On the Pharmacotherapy of Sleep Bruxism: Placebo-Controlled Polysomnographic and Psychometric Studies with Clonazepam

Abstract

Objectives: Sleep bruxism (SB) is a parasomnia defined as a stereotyped movement disorder characterized by grinding or clenching of the teeth during sleep. Pathophysiologically, SB is the result of biological and psychosocial influences. Treatment comprises behavioral, orthodontic and pharmacological interventions. While benzodiazepines and muscle relaxants have been reported by clinicians to reduce bruxism-related motor activity, placebo-controlled studies are lacking. Thus, the aim of the present study was to investigate the acute effects of clonazepam (Rivotril^®) as compared with placebo, utilizing polysomnography and psychometry. Method: Ten drug-free outpatients (6 females, 4 males), aged 46.5 ± 13.1 years, suffering from SB (ICD-10: F45.8; ICSD: 306.8) and having been treated by bite splints were included in the trial. Comorbidity was high: 7 patients presented nonorganic insomnia related to adjustment or anxiety disorders (5 patients) or depression (2 patients); all patients had a concomitant movement disorder (6 restless legs syndrome, 4 periodic leg movement disorder). After one adaptation night, patients received placebo and 1 mg clonazepam 1/2 hour before lights out in a single-blind, nonrandomized study design. Objective sleep quality was determined by polysomnography, subjective sleep and awakening quality by rating scales, objective awakening quality by psychometric tests. Clinical evaluation was based on the Pittsburgh Sleep Quality Index (PSQI), the Zung Depression (SDS) and Anxiety (SAS) Scales, the Quality of Life Index, the Epworth Sleepiness Scale and the International Restless Legs Syndrome Study Group (IRLSSG) Scale. Results: On admission, SB patients exhibited deteriorated PSQI, SAS, SDS and IRLSSG measures. As compared with placebo, 1 mg clonazepam significantly improved the mean bruxism index from 9.3 to 6.3/h of sleep. Furthermore, it significantly improved the total sleep period, total sleep time, sleep efficiency, sleep latency and time awake during the total sleep period, and increased stage 2 sleep and movement time. Periodic leg movements decreased significantly, while the apnea index and apnea-hypopnea index increased marginally, but remained within normal limits. Subjective sleep quality improved as well, while in mood, performance and psychophysiology no changes were observed. Conclusion: Acute clonazepam therapy significantly improved not only the bruxism index but also objective and subjective sleep quality, with unchanged mood, performance and psychophysiological measures upon awakening, suggesting good tolerability of the drug.

Bruxismo do sono: possibilidades terapêuticas baseadas em evidências

“…6 Thus, clonazepam becomes a safer alternative and with satisfactory results in the short term. 7,18 It is important to mention here that the clonazepam, like other benzodiazepine drugs, may exacerbate OSAS. In other words, if the patient has a diagnosis of bruxism and OSAS, the clonazepam may be contraindicated.…”

“…A study not selected by the inclusion criteria, as it was not randomized, but with interesting findings, was of Saletu et al, 18 in which a blind and controlled study investigated the acute effects of clonazepam on the SB. The sample consisted of 10 patients who received prior treatment with occlusal splint.…”

Evaluation and Treatment of Poor Sleep

“…Benzodiazepines improve insomnia by decreasing sleep latency and by decreasing nocturnal awakenings 19 ; clonazepam has also proven effective for insomnia related to restless legs syndrome, periodic limb movement disorder, 23 and sleep bruxism. 24 All benzodiazepines act on the benzodiazepine γ-aminobutyric acid (GABA) receptor-complex and may lead to physiologic and psychological dependence. Physical dependence can be clinically significant; in a study of long-term usage, 43% of individuals taking diazepam for 8 months or longer developed withdrawal symptoms when the medication was tapered rapidly or discontinued.…”

Utilização da toxina botulínica no tratamento do bruxismo em pacientes portadores de paralisia cerebral: revisão de literatura

“…Several types of treatment for bruxism have been investigated, such as occlusal splints, medication, and psychological treatment, but they are ineffective (24,25). Recently, the local injection of botulinum toxin (BTX) has been successfully used to treat various movement disorders (26,27).…”