[en] Given the importance of the detection and classification of sleep apneas and hypopneas (SAHs) in the diagnosis and the characterization of the SAH syndrome, there is a need for a reliable noninvasive technique measuring respiratory effort. This paper proposes a new method for the scoring of SAHs based on the recording of the midsagittal jaw motion (MJM, mouth opening) and on a dedicated automatic analysis of this signal. Continuous wavelet transform is used to quantize respiratory effort from the jaw motion, to detect salient mandibular movements related to SAHs and to delineate events which are likely to contain the respiratory events. The classification of the delimited events is performed using multilayer perceptrons which were trained and tested on sleep data from 34 recordings. Compared with SAHs scored manually by an expert, the sensitivity and specificity of the detection were 86.1% and 87.4%, respectively. Moreover, the overall classification agreement in the recognition of obstructive, central, and mixed respiratory events between the manual and automatic scorings was 73.1%. The MJM signal is hence a reliable marker of respiratory effort and allows an accurate detection and classification of SAHs.
Disciplines :
Engineering, computing & technology: Multidisciplinary, general & others
Author, co-author :
Senny, Frédéric ; Université de Liège - ULiège > Dép. d'électric., électron. et informat. (Inst.Montefiore) > Electronique, microsystèmes, mesures et instrumentation
Destiné, Jacques ; Université de Liège - ULiège > Dép. d'électric., électron. et informat. (Inst.Montefiore) > Electronique, microsystèmes, mesures et instrumentation
Poirrier, Robert ; Université de Liège - ULiège > Services généraux (Faculté de médecine) > Relations académiques et scientifiques (Médecine)
Language :
English
Title :
Midsagittal Jaw Movement Analysis for the Scoring of Sleep Apneas and Hypopneas
Publication date :
January 2008
Journal title :
IEEE Transactions on Biomedical Engineering
ISSN :
0018-9294
eISSN :
1558-2531
Publisher :
Institute of Electrical and Electronics Engineers, United States - New York
T. Young, M. Palta, J. Dempsey, J. Skatrud, S. Weber, and S. Badr, "The occurrence of sleep-disordered breathing among middle-aged adults," New England J. Med., vol. 328, no. 7, pp. 1230-1235, 1993.
The American Academy of Sleep Medicine Task Force, "Sleep-related breathing disorders in adults: Recommendations for syndrome definition and measurement techniques in clinical research," Sleep, vol. 22, no. 5, pp. 667-689, 1999.
J. Hung, E. Whitford, R. W. Parsons, and D. R. Hillman, "Association of sleep apnea with myocardial infarction in men," Lancet, vol. 336, pp. 261-264, 1990.
C. Bassetti and M. Aldrich, "Sleep apnea in acute cerebrovascular diseases: Final report on 128 patients," Sleep, vol. 22, pp. 217-223, 1999.
P. Peppard, T. Young, M. Palta, and J. Skatrud, "Prospective study of the association between sleep-disordered breathing and hypertension," New England J. Med., vol. 342, pp. 1378-1384, 2000.
A. L. Meoli, K. R. Casey, R. W. Clark, J. A. Coleman, R. W. Fayle, R. J. Troell, and C. Iber, "Hypopnea in sleep-disordered breathing in adults," Sleep, vol. 24, pp. 469-470, 2001.
J. R. Stradling, D. J. Pitson, L. Bennet, C. Barbour, and R. J. O. Davies, "Variation in the arousal pattern after obstructive events in obstructive sleep apnea," Amer. J. Respiratory Critical Care Med., vol. 159, pp. 130-136, 1999.
J. Krieger, C. Schröder, and C. Erhardt, "Cortical autonomous arousal. Technical evaluations and clinical interest.," Revue Neurologique (Paris), vol. 159, 2003.
K. Rees, D. P. Spence, J. E. Earis, and P. M. A. Calverley, "Arousal responses from apneic events during non-rapid-eye-movement sleep," Amer. J. Respiratory Critical Care Med., vol. 152, pp. 1016-1021, 1995.
K. Dingli, I. Fietze, T. Assimakopoulos, S. Quispe-Bravo, C. Witt, and N. J. Douglas, "Arousability in sleep apnoea/hypopnoea syndrome patients," Eur. Respiratory J., vol. 20, pp. 733-740, 2002.
M. H. Kryger, T. Roth, and W. C. Dement, Principles and Practice of Sleep Medicine. Philadelphia, PA: Saunders, 2000, ch. Monitoring respiratory and cardiac function, pp. 1217-1230.
S. Berg, J. C. Hybbinette, T. Gislason, and M. Hawke, "Continuous intrathoracic pressure monitoring with a new esophageal microchip catheter in sleep-related upper airway obstructions," J. Otolaryngology, vol. 24, no. 3, pp. 160-164, 1995.
P. Varady, T. Micsik, S. Benedek, and Z. Benyo, "A novel method for the detection of apnea and hypopnea events in respiration signals," IEEE Trans. Biomed. Eng., vol. 49, no. 9, pp. 936-942, Sep. 2002.
R. G. Norman, M. M. Ahmed, J. A. Walsleben, and D. M. Rapoport, "Detection of respiratory events during NPSG: Nasal cannula/pressure sensor versus thermistor," Sleep, vol. 20, no. 12, pp. 1175-1184, 1997.
I. Ayappa, R. G. Norman, A. C. Krieger, A. Rosen, R. L. O'Malley, and D. M. Rapoport, "Non-invasive detection of respiratory effort-related arousals (RERAs) by a nasal cannula/pressure transducer system," Sleep, vol. 23, no. 6, pp. 763-771, 2000.
C. Cracowski, J. Pépin, B. Wuyam, and P. Levy, "Characterization of obstructive nonapneic respiratory events in moderate sleep apnea syndrome," Amer. J. Respiratory Critical Care Med., vol. 164, pp. 944-948, 2001.
R. Farré, J. Montserrat, and D. Navajas, "Noninvasive monitoring of respiratory mechanics during sleep," Eur. Respiratory J., vol. 24, pp. 1052-1060, 2004.
O. Fontenla-Romero, B. Guijarro-Berdinas, A. Alonso-Betanzos, and V. Moret-Bonillo, "A new method for sleep apnea classification using wavelets and feedforward neural networks," Artif. Intell. Med., vol. 34, pp. 65-76, 2005.
D. J. Pitson, A. Sandell, R. van den Hout, and J. R. Stradling, "Use of pulse transit time as a measure of inspiratory effort in patients with obstructive sleep apnea," Eur. Respiratory J., vol. 8, pp. 1669-1674, 1995.
J. Argod, J. Pépin, R. P. Smith, and P. Levy, " Differentiating obstructive and central sleep respiratory events through pulse transit time," Amer. J. Respiratory Critical Care Med., vol. 158, pp. 1778-1783, 1998.
S. Reisch, J. Daniuk, H. Steltner, K.-H. Rühle, J. Timmer, and J. Guttmann, "Detection of sleep apnea with the forced oscillation technique compared to three standard polysomnographic signals," Respiration, vol. 67, pp. 518-525, 2000.
H. Steltner, R. Staats, J. Timmer, M. Vogel, J. Guttmann, and H. Matthys, "Diagnosis of sleep apnea by automatic analysis of nasal pressure and forced oscillation impedance," Amer. J. Respiratory Critical Care Med., vol. 165, pp. 940-944, 2002.
R. Schnall, A. Shlitner, J. Sheffy, R. Kedar, and P. Lavie, "Periodic, profound peripheral vasoconstriction - A new marker of obstructive sleep apnea," Sleep, vol. 22, no. 7, pp. 939-946, 1999.
A. Bar, G. Pillar, I. Dvir, J. Sheffy, A. Shlitner, and P. Lavie, "Evaluation of a portable device based on peripheral arterial tone for unattended home sleep studies," Chest, vol. 123, no. 3, pp. 695-703, 2003.
T. Penzel, J. McNames, P. de Chazal, B. Raymond, A. Murray, and G. Moody, "Systematic comparison of different algorithms for apnoea detection based on electrocardiogram recordings," Med. Biol. Eng. Comput., vol. 40, pp. 402-407, 2002.
P. de Chazal, T. Penzel, and C. Heneghan, "Automated detection of obstructive sleep apnoea at different time scales using the electrocardiogram, " Physiol. Meas., vol. 25, pp. 967-983, 2004.
W. B. van de Graaf, "Thoracic influence on upper airway patency," J. Appl. Physiol., vol. 65, pp. 2124-2131, 1988.
D. E. Hollowel and P. M. Surrat, "Mandible position and activation of submental and masseter muscles during sleep," J. Appl. Physiol., vol. 71, no. 6, pp. 2267-2273, 1991.
R. Poirrier, B. Chakar, A. Lacroix, D. Dive, I. Hansen, and G. Frank, "Relationship between mouth opening and intrathoracic pressure during sleep apnea," in Somnologie Suppl. 5th World Congr. Sleep Apnea, Feb. 14-18, 1997, no. 2, p. 37.
R. Poirrier, "Etude du comportement de la mandibule au cours des arythmies ventilatoires du sommeil. contribution la physiopathologie du syndrome des apnées obstructives et mise au point d'un système de dépistage," Thèse d'Agrégation de l'enseignement supérieur, Dèpartement de Neurologie, Université de Liège, Liège, Belgium, 1998.
K. Miyamoto, M. M. Özbek, A. A. Lowe, T. T. Sjöholm, L. L. Love, J. A. Fleetham, and C. F. Ryan, "Mandibular posture during sleep in patients with obstructive sleep apnoea," Arch. Oral Biol., vol. 44, pp. 657-664, 1999.
F. Senny, J. Destiné, J. Verly, P. Ansay, and R. Poirrier, "Automatic scoring of sleep apnea and hypopnea by the analysis of mandibular movements," in Proc. 3rd Int. Assoc. Sci. Technol. Develop. (IASTED) Conf. Biomed. Eng., Feb. 14-18, 2005, pp. 373-378.
F. Senny, J. Destiné, P. Ansay, L. Cambron, P. Maquet, and R. Poirrier, "Diagnosis of obstructive sleep apneoa and hypopneoa syndrome based on automatic analysis of mandibular movements," in Proc. 1st Congr. World Assoc. Sleep Med., Oct. 15-18, 2005, pp. 73-77.
A. Rechtschaffen and A. Kale, A manual of Standardized Terminology, Techniques and Scoring System for Sleep Stages of Human Subjects. Washington, DC: National Institue of Health, 1968.
E. Graas, V. Remouchamps, D. Dive, and R. Poirrier, "A broad range of new clinical applications for a magnetic sensor measuring distance on human body," in Proc. 3rd IEEE-EMBS Int. Summer School Symp. Med. Dev. Biosens., Sep. 4-6, 2007, pp. 73-76.
B. Beckers, R. Poirrier, and J. Destiné, "Screening of sleep-disordered breathing through the recording of mandibular movements," in Proc. 1st Annu. Int. IEEE-EMBS - Special Topic Conf. Microtechnol. Med. Biol., Oct. 12-14, 2000, pp. 593-596.
European Data Format (edf) [Online]. Available: http://www.edfplus.info/
Massachusetts Institute of Technology, Lincoln Laboratory, Lnknet Software Lexington, MA [Online]. Available: http://www.ll.mit.edu/IST/lnknet/
S. Mallat, A Wavelet Tour of Signal Processing. New York: Academic, 1999.
A. Aldroubi and M. Unser, Eds., Wavelets in Medicine and Biology. Boca Raton, FL: CRC Press, 1996.
C. Ducottet, T. Fournel, and C. Barat, "Scale-adaptive detection and local characterization of edges based on wavelet transform," Signal Process., vol. 84, pp. 2115-2137, 2004.
Y. Chen, Z. Tian, and Z. Miao, "Detection of singularities in the pressure fluctuations of circulating fluidized beds based on wavelet modulus maximum method," Chem. Eng. Sci., vol. 59, pp. 3569-3575, 2004.
