Multimodal transcutaneous auricular vagus nerve stimulation: An option in the treatment of sleep bruxism in a “polyvagal” context

Practice recommendations for the role of physiotherapy in the management of sleep disorders: the 2022 Brazilian Sleep Association Guidelines

“…Use of Pro-fono device + encouragement, education, stretching, muscle relaxation + home exercises 302 39 adults intervention vs. control 1-3 series of 15-20 repetitions of isometric contraction ↓Muscle activity of the masseter muscle activity of the buccinator (intercalated contraction) ↓Intensity of pain ↑Function Static stretching of masticatory muscle 303 24 adults (SB without pain) intervention vs. control 10 days ↑ROM mandibular ↑Threshold of pain at pressure ↑ # SB episodes/h of sleep Ineffective therapy to reduce SB in the absence of pain and dysfunction Electrotherapy TENS vs. occlusal splint 304 24 adults TENS: 45-60min. session every 2 days/15 sessions Occlusal splint: 45 days, 24h/day Therapies did not improve SB symptoms Auricular TENS in specific auricular areas associated with the vagus nerve 305 10 adults 4 sessions ↓SB tonic index (PSG) ↓Contraction time of SB episodes (PSG) ↑Vagal tone after each stimulation session (HRV) TENS (electrode in the masseter; F: 50Hz, τ: 0.5 msec, intensity: maximum tolerable by the patient) vs. Micro currents (electrode in the masseter; F: 0.5Hz, intensity: maximum tolerable by patient) 306…”