Mouth puffing phenomena of patients with obstructive sleep apnea when mouth-taped: device's efficacy confirmed with physical video observation

Je-Yang Jau; Terry B J Kuo; Lieber P H Li; Tien-Yu Chen; Chun-Ting Lai; Pin-Hsuan Huang; Cheryl C H Yang

doi:10.1007/s11325-022-02588-0

Mouth puffing phenomena of patients with obstructive sleep apnea when mouth-taped: device's efficacy confirmed with physical video observation

Sleep Breath. 2023 Mar;27(1):153-164. doi: 10.1007/s11325-022-02588-0. Epub 2022 Mar 11.

Authors

Je-Yang Jau¹, Terry B J Kuo^{1

2

3}, Lieber P H Li^{4

5

6

7}, Tien-Yu Chen^{1

8}, Chun-Ting Lai^{1

2}, Pin-Hsuan Huang⁹, Cheryl C H Yang^{10

11

12

13}

Affiliations

¹ Faculty of Medicine, and Institute of Brain Science, National Yang-Ming Chiao-Tung University, No. 155, Sec. 2, Li-Nong St., Beitou, Taipei, 11221, Taiwan.
² Sleep Research Center, National Yang Ming Chiao Tung University, Taipei, Taiwan.
³ Clinical Research Center, Taoyuan Psychiatric Center, Ministry of Health and Welfare, Taoyuan, Taiwan.
⁴ Faculty of Medicine, and Institute of Brain Science, National Yang-Ming Chiao-Tung University, No. 155, Sec. 2, Li-Nong St., Beitou, Taipei, 11221, Taiwan. lieber.chgh@gmail.com.
⁵ Department of Otolaryngology, Cheng Hsin General Hospital, No. 45, Cheng Hsin St., Beitou, Taipei, 11221, Taiwan. lieber.chgh@gmail.com.
⁶ Department of Medical Research, China Medical University Hospital, China Medical University, Taichung, Taiwan. lieber.chgh@gmail.com.
⁷ Department of Speech Language Pathology and Audiology, College of Health Technology, National Taipei University of Nursing and Health Sciences, Taipei, Taiwan. lieber.chgh@gmail.com.
⁸ Department of Psychiatry, Tri-Service General Hospital, School of Medicine, National Defense Medical Center, Taipei, Taiwan.
⁹ Department of Health Promotion and Health Education, National Taiwan Normal University, Taipei, Taiwan.
¹⁰ Faculty of Medicine, and Institute of Brain Science, National Yang-Ming Chiao-Tung University, No. 155, Sec. 2, Li-Nong St., Beitou, Taipei, 11221, Taiwan. cchyang@ym.edu.tw.
¹¹ Sleep Research Center, National Yang Ming Chiao Tung University, Taipei, Taiwan. cchyang@ym.edu.tw.
¹² Department of Education and Research, Taipei City Hospital, Taipei, Taiwan. cchyang@ym.edu.tw.
¹³ Brain Research Center, National Yang Ming Chiao Tung University, Taipei, Taiwan. cchyang@ym.edu.tw.

Abstract

Purpose: This study aimed to design a device to monitor mouth puffing phenomena of patients with obstructive sleep apnea when mouth-taped and to employ video recording and computing algorithms to double-check and verify the efficacy of the device.

Methods: A mouth puffing detector (MPD) was developed, and a video camera was set to record the patients' mouth puffing phenomena in order to make ensure the data obtained from the device was appropriate and valid. Ten patients were recruited and had polysomnography. A program written in Python was used to investigate the efficacy of the program's algorithms and the relationship between variables in polysomnography (sleep stage, apnea-hypopnea index or AHI, oxygen-related variables) and mouth puffing signals (MPSs). The video recording was used to validate the program. Bland-Altman plot, correlations, independent sample t-test, and ANOVA were analyzed by SPSS 24.0.

Results: Patients were found to mouth puff when they sleep with their mouths taped. An MPD was able to detect the signals of mouth puffing. Mouth puffing signals were noted and categorized into four types of MPSs by our algorithms. MPSs were found to be significantly related to relative OSA indices. When all participants' data were divided into minutes, intermittent mouth puffing (IMP) was found to be significantly different from non-mouth puffing in AHI, oxygen desaturation index (ODI), and time of oxygen saturation under 90% (T90) (AHI: 0.75 vs. 0.31; ODI: 0.75 vs. 0.30; T90: 5.52 vs. 1.25; p < 0.001). Participants with severe OSA showed a higher IMP percentage compared to participants with mild to moderate OSA and the control group (severe: 38%, mild-to-moderate: 65%, control: 95%; p < 0.001).

Conclusions: This study established a simple way to detect mouth puffing phenomena when patients were mouth-taped during sleep, and the signals were classified into four types of MPSs. We propose that MPSs obtained from patients wearing the MPD can be used as a complement for clinicians to evaluate OSA.

Keywords: Breathing monitoring; Mouth breathing; Mouth puffing; OSA; Sleep disorder breathing.

MeSH terms

Algorithms
Humans
Oxygen
Physical Examination
Sleep
Sleep Apnea, Obstructive* / diagnosis

Substances

Oxygen

Abstract

MeSH terms

Substances

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