Abstract
BACKGROUND: 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. METHODS: 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. RESULTS: 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. CONCLUSIONS: 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.