Interpreting the mandibular jaw movement signal in pediatric obstructive sleep apnea diagnosis: A technical and practical review.

Pediatric obstructive sleep apnea (OSA) is a common yet often underdiagnosed condition, partly due to limited access to polysomnography. Mandibular jaw movement (MJM) analysis offers a promising alternative to conventional home sleep apnea testing in children, capturing the dynamic interactions between respiratory drive and upper airway musculature, enabling accurate identification of, and critical insights into, sleep-disordered breathing events. This technical and practical review provides a structured framework for understanding and interpreting MJM signals during sleep in pediatric patients. It begins with the physiological basis and technical aspects of using a single-point contact device with integrated inertial sensors. It offers step-by-step instructions for interpreting MJM signals, from distinguishing sleep stages to identifying obstructive and central apneas, hypopneas, and respiratory effort-related arousals. The review is accompanied by an atlas of 30 annotated examples that illustrate key MJM signal patterns across scoring tasks. Key findings from several clinical studies on the utility of MJM analysis in pediatric OSA are also summarized. As the demand for accessible and accurate home-based diagnostic tools grows, MJM analysis stands out as an effective option for both the diagnosis and monitoring of pediatric OSA, with the potential to transform routine clinical practice and improve patient access to care.