medicine Reviews 6(2):113-124 (Pubitemid 35231067)
Ancoli-Israel S, Cole R, Alessi C, Chambers M, Moocroft W, Pollak CP (2003) The role of actigraphy in the study of sleep and circadian rhythms, American Academy of Sleep Medicine Review Paper. Sleep 26(3):342-392 (Pubitemid 39610685)
Tahmasian M, Khazaie H, Sepehry AA, Russo MB (2010) Ambulatory monitoring of sleep disorders. J Pak Med Assoc 60 (6):480-487
Elbaz M, Roue GM, Lofaso F, Quera Salva MA (2002) Utility of actigraphy in the diagnosis of OSA. Sleep 25(5):527-531
Hedner J, Pillar G, Pittman SD, Sou D, Grote L, White DP (2004) A novel adaptive wrist actigraphy algorithm for sleep-wake assessment in sleep apnea patients. Sleep 27(8):1560-1566 (Pubitemid 40041626)
Lötjönen J, Korhonen I, Hirvonen K, Rekola M, Myllymäki M, Partinen M (2001) Sleep/wake detection using an active security device. Sleep 24(suppl, No. Abstract 708.R):A399
Sánchez-Ortuño MM, Edinger JD, Means MK, Almirall D (2010) Home is where sleep is: an ecological approach to test the validity of actigraphy for the assessment of insomnia. J Clin Sleep Med 6 (1):21-29
Paquet J, Kawinska A, Carrier J (2007) Wake detection capacity of actigraphy during sleep. Sleep 30(10):1362-1369 (Pubitemid 47548287)
Van de Graaf WB (1988) Thoracic influence on upper airway patency. J Appl Physiol 65:2124-2131
Hollowel DE, Surrat PM (1991) Mandible position and activation of submental and masseter muscles during sleep. J Appl Physiol 71(6):2267-2273
Poirrier R, Chakar B, Lacroix A, Dive D, Hansen I, Frank G (1997) Relationship between mouth opening and intrathoracic pressure during sleep apnea. In: Somnologie Suppl. of the 5th World Congress on Sleep Apnea, number 2, page 37, 14-18 Feb
Miyamoto K, Özbek MM, Lowe AA, Sjöholm TT, Love LL, Fleetham JA, Ryan CF (1999) Mandibular posture during sleep in patients with obstructive sleep apnoea. Archives of Oral Biology 44:657-664 (Pubitemid 29334705)
Senny F, Destiné J, Poirrier R (2008) Midsagittal jaw movement analysis for the scoring of sleep apneas and hypopneas. IEEE Trans Biomed Eng 55(1):87-95 (Pubitemid 350308409)
Poirrier R, Cambron L, Maquet P, Ansay P, Destiné J, Senny F (2005) Maxillo-mandibular distance recording as a marker of non apneic sleep-disordered breathing. Sleep Medicine 6(Suppl)
Miyamoto K, Özbek MM, Lowe AA, Sjöholm TT, Love LL, Fleetham JA, Ryan CF (1998) Mandibular posture during sleep in healthy adults. Archives of Oral Biology 43(4):657-664
Senny F, Destiné J, Poirrier R (2009) Midsagittal jaw movements as sleep/wake marker. IEEE Trans Biomed Eng 56(2):303-309
ASDA (American Sleep Disorders Association and Sleep Research Society) Atlas Task Force (1992) EEG arousals: scoring rules and examples. Sleep 15:173-184
The Report of an American Academy of Sleep Medicine Task Force (1999) Sleep-related breathing disorders in adults: recommendations for syndrome definition and measurement techniques in clinical research. Sleep 22:667-689
European data format (edf). Available at http://www.edfplus.info/. Accessed 26 May 2011
MATLAB. Available at http://www.mathworks.com. Accessed 26 May 2011
R Development Core Team (2011) R: a language and environment for statistical computing, reference index version 2.13.0. R Foundation for Statistical Computing, Vienna. ISBN 3-900051-07-0. Available at http://www.R-project.org. Accessed 26 May 2011
