Respiratory effort burden measured by mandibular jaw movements as a digital marker with clinical insights in obstructive sleep apnea

The clinical symptoms of obstructive sleep apnea (OSA) are poorly correlated with disease severity based on the apnea-hypopnea index (AHI). The cumulative duration of respiratory effort assessed by mandibular jaw movement monitoring with automated analysis (REMOV) may better capture the clinical burden of OSA. This cross-sectional study assessed the association between REMOV and patient-reported outcomes (PROs), including sleepiness, fatigue, and depression. One thousand adults referred for suspected OSA underwent polysomnography, REMOV analysis, and PRO assessment using validated questionnaires. Relationships between REMOV, AHI, and PROs were examined using principal component analysis and regression models. Median REMOV values align with OSA severity (6.5%, 23.4%, 28.8%, and 42.8% of total sleep time at AHI values of <5, 5–15, 15– < 30, and ≥30 events/h, respectively). REMOV is significantly associated with sleepiness, fatigue, and depression. These associations are most evident in patients with an AHI ≤ 15 events/h. AHI is not significantly associated with any PROs. These data suggest that REMOV may serve as a complementary metric in OSA, especially in patients with mild disease. Incorporating REMOV into OSA severity grading may improve the alignment between PROs and therapeutic decisions. Martinot et al. examine the relationship between the percentage of sleep time spent with increased respiratory effort (REMOV) and OSA symptoms. Findings reveal that REMOV is significantly associated with sleepiness, fatigue, and depression, particularly among patients with mild OSA. Obstructive sleep apnea (OSA) can cause excessive daytime sleepiness, fatigue, or depressed mood. However, these symptoms often do not align with the conventional apnea-hypopnea index (AHI), which measures the number of breathing interruptions per hour of sleep. This study tested a new metric called REMOV, which quantifies the percentage of sleep time spent with increased respiratory effort. We studied 1,000 adults referred for suspected OSA. Each participant underwent an overnight polysomnography with simultaneous REMOV measurement based on mandibular jaw movement analysis and completed questionnaires about their symptoms. We found that higher REMOV values were significantly associated with more severe symptoms, especially in patients with mild OSA. Our findings suggest that REMOV could complement the AHI in routine practice, supporting earlier treatment decisions, and thereby improving OSA management outcomes.