title: Mandibular movements identify respiratory effort in pediatric obstructive sleep apnea.
abstract: OBJECTIVE
  Obstructive sleep apnea-hypopnea (OAH) diagnosis in children is based on the quantification of flow and respiratory effort (RE). Pulse transit time (PTT) is one validated tool to recognize RE. Pattern analysis of mandibular movements (MM) might be an alternative method to detect RE. We compared several patterns of MM to concomittant changes in PTT during OAH in children with adenotonsillar hypertrophy.
  
  
  METHODS
  
  
  
  METHODS
  33 consecutive children with snoring and symptoms/signs of OAH.
  
  
  METHODS
  MMs were measured during polysomnography with a magnetometer device (Brizzy Nomics, Liege, Belgium) placed on the chin and forehead. Patterns of MM were evaluated representing peak to peak fluctuations > 0.3 mm in mandibular excursion (MML), mandibular opening (MMO), and sharp MM (MMS), which closed the mouth on cortical arousal (CAr).
  
  
  RESULTS
  The median (95% CI) hourly rate of at least 1 MM (MML, or MMO, or MMS) was 18.1 (13.2-36.3) and strongly correlated with OAHI (p = 0.003) but not with central apnea-hypopnea index (CAHI; p = 0.292). The durations when the MM amplitude was > 0.4 mm and PTT > 15 ms were strongly correlated (p < 0.001). The mean (SD) of MM peak to peak amplitude was larger during OAH than CAH (0.9 ± 0.7 mm and 0.2 ± 0.3 mm; p < 0.001, respectively). MMS at the termination of OAH had larger amplitude compared to MMS with CAH (1.5 ± 0.9 mm and 0.5 ± 0.7 mm, respectively, p < 0.001).
  
  
  CONCLUSIONS
  MM > 0.4 mm occurred frequently during periods of OAH and were frequently terminated by MMS corresponding to mouth closure on CAr. The MM findings strongly correlated with changes in PTT. MM analysis could be a simple and accurate promising tool for RE characterization and optimization of OAH diagnosis in children.
authors.affiliation: Départements de Pneumologie et de Pédiatrie, Clinique et Maternité St Elisabeth, Namur, Belgium.
authors.forename: Jean-Benoît
authors.initials: JB
authors.lastname: Martinot
authors.affiliation: Electronic unit, HELMo-Gramme, Liège, Belgium.
authors.forename: Fréderic
authors.initials: F
authors.lastname: Senny
authors.affiliation: Départements de Pneumologie et de Pédiatrie, Clinique et Maternité St Elisabeth, Namur, Belgium.
authors.forename: Stéphane
authors.initials: S
authors.lastname: Denison
authors.affiliation: Départements de Pneumologie et de Pédiatrie, Clinique et Maternité St Elisabeth, Namur, Belgium.
authors.forename: Valérie
authors.initials: V
authors.lastname: Cuthbert
authors.affiliation: Départements de Pneumologie et de Pédiatrie, Clinique et Maternité St Elisabeth, Namur, Belgium.
authors.forename: Emmanuelle
authors.initials: E
authors.lastname: Gueulette
authors.affiliation: Laboratoire de Physiologie et CHU de Bordeaux, France.
authors.forename: Hervé
authors.initials: H
authors.lastname: Guénard
authors.affiliation: Université Grenoble Alpes, HP2; Inserm U1042, Grenoble, France. CHU de Grenoble, Laboratoire EFCR, Secteur Physiologie Sommeil et Exercice, Pole THORAX et VAISSEAUX Grenoble, France.
authors.forename: Jean-Louis
authors.initials: JL
authors.lastname: Pépin
mesh_terms: D002675:Child, Preschool; D005260:Female; D006801:Humans; D008297:Male; D008334:Mandible / Q000503:physiopathology*; D017286:Polysomnography; D015203:Reproducibility of Results; D012119:Respiration; D020181:Sleep Apnea, Obstructive / Q000503:physiopathology*
keywords: mandibular movements; pediatric obstructive sleep apnea; pulse transit time; respiratory effort