Is it possible to differentiate between an obstructive and central event?
Mandibular movements are directly correlated with respiratory effort. It is the reduction or complete pause (for central events) or increase (for obstructive events) of respiratory effort that shows the difference between obstructive and central apnea events. Therefore, it is possible to make a differentiation based on mandibular movements. The central events produce movements visible on the Sunrise raw signal report. An automatic detection and analysis of central events will be implemented into the report by the end of 2021.
Is it possible to differentiate between an apnea and a hyponea?
It is possible to differentiate apnea from hypopnea on the raw signal report. The amplitude of the mandibular movement changes proportionally to diaphragmatic EMG activity (and esophageal pressure - publication to come) and accurately identifies variations of respiratory effort during normal sleep and SDB (Martinot et al, Frontiers in Neurology, 2017).
Consequently, an obstructive apnea event creates a bigger amplitude of mandibular movement than an obstructive hypopnea.
Is the accuracy of the device affected by the presence of mouth breathing?
The Sunrise sensor detects mandibular movements very precisely, regardless of how open the mouth is, as shown by the gyroscope. Mandibular movements are detected even during a greater magnitude of mouth opening, despite their amplitude being reduced. There is no reduction of accuracy with opening of the mouth.
Is it possible that change in possition can affect the Sunrise test measurements?
Mandibular movements have been measured with the algorithm trained and validated on a large number of patients while sleeping in all possible positions. Mandibular movement (generated by the activation of muscles of the upper airway) is preserved no matter the head or body position. This happens physiologically and is important for preservation of respiration during sleep by ensuring stability of the upper airways.
What is the added value of Artificial Intelligence?
A computer is able to analyse events that an experiencesd lab. technician scorer would need years to learn.
The advantage is that such analysis becomes free of the human factor and is very sensitive. It permits to detect small variations in terms of signal frequency and amplitude.
This automatic analysis acts as a decision tool for the clinician who is able to review the analysis by themselves and access the raw data.
What happens if the patient has a beard?
Extra adhesive is provided for better fixation on a stable/ few day beard.
For beards that are very thick, the patient is advised to shave.
Can this be scored manually?
It is possible to export the raw data in an .edf format to manually score the signal in an .edf viewer of your choice.
Is Sunrise able to measure snoring?
For now, there is no microphone for snoring detection. However, the presence of respiratory effort provides information about snoring. This measurement can indeed be an indicator of snoring when it is not associated with respiratory disturbance.
Is Mandibular Movement affected by the presence of a TMJ condition?
The movements remain even in the presence of a pathology of the temporomandibular joint cartilage and often it is the chewing movements (not breathing) that are painful, especially when they are extreme. These often occur during the state of wakefulness and not sleep. Respiratory movements are only affected in advanced ankylosis of the joint which is very rare.
In practice there is no interference with TMJ pathologies.
What does the measurement of Respiratory effort mean?
Respiratory effort is the percentage of sleep time experiencing breathing difficulties to a level that it can lead to daytime sleepiness. When respiratory effort is not associated with breathing disturbances it can be an indicator of snoring.
The presence of a % of respiratory effort during the night is an important new parameter for certain clinical situations such as upper airway resistance syndrome. In such cases, there is a weak AHI but a significant respiratory effort during the night, especially during the 3 and 4 stages of sleep.
It is also interesting when in children where AHI is low for most of them, there is an increased respiratory effort regardless of the sleep stage.
For how long can the therapist access to the results?
The therapist has access to view the report for as long as the patient links their account to that of the doctor and/or keeps their data with Sunrise.
Is Sunrise reimbursed?
We are currently in discussion for reimbursement with health authorities in different countries.
What is the required minimum sleeping time for the test?
4 hours of total sleep time is the requirement. In any case, the results are always accessible to the doctor. However, for under 4 hours, a message is displayed specifying that the duration of sleeping time might be insufficient. We apply the same standard as for the PSG.
Can Sunrise be used for titration of Mandibular Advancement Devices?
Sunrise allows the advantage of repeating tests for patients in different clinical situations. It is therefore possible to use Sunrise for a patient with a mandibular advancement appliance and use the residual AHI measurement for adjusting the device. For more information, see the publication: Les mouvements de la mandibule informent sur l’effet thérapeutique de l’orthèse d’avancée mandibulaire dans Vaisseaux, Coeur, Poumons, Vol 24, N°2 I 2019 by Martinot et al.