Analysis of mandibular jaw movements to assess ventilatory support management of children with obstructive sleep apnea syndrome treated with positive airway pressure therapies.

BACKGROUND: The polysomnography (PSG) is the gold-standard for obstructive sleep apnea (OSA) syndrome diagnosis and assessment under positive airway pressure (PAP) therapies in children. Recently, an innovative digital medicine solution, including a mandibular jaw movement (MJM) sensor coupled with automated analysis, has been validated as an alternative to PSG for pediatric application. OBJECTIVE: This study aimed to assess the reliability of MJM automated analysis for the assessment of residual apnea/hypopnea events during sleep in children with OSA treated with noninvasive ventilation (NIV) or continuous PAP (CPAP). METHODS: In this open-label prospective non-randomized multicentric trial, we included children aged from 5 to 18 years with a diagnosis of severe OSA. The children underwent in-laboratory PSG with simultaneous MJM monitoring and at-home recording with MJM monitoring 3 months later. Agreement between PSG and MJM analysis in measuring the residual apnea-hypopnea index (AHI) was evaluated by the Bland-Altman method. The treatment effect on residual AHI was estimated for both PSG and MJM analysis. RESULTS: Fifteen (60% males) children were included with a median age of 12 years [interquartile range 8-15]. Two (17%) were ventilated with NIV and 13 (83%) with CPAP. There was a good agreement between MJM-AHI and PSG-AHI with a median bias of -0.25 (95% CI: -3.40 to +2.04) events/h. The reduction in AHI under treatment was consistently significant across the three measurement methods: in-laboratory PSG and MJM recordings in the laboratory and at home. CONCLUSION: Automated analysis of MJM is a highly reliable alternative method to assess residual events in a small population treated with PAP therapies.

Mandibular Jaw Movement and Masticatory Muscle Activity during Dynamic Trunk Exercise.

The examination of jaw movement during exercise is essential for an improved understanding of jaw function. Currently, there is no unified view of the mechanism by which the mandible is fixed during physical exercise. We hypothesized that during strong skeletal muscle force exertion in dynamic exercises, the mandible is displaced to a position other than the maximal intercuspal position and that mouth-opening and mouth-closing muscles simultaneously contract to fix the displaced mandible. Therefore, we simultaneously recorded mandibular jaw movements and masticatory muscle activities during dynamic trunk muscle force exertion (deadlift exercise) in 24 healthy adult males (age, 27.3 ± 2.58 years). The deadlift was divided into three steps: Ready (reference), Pull, and Down. During Pull, the mandibular incisal point moved significantly posteriorly (-0.24 mm, p = 0.023) and inferiorly (-0.55 mm, p = 0.019) from the maximal intercuspal position. Additionally, temporal, masseter, and digastric muscles were activated simultaneously and significantly during Pull (18.63 ± 17.13%, 21.21 ± 18.73%, 21.82 ± 19.97% of the maximum voluntary contraction, respectively), with maintained activities during Down (p < 0.001). Thus, during dynamic trunk muscle force exertion, the mandibular incisal point moved to a posteroinferior position without tooth-touch (an open-mouth position). Simultaneously, the activities of the mouth-opening digastric muscles and the mouth-closing temporal and masseter muscles led to mandibular fixation, which is a type of mandible fixing called bracing.

Markerless three-dimensional tracking of masticatory movement.

Conventional methods for measuring mandibular movement are expensive and require headgear and a marker attached to the mandibular incisors. These make assessment of normal chewing difficult. The aim of the present study was to test the validity of a markerless three-dimensional system for tracking masticatory movement by comparing it with a conventional method using an incisal marker. The study investigated 100 chewing cycles in 10 participants. The jaw tracking system consisted of a camera capable of recording depth and red, green, and blue data simultaneously, a laptop computer, and data analysis software. Depth data for each participant's face, tracked in real time, produced a computed 3D mask. The most prominent point of the soft tissue under the lip was defined as the chin point. A dental clasp cemented to the labial surface of the mandibular incisors was defined as the incisal point. The movement of these two measuring points was simultaneously recorded during mastication of chewing gum for 20s. To conduct the same analysis on each cycle from the two measuring points, all cycles were normalized by dividing by the corresponding vertical displacement because of their size variation. The findings showed excellent intramethod correlation for normalized horizontal displacement at every level (>0.9; except for 2 out of 19 levels; 0.896 and 0.898), and a lack of proportional bias. These findings suggest a correlation between the chewing cycles from two measuring points, the incisor and the chin, further suggesting the feasibility of a markerless system for tracking masticatory movement.