Controlled clinical, polysomnographic and psychometric studies on differences between sleep bruxers and controls and acute effects of clonazepam as compared with placebo

Abstract

The pathogenesis, pathophysiology, and pharmacotherapy of sleep bruxism (SB) are still not fully understood. We investigated symptomatology, objective and subjective sleep and awakening quality of middle-aged bruxers compared with controls and acute effects of clonazepam 1 mg compared with placebo by polysomnography and psychometry. Twenty-one drug-free bruxers spent 3 nights in the sleep lab, 21 age- and sex-matched controls 2 nights. Clinically, bruxers exhibited deteriorated PSQI, SAS, SDS and IRLSSG measures, polysomnographically impaired sleep maintenance, increased movement time, stage shift index, periodic leg movements (PLM) and arousals and psychometrically deteriorated subjective sleep and awakening quality, evening/morning well-being, drive, mood, drowsiness, attention variability, memory, and fine motor activity. As compared with placebo, clonazepam significantly decreased the SB index in all patients (mean: -42 +/- 15%). Sleep efficiency, maintenance, latency, awakenings and nocturnal wake time, the stage shift index, S1, PLM, the arousal index, subjective sleep and awakening quality, and fine motor activity improved.

Management of sleep bruxism in adults: a qualitative systematic literature review

“…As for the results, it seems that all tested pharmacological approaches [i.e. botulinum toxin (two papers) , clonazepam (one paper) and clonidine (one paper) ] may reduce SB with respect to placebo. Botulinum toxin's effects are not surprising, and they are in line with the expected pharmacological properties of the drug.…”

“…Thus, fourteen papers were included in the review. Of them, twelve were RCTs and two were uncontrolled before–after studies .…”

“…Follow‐up assessments are provided for up to 12 weeks, thus not allowing to draw conclusions on the duration of those effects. The two placebo‐controlled crossover studies have an observation period limited to the three nights of the protocol regime and suggest that both the benzodiazepine clonazepam and the antihypertension drug clonidine may have SB‐reducing effects .…”

Overview on Sleep Bruxism for Sleep Medicine Clinicians

“…6 A placebo-controlled study found a 40% reduction of SB activity with a single dose of clonazepam (1 mg). 47 An acute dose (0.3 mg) of the alpha 2 -adrenergic agonist clonidine reduced SB by 60%. 48 What limits the use of clonidine in clinical practice is that severe morning hypotension may occur.…”

Bruxism and Current Treatment Approaches

“…Farmakolojik tedavi uyku bruksizminden iddetli olarak etkilenmi bireylerde yalnızca kısa dönemli bir tedavi olarak düünülebilir. Yakın zamanda plasebo kontrollü yapılmı bir çalımada klonezepam 1mg'lık dozunun bruksizmi %40 oranında azalttığı kanıtlanmıtır 89 .…”