Clinical validation of a mandibular movement signal based system for the diagnosis of pediatric sleep apnea.

BACKGROUND: Given the high prevalence and risk for outcomes associated with pediatric obstructive sleep apnea (OSA), there is a need for simplified diagnostic approaches. A prospective study in 140 children undergoing in-laboratory polysomnography (PSG) evaluates the accuracy of a recently developed system (Sunrise) to estimate respiratory efforts by monitoring sleep mandibular movements (MM) for the diagnosis of OSA (Sunrise™). METHODS: Diagnosis and severity were defined by an obstructive apnea/hypopnea index (OAHI) ≥ 1 (mild), ≥ 5 (moderate), and ≥ 10 events/h (severe). Agreement between PSG and Sunrise™ was assessed by Bland-Altman method comparing respiratory disturbances hourly index (RDI) (obstructive apneas, hypopneas, and respiratory effort-related arousals) during PSG (PSG_RDI), and Sunrise RDI (Sr_RDI). Performance of Sr_RDI was determined via ROC curves evaluating the device sensitivity and specificity at PSG_OAHI ≥ 1, 5, and 15 events/h. RESULTS: A median difference of 1.57 events/h, 95% confidence interval: -2.49 to 8.11 was found between Sr_RDI and PSG_RDI. Areas under the ROC curves of Sr_RDI were 0.75 (interquartile range [IQR]: 0.72-0.78), 0.90 (IQR: 0.86-0.92) and 0.95 (IQR: 0.90-0.99) for detecting children with PSG_OAHI ≥ 1, PSG_OAHI ≥ 5, or PSG_ OAHI ≥ 10, respectively. CONCLUSION: MM automated analysis shows significant promise to diagnose moderate-to-severe pediatric OSA.

Assessment of Mandibular Movement Monitoring With Machine Learning Analysis for the Diagnosis of Obstructive Sleep Apnea.

Importance: Given the high prevalence of obstructive sleep apnea (OSA), there is a need for simpler and automated diagnostic approaches. Objective: To evaluate whether mandibular movement (MM) monitoring during sleep coupled with an automated analysis by machine learning is appropriate for OSA diagnosis. Design, Setting, and Participants: Diagnostic study of adults undergoing overnight in-laboratory polysomnography (PSG) as the reference method compared with simultaneous MM monitoring at a sleep clinic in an academic institution (Sleep Laboratory, Centre Hospitalier Universitaire Université Catholique de Louvain Namur Site Sainte-Elisabeth, Namur, Belgium). Patients with suspected OSA were enrolled from July 5, 2017, to October 31, 2018. Main Outcomes and Measures: Obstructive sleep apnea diagnosis required either evoking signs or symptoms or related medical or psychiatric comorbidities coupled with a PSG-derived respiratory disturbance index (PSG-RDI) of at least 5 events/h. A PSG-RDI of at least 15 events/h satisfied the diagnosis criteria even in the absence of associated symptoms or comorbidities. Patients who did not meet these criteria were classified as not having OSA. Agreement analysis and diagnostic performance were assessed by Bland-Altman plot comparing PSG-RDI and the Sunrise system RDI (Sr-RDI) with diagnosis threshold optimization via receiver operating characteristic curves, allowing for evaluation of the device sensitivity and specificity in detecting OSA at 5 events/h and 15 events/h. Results: Among 376 consecutive adults with suspected OSA, the mean (SD) age was 49.7 (13.2) years, the mean (SD) body mass index was 31.0 (7.1), and 207 (55.1%) were men. Reliable agreement was found between PSG-RDI and Sr-RDI in patients without OSA (n = 46; mean difference, 1.31; 95% CI, -1.05 to 3.66 events/h) and in patients with OSA with a PSG-RDI of at least 5 events/h with symptoms (n = 107; mean difference, -0.69; 95% CI, -3.77 to 2.38 events/h). An Sr-RDI underestimation of -11.74 (95% CI, -20.83 to -2.67) events/h in patients with OSA with a PSG-RDI of at least 15 events/h was detected and corrected by optimization of the Sunrise system diagnostic threshold. The Sr-RDI showed diagnostic capability, with areas under the receiver operating characteristic curve of 0.95 (95% CI, 0.92-0.96) and 0.93 (95% CI, 0.90-0.93) for corresponding PSG-RDIs of 5 events/h and 15 events/h, respectively. At the 2 optimal cutoffs of 7.63 events/h and 12.65 events/h, Sr-RDI had accuracy of 0.92 (95% CI, 0.90-0.94) and 0.88 (95% CI, 0.86-0.90) as well as posttest probabilities of 0.99 (95% CI, 0.99-0.99) and 0.89 (95% CI, 0.88-0.91) at PSG-RDIs of at least 5 events/h and at least 15 events/h, respectively, corresponding to positive likelihood ratios of 14.86 (95% CI, 9.86-30.12) and 5.63 (95% CI, 4.92-7.27), respectively. Conclusions and Relevance: Automatic analysis of MM patterns provided reliable performance in RDI calculation. The use of this index in OSA diagnosis appears to be promising.

Time course of overt attentional shifts in mental arithmetic: Evidence from gaze metrics.

Processing numbers induces shifts of spatial attention in probe detection tasks, with small numbers orienting attention to the left and large numbers to the right side of space. This has been interpreted as supporting the concept of a mental number line with number magnitudes ranging from left to right, from small to large numbers. Recently, the investigation of this spatial-numerical link has been extended to mental arithmetic with the hypothesis that solving addition or subtraction problems might induce attentional displacements, rightward or leftward, respectively. At the neurofunctional level, the activations elicited by the solving of additions have been shown to resemble those induced by rightward eye movements. However, the possible behavioural counterpart of these activations has not yet been observed. Here, we investigated overt attentional shifts with a target detection task primed by addition and subtraction problems (2-digit ± 1-digit operands) in participants whose gaze orientation was recorded during the presentation of the problems and while calculating. No evidence of early overt attentional shifts was observed while participants were hearing the first operand, the operator or the second operand, but they shifted their gaze towards the right during the solving step of addition problems. These results show that gaze shifts related to arithmetic problem solving are elicited during the solving procedure and suggest that their functional role is to access, from the first operand, the representation of the result.

Seeing it both ways: Using a double-cuing task to investigate the role of spatial cuing in Level-1 visual perspective-taking.

Previous research using the dot-perspective task has produced evidence that humans may be equipped with a mechanism that spontaneously tracks others' gaze direction and thereby acquires information about what they can see. Other findings, however, support the alternative hypothesis that a spatial-cuing mechanism underpins the effect observed in the dot-perspective task. To adjudicate between these hypotheses, we developed a double-cuing version of Posner's (1980) spatial-cuing paradigm to be implemented in the dot-perspective task, and conducted 3 experiments in which we manipulated stimulus-onset asynchrony, as well as secondary task demands. Crucially, the 2 conflicting hypotheses generated divergent patterns of predictions across these experimental conditions. Our results support the hypothesis of an automatic perspective-taking mechanism. (PsycINFO Database Record

Different but complementary roles of action and gaze in action observation priming: Insights from eye- and motion-tracking measures.

Action priming following action observation is thought to be caused by the observed action kinematics being represented in the same brain areas as those used for action execution. But, action priming can also be explained by shared goal representations, with compatibility between observation of the agent's gaze and the intended action of the observer. To assess the contribution of action kinematics and eye-gaze cues in the prediction of an agent's action goal and action priming, participants observed actions where the availability of both cues was manipulated. Action observation was followed by action execution, and the congruency between the target of the agent's and observer's actions, and the congruency between the observed and executed action spatial location were manipulated. Eye movements were recorded during the observation phase, and the action priming was assessed using motion analysis. The results showed that the observation of gaze information influenced the observer's prediction speed to attend to the target, and that observation of action kinematic information influenced the accuracy of these predictions. Motion analysis results showed that observed action cues alone primed both spatial incongruent and object congruent actions, consistent with the idea that the prime effect was driven by similarity between goals and kinematics. The observation of action and eye-gaze cues together induced a prime effect complementarily sensitive to object and spatial congruency. While observation of the agent's action kinematics triggered an object-centered and kinematic-centered action representation, independently, the complementary observation of eye-gaze triggered a more fine-grained representation illustrating a specification of action kinematics toward the selected goal. Even though both cues differentially contributed to action priming, their complementary integration led to a more refined pattern of action priming.

Early attentional modulation by alcohol-related cues in young binge drinkers: an event-related potentials study.

OBJECTIVE: Episodic excessive alcohol consumption (i.e., binge drinking) is now considered to be a major concern in our society. Previous studies have shown that alcohol cues can capture attentional resources in chronic alcoholic populations and that the phenomenon is associated with the development and maintenance of alcoholism. Using event-related potentials (ERPs), we investigated the responses of binge drinkers to alcohol-related pictures. METHODS: Two groups of college students (n=18 in each group) were recruited for the study. One group was composed of binge drinkers and the other of controls. Each student completed a simple visual oddball paradigm in which alcohol-related and non-alcohol-related pictures (positive, neutral or negative) were presented. ERPs were recorded to explore the electrophysiological activity associated with the processing of each cue during the different cognitive steps. RESULTS: Although there were no behavioural differences between the two groups after detection of alcohol- and non-alcohol-related cues, the ERP data indicated that processing of alcohol-related stimuli was modulated by binge drinking: in the binge drinkers, the P100 amplitudes elicited by the alcohol-related pictures were significantly larger than those elicited by the non-alcohol pictures. CONCLUSIONS: The present study provides evidence for an early processing enhancement, indexed by increased P100 amplitude, in binge drinkers when confronted with alcohol cues. SIGNIFICANCE: These findings suggest that higher reactivity to alcohol cues is not a phenomenon limited to adult alcoholics, but that young binge drinkers exhibit signs of prioritizing processing related to alcohol. Prevention intervention for alcohol misuse in young people should consider approaches that address this automatic cue reactivity.