Sleep bruxism events: an epiphenomenon of severe obstructive sleep apnea?

Yap, Adrian Ujin; Tan, Madeleine Wan Yong; Tan, Sharon Hui Xuan; Chua, Ai-Ping

doi:10.1007/s00784-023-05089-w

Cited by 6 publications

(2 citation statements)

References 50 publications

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“…Okeson and Sjöholm did not find any differences in SB between OSA and non-OSA patients, but their sample was not segmented by the severity of OSA, and severe OSA patients were not included in the sample, respectively [30,31]. On the other hand, Okura suggests that OSA patients with SB have a unique phenotype of OSA and also emphasizes the distinct relationship of respiratory events with RMMA and non-specific masticatory activity (NSMA) [61].…”

Section: Discussionmentioning

confidence: 95%

Diagnostic Accuracy of a Portable Electromyography and Electrocardiography Device to Measure Sleep Bruxism in a Sleep Apnea Population: A Comparative Study

Cid-Verdejo,

Domínguez Gordillo,

Sánchez-Romero

et al. 2023

Clocks & Sleep

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Background: The gold standard for diagnosing sleep bruxism (SB) and obstructive sleep apnea (OSA) is polysomnography (PSG). However, a final hypermotor muscle activity often occurs after apnea episodes, which can confuse the diagnosis of SB when using portable electromyography (EMG) devices. This study aimed to compare the number of SB episodes obtained from PSG with manual analysis by a sleep expert, and from a manual and automatic analysis of an EMG and electrocardiography (EKG) device, in a population with suspected OSA. Methods: Twenty-two subjects underwent a polysomnographic study with simultaneous recording with the EMG-EKG device. SB episodes and SB index measured with both tools and analyzed manually and automatically were compared. Masticatory muscle activity was scored according to published criteria. Patients were segmented by severity of OSA (mild, moderate, severe) following the American Academy of Sleep Medicine (AASM) criteria. ANOVA and the Bland–Altman plot were used to quantify the agreement between both methods. The concordance was calculated through the intraclass correlation coefficient (ICC). Results: On average, the total events of SB per night in the PSG study were (8.41 ± 0.85), lower than the one obtained with EMG-EKG manual (14.64 ± 0.76) and automatic (22.68 ± 16.02) analysis. The mean number of SB episodes decreases from the non-OSA group to the OSA group with both PSG (5.93 ± 8.64) and EMG-EKG analyses (automatic = 22.47 ± 18.07, manual = 13.93 ± 11.08). However, this decrease was minor in proportion compared to the automatic EMG-EKG analysis mode (from 23.14 to 22.47). The ICC based on the number of SB episodes in the segmented sample by severity degree of OSA along the three tools shows a moderate correlation in the non-OSA (0.61) and mild OSA (0.53) groups. However, it is poorly correlated in the moderate (0.24) and severe (0.23) OSA groups: the EMG-EKG automatic analysis measures 14.27 units more than PSG. The results of the manual EMG-EKG analysis improved this correlation but are not good enough. Conclusions: The results obtained in the PSG manual analysis and those obtained by the EMG-EKG device with automatic and manual analysis for the diagnosis of SB are acceptable but only in patients without OSA or with mild OSA. In patients with moderate or severe OSA, SB diagnosis with portable electromyography devices can be confused due to apneas, and further study is needed to investigate this.

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Section: Discussionmentioning

confidence: 95%

Diagnostic Accuracy of a Portable Electromyography and Electrocardiography Device to Measure Sleep Bruxism in a Sleep Apnea Population: A Comparative Study

Cid-Verdejo,

Domínguez Gordillo,

Sánchez-Romero

et al. 2023

Clocks & Sleep

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“…This relationship appears to be so significant that some authors have even referred to SB as a “protective factor” against the development of OSA [ 32 ]. Articles found in our analysis of the existing literature have not shown a positive correlation between AHI and BEI in OSA [ 40 , 41 , 42 ]. Our COMISA group with an increased AHI value also lacks a correlation between respiratory disturbances and BEI, which could indicate that COMISA may be a protective factor against the development of SB.…”

Section: Discussionmentioning

confidence: 99%

Sleep Bruxism and Sleep Structure in Comorbid Insomnia and Obstructive Sleep Apnea (COMISA) Syndrome: A Polysomnographic Study

Blaszczyk,

Meira e Cruz,

Waliszewska-Prosol

et al. 2024

JCM

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Introduction: Comorbid insomnia and obstructive sleep apnea (COMISA) is not a well-identified sleep disorder, despite having a significant impact on health. This study investigates the relationship between sleep bruxism (SB) and sleep architecture in patients with COMISA, obstructive sleep apnea (OSA), and in those without any sleep disorders. Methods: 119 patients were included in the study and divided into three groups: OSA, COMISA, and a control group. Polysomnographic (PSG) examination provided parameters related to sleep architecture, OSA, and characteristics of SB. Results: The bruxism episode index (BEI) and other SB parameters were not found to be statistically different between the three groups (p > 0.05). There was no statistical difference in measured sleep architecture between the COMISA and OSA groups (p > 0.05). In comparison to the control group, participants in the COMISA group were found to have an increased apnea–hypopnea index (AHI), oxygen desaturation index (ODI), respiratory disturbance index (RDI), all arousals (AA), and respiratory arousals (RA) (p < 0.05). Among COMISA patients, AA and RA were shown to have a positive linear correlation with the number of bradycardia events per hour (r = 0.49, r = 0.48, p < 0.05). Conclusions: SB does not occur in patients with COMISA more frequently than in patients with OSA or those without any sleep disorders. PSG parameters are not specific for COMISA; therefore, in order to differentiate this disorder from OSA alone, a comprehensive patient assessment has to be performed.

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Botulinum toxin for bruxism treatment: a nationwide study among oral and maxillofacial surgeons in Germany

Pabst,

Kämmerer,

Heimes

et al. 2024

Clin Oral Invest

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Sleep bruxism events: an epiphenomenon of severe obstructive sleep apnea?

Cited by 6 publications

References 50 publications

Diagnostic Accuracy of a Portable Electromyography and Electrocardiography Device to Measure Sleep Bruxism in a Sleep Apnea Population: A Comparative Study

Diagnostic Accuracy of a Portable Electromyography and Electrocardiography Device to Measure Sleep Bruxism in a Sleep Apnea Population: A Comparative Study

Sleep Bruxism and Sleep Structure in Comorbid Insomnia and Obstructive Sleep Apnea (COMISA) Syndrome: A Polysomnographic Study

Botulinum toxin for bruxism treatment: a nationwide study among oral and maxillofacial surgeons in Germany

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