Synchronized mandibular movement and capnography: a novel approach to obstructive airway detection during procedural sedation—a post hoc analysis of a prospective study

Abstract

Perioperative complications related to obstructive sleep apnea still occur despite the use of partial pressure end-tidal CO2\(\left( {{{\text{P}}_{{\text{ETC}}{{\text{O}}_2}}}} \right)\) and pulse oximetry. Airway obstruction can complicate propofol sedation and a novel monitor combining mandibular movement analysis with capnography may facilitate its detection. Patients scheduled for sleep endoscopy were recruited and monitored with standard monitoring, \({{\text{P}}_{{\text{ETC}}{{\text{O}}_2}}},\) and Jaw Activity (JAWAC) mandibular movement sensors. A post hoc analysis investigated airway obstruction prediction using a Respiratory Effort Sequential Detection Algorithm (RESDA) based on \({{\text{P}}_{{\text{ETC}}{{\text{O}}_2}}}\) and mandibular movement signals. 21 patients were recruited and 54 episodes of airway obstruction occurred. RESDA detected obstructive apnea [mean ± SD (median)] 29 ± 29 (21) s, p < 0.0001, before \({{\text{P}}_{{\text{ETC}}{{\text{O}}_2}}}\) alone. This prolonged the time between obstructive apnea detection and decrease to 90% oxygen saturation 64 ± 38 (54) versus 38 ± 20 (35) s, p < 0.0001. It predicted airway obstruction with a sensitivity and specificity of 81% and 93%, respectively. The RESDA algorithm, which is based on the combination of capnography with mandibular movement assessment of respiratory effort, can more rapidly alarm anesthetists of airway obstruction during propofol sedation than \({{\text{P}}_{{\text{ETC}}{{\text{O}}_2}}}\) alone. However, \({{\text{P}}_{{\text{ETC}}{{\text{O}}_2}}},\) pulse oximetry, and clinical monitoring are still required.

Trial Registry numbers: ClinicalTrial.gov (NCT02909309) https://clinicaltrials.gov/ct2/show/NCT02909309.

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Acknowledgements

The authors would like to thank Vincent Jame for his help, the medical teams of the Erasme Hospital for providing the highest possible quality of care to all patients, and Nomics for providing the monitor and developing the software for this study.

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NP: study design, patient recruitment, acquisition of data, data analysis, initial draft writing and approval of manuscript. SC: data analysis, interpretation of data, initial draft, and approval of manuscript. EE: data analysis, interpretation of data, critical revision of draft and approval of manuscript. TT: study design, critical revision of draft, and approval of manuscript. LVO: study design, critical revision of draft, and approval of manuscript. LB: study design, critical revision of draft, and approval of manuscript. All authors agree to be accountable for all aspects of their work and ensure that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

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Correspondence to Sean Coeckelenbergh.

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Ponthieu, N., Coeckelenbergh, S., Engelman, E. et al. Synchronized mandibular movement and capnography: a novel approach to obstructive airway detection during procedural sedation—a post hoc analysis of a prospective study. J Clin Monit Comput 33, 1065–1070 (2019). https://doi.org/10.1007/s10877-018-00250-3

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Keywords

  • Perioperative medicine
  • Monitoring
  • Postoperative complications
  • Respiratory insufficiency
  • Obstructive sleep apnea syndrome
  • Anesthesia