PreprintArticleVersion 2Preserved in Portico This version is not peer-reviewed
Diagnostic Accuracy of a Portable Electromyography and Electrocardiography Device to Measure Sleep Bruxism in a Sleep Apnea Population: A Comparative Study
Version 1
: Received: 30 June 2023 / Approved: 3 July 2023 / Online: 4 July 2023 (08:05:40 CEST)
Version 2
: Received: 12 September 2023 / Approved: 12 September 2023 / Online: 13 September 2023 (10:20:40 CEST)
Version 3
: Received: 12 November 2023 / Approved: 13 November 2023 / Online: 14 November 2023 (07:55:30 CET)
Cid-Verdejo, R.; Domínguez Gordillo, A.A.; Sánchez-Romero, E.A.; Ardizone García, I.; Martínez Orozco, F.J. Diagnostic Accuracy of a Portable Electromyography and Electrocardiography Device to Measure Sleep Bruxism in a Sleep Apnea Population: A Comparative Study. Clocks & Sleep 2023, 5, 717-733. https://doi.org/10.3390/clockssleep5040047
Cid-Verdejo, R.; Domínguez Gordillo, A.A.; Sánchez-Romero, E.A.; Ardizone García, I.; Martínez Orozco, F.J. Diagnostic Accuracy of a Portable Electromyography and Electrocardiography Device to Measure Sleep Bruxism in a Sleep Apnea Population: A Comparative Study. Clocks & Sleep 2023, 5, 717-733. https://doi.org/10.3390/clockssleep5040047
Cid-Verdejo, R.; Domínguez Gordillo, A.A.; Sánchez-Romero, E.A.; Ardizone García, I.; Martínez Orozco, F.J. Diagnostic Accuracy of a Portable Electromyography and Electrocardiography Device to Measure Sleep Bruxism in a Sleep Apnea Population: A Comparative Study. Clocks & Sleep 2023, 5, 717-733. https://doi.org/10.3390/clockssleep5040047
Cid-Verdejo, R.; Domínguez Gordillo, A.A.; Sánchez-Romero, E.A.; Ardizone García, I.; Martínez Orozco, F.J. Diagnostic Accuracy of a Portable Electromyography and Electrocardiography Device to Measure Sleep Bruxism in a Sleep Apnea Population: A Comparative Study. Clocks & Sleep 2023, 5, 717-733. https://doi.org/10.3390/clockssleep5040047
Abstract
Background: The gold standard for the diagnosis of sleep bruxism (SB) and obstructive sleep apnea (OSA) is Polysmnography (PSG). At the end of the apnea episodes there is frequently a final hy-permotor muscle activity that could act as a confusion factor in the diagnosis of SB with the elec-tromyography portable devices. The aim of this study was to compare the concordance on the number of episodes of SB in a population with OSA, between the diagnosis obtained by PSG, an-alyzed manually by a neurophysiologist and that obtained manually and automatically by a portable electromyography (EMG) and electrocardiography (EKG) device. Methods: Twenty-three subjects underwent one night of polysomnographic study with simulta-neous recording with the EMG-EKG device. The variables referring to the number of episodes and the SB index measured with both tools and analyzed in the manual and automatic modes were compared. Masticatory muscle activity was scored according to published criteria. The sample was segmented by severity of OSA according to AASM criteria. ANOVA, correlations, and the Bland–Altman plot were used to quantify the agreement between both methods. The concordance was calculated through the ICC. Results: The total events of SB per night in the PSG study were on average (8.17), lower than the one obtained with EMG-EKG manual analysis (14.13) and automatic (29.26). Both the SB PSG and Manual EMG-EKG episodes decrease from non-OSA (PSG = 16 ± 13,55, EMG-EKG = 16,83 ±11,58) to severe OSA (PSG = 3,14 ± 4,26, EMG-EKG = 9,86 ± 8,09). However, in the case of automatic EMG-EKG mode: the number of SB episodes in severe OSA doubled (41,23 ± 12,50) with respect to non OSA (24,50 ± 12,19). On average: the EMG-EKG device Automatic analysis measures 21.08 units more than PSG. The results with the manual EMG-EKG analysis improved. Conclusion: There is no concordance between the results obtained in the PSG neurophysiologic analysis and those obtained by means of the EMG-EKG device automatic and manual analysis for the diagnosis of SB in a population mostly with OSA. The OSA could act as a confusion factor in the diagnosis of SB with the electromyography portable devices, but further study is needed.
Keywords
bruxism; electromyography; sleep apnea; polysomnography; sleep bruxism; sleep wake disorders
Subject
Medicine and Pharmacology, Clinical Medicine
Copyright:
This is an open access article distributed under the Creative Commons Attribution License which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Received:
13 September 2023
Commenter:
Eleuterio A. Sánchez Romero
Commenter's Conflict of Interests:
Author
Comment: The revision process has made the manuscript clearer. It should be clarified that a professional statistician was involved in this correction, in accordance with the advice we received in the review. As can be seen in the statistical analysis chapter, there are some changes and clarifications that we hope will make our study easier to understand, but the most important change recommended by the statistician has been the elimination in the study of an atypical case from the sample, which distorted our results. We have managed to identify the subject and have discovered technical errors in the data transcription. Once this atypical case was eliminated, we have updated the statistical analysis with a sample of 22 participants instead of 23 and we have obtained similar results in relation to the hypothesis and the conclusions but with more homogeneous data and normalized statistical analysis.
Commenter: Eleuterio A. Sánchez Romero
Commenter's Conflict of Interests: Author
It should be clarified that a professional statistician was involved in this correction, in accordance with the advice we received in the review. As can be seen in the statistical analysis chapter, there are some changes and clarifications that we hope will make our study easier to understand, but the most important change recommended by the statistician has been the elimination in the study of an atypical case from the sample, which distorted our results. We have managed to identify the subject and have discovered technical errors in the data transcription. Once this atypical case was eliminated, we have updated the statistical analysis with a sample of 22 participants instead of 23 and we have obtained similar results in relation to the hypothesis and the conclusions but with more homogeneous data and normalized statistical analysis.