title: Mandibular position and movements: Suitability for diagnosis of sleep apnoea.
abstract: Mandibular movements (MMs) and position during sleep reflect respiratory efforts related to increases in upper airway resistance and micro-arousals. The study objective was to assess whether MM identifies sleep-disordered breathing (SDB) in patients with moderate to high pre-test probability.
  
  
  
  This was a prospective study of 87 consecutive patients referred for an in-laboratory sleep test. Magnetometer-derived MM signals were incorporated into standard polysomnography (PSG). Respiratory events detected with MM analysis were compared with PSG for respiratory disturbance index (RDI) with a blinded scoring. All records were scored manually according to American Academy of Sleep Medicine rules. Primary outcome was to rule-in obstructive sleep apnoea syndrome (OSAS) defined as RDI cut-off value ≥5 or 15/h total sleep time (TST).
  
  
  
  High concordance emerged between MM and PSG-derived RDI with high temporal coincidence between events (R2= 0.906; P < 0.001). The mean diagnostic accuracy of MM for OSAS using RDI MM cut-off values of 5.9 and 13.5 was 0.935 (0.86-0.97) and 0.913 (0.84-0.95), with a mean positive likelihood ratio (LLR+) of 3.73 (2.7-20.4) and 8.46 (2.3-31.5), respectively. Receiver operating characteristic (ROC) curves at PSG cut-off values of 5 and 15/h TST had areas under the curve (AUC) of 0.96 (95% CI: 0.89-0.99) and 0.97 (95% CI: 0.91-0.99) (P < 0.001), respectively. MM analysis accurately identified SDB at different levels of severity.
  
  
  
  RDI assessed by MM is highly concordant with PSG, suggesting a role of ambulatory MM recordings to screen for SDB in patients with moderate to high pre-test probability.
authors.affiliation: Laboratory of Sleep Medicine, CHU UCL Namur, Namur, Belgium.
authors.forename: Jean-Benoit
authors.initials: JB
authors.lastname: Martinot
authors.affiliation: 'AGIR à dom' Association, La Tronche, Grenoble, France.|University Grenoble Alpes, Grenoble, France.
authors.forename: Jean-Christian
authors.initials: JC
authors.lastname: Borel
authors.affiliation: Laboratory of Sleep Medicine, CHU UCL Namur, Namur, Belgium.
authors.forename: Valérie
authors.initials: V
authors.lastname: Cuthbert
authors.affiliation: Laboratory of Physiology, Bordeaux University, Bordeaux, France.
authors.forename: Hervé Jean-Pierre
authors.initials: HJ
authors.lastname: Guénard
authors.affiliation: Laboratory of Sleep Medicine, CHU UCL Namur, Namur, Belgium.
authors.forename: Stéphane
authors.initials: S
authors.lastname: Denison
authors.affiliation: Department of Physiology, Temple University, Philadelphia, Pennsylvania, USA.
authors.forename: Philip E
authors.initials: PE
authors.lastname: Silkoff
authors.affiliation: Department of Medicine, University of Chicago, Chicago, Illinois, USA.
authors.forename: David
authors.initials: D
authors.lastname: Gozal
authors.affiliation: University Grenoble Alpes, Grenoble, France.|Sleep and Exercise Laboratory, Thorax and Vessels Division, Grenoble Alpes University Hospital, Grenoble, France.
authors.forename: Jean-Louis
authors.initials: JL
authors.lastname: Pepin
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D019540:Area Under Curve; D005260:Female; D006801:Humans; D060306:Magnetometry; D008297:Male; D008334:Mandible / Q000503:physiopathology*; D008875:Middle Aged; D018670:Monitoring, Ambulatory; D009068:Movement; D017286:Polysomnography; D011446:Prospective Studies; D012372:ROC Curve; D012720:Severity of Illness Index; D012890:Sleep / Q000502:physiology; D020181:Sleep Apnea, Obstructive / Q000175:diagnosis* / Q000503:physiopathology*; D055815:Young Adult
keywords: obstructive sleep apnoea syndrome; portable monitor device; respiratory effort; sleep mandibular movements