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J Clin Sleep Med. 2018 May 15;14(5):725-733. doi: 10.5664/jcsm.7092.

Use of Chest Wall EMG to Classify Hypopneas as Obstructive or Central.

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Division of Pulmonary, Critical Care, and Sleep Medicine, University of Florida, Gainesville, Florida.
Department of Pediatrics, University of Florida, Gainesville, Florida.



To compare classification of hypopneas as obstructive or central based on an effort signal derived from surface chest wall electromyography (CW-EMG-EF) coupled with airflow amplitude versus classification using The AASM Manual for the Scoring of Sleep and Associated Events: Rules, Terminology and Technical Specifications (AASM Scoring Manual) criteria; and to characterize hypopneas classified as obstructive versus central using a resistance surrogate.


CW-EMG was recorded in the eighth intercostal space at the right midaxillary line. Five hypopneas were randomly selected from 65 consecutive adult clinical positive airway pressure titration studies meeting study criteria. A blinded scorer classified the hypopneas based on two groups of signals: Group 1: positive airway pressure flow (PAP flow), chest and abdominal effort, and snoring; or Group 2: smoothed PAP flow (for blinding amplitude but not flattening visible) and effort (CW-EMG-EF). A resistance surrogate (CW-EMG-EF / PAP flow) normalized to a pre-event breath was compared between obstructive and central hypopneas classified by AASM Scoring Manual criteria.


The percentage agreement (Group 1 versus Group 2) was 92% and the kappa was 0.75 (95% confidence interval 0.65 to 0.85). The resistance surrogate was significantly higher in obstructive hypopneas versus central hypopneas during the first and second half of hypopneas. The resistance surrogate (mean ± standard deviation) for the second half of hypopnea was obstructive: 7.59 ± 7.24 versus central: 1.27 ± 0.56, P < .001). The resistance surrogate increased from the first to second half of hypopnea only for obstructive hypopneas.


CW-EMG provides a useful complementary signal for hypopnea classification and a resistance surrogate based on CW-EMG is much higher in hypopneas classified as obstructive by AASM Scoring Manual criteria.


EMG; diaphragmatic EMG; hypopnea; respiratory effort

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