title: Assessment of respiratory effort during sleep: Esophageal pressure versus noninvasive monitoring techniques.
abstract: Monitoring of respiratory effort is paramount in the clinical diagnostic recording of sleep. Increased respiratory effort is a sign of obstructive sleep-disordered breathing and is associated with arousals from sleep. Respiration is the result of muscle activity that induces negative intrathoracic pressure and expansion of the thoracic and abdominal cavities. Therefore respiratory effort may be recorded from mechanical, electrical and electromechanical signals. Several techniques are available for the recording of respiratory effort. Monitoring of esophageal pressure is still the method of choice, as the pressure signal directly reflects the respiratory muscle force. However, esophageal pressure monitoring is cumbersome and may be replaced with noninvasive techniques. In order to be reliable, these techniques must be validated against the esophageal pressure standard. The present review presents a concise description of the technical principles and, if available, a comparison with esophageal pressure data, based on a systematic literature search. Most data are available on respiratory inductance plethysmography, and confirm that this technique is suitable for routine diagnostic investigation of respiratory effort during sleep. Pulse transit time, diaphragmatic electromyography, snoring loudness, suprasternal pressure monitoring, midsagittal jaw movement and forehead venous pressure monitoring are promising alternative techniques although only limited validation is available.
authors: Kempenhaeghe Foundation, Sleep Medicine Centre, P.O. Box 61, 5590 AB Heeze, The Netherlands. Electronic address: VandenbusscheN@Kempenhaeghe.nl.
authors: Nele L
authors: NL
authors: Vandenbussche
authors: Kempenhaeghe Foundation, Sleep Medicine Centre, P.O. Box 61, 5590 AB Heeze, The Netherlands; Department of Neurology, Donders Institute for Neuroscience, Radboud University Medical Centre, PO Box 9101, 6500HB Nijmegen, The Netherlands.
authors: Sebastiaan
authors: S
authors: Overeem
authors: Kempenhaeghe Foundation, Sleep Medicine Centre, P.O. Box 61, 5590 AB Heeze, The Netherlands.
authors: Johannes P
authors: JP
authors: van Dijk
authors: Kempenhaeghe Foundation, Sleep Medicine Centre, P.O. Box 61, 5590 AB Heeze, The Netherlands.
authors: Pieter Jan
authors: PJ
authors: Simons
authors: Kempenhaeghe Foundation, Sleep Medicine Centre, P.O. Box 61, 5590 AB Heeze, The Netherlands; University of Ghent, Faculty of Medicine and Health Sciences, Department of Internal Medicine, 25 Sint-Pietersnieuwstraat, 9000 Ghent, Belgium.
authors: Dirk A
authors: DA
authors: Pevernagie
mesh_terms: D001143:Arousal / Q000502:physiology; D004947:Esophagus / Q000503:physiopathology; D006801:Humans; D010991:Plethysmography; D017286:Polysomnography / Q000379:methods*; D011312:Pressure; D012143:Respiratory Physiological Phenomena; D012890:Sleep / Q000502:physiology*; D020181:Sleep Apnea, Obstructive / Q000503:physiopathology
keywords: Assessment; Electromyography; Esophageal pressure; Inductance plethysmography; Mandibular movement; Pulse transit time; Respiratory effort; Sleep apnea; Venous pressure