Sleep Bruxism: Validity of Clinical Research Diagnostic Criteria in a Controlled Polysomnographic Study

Abstract

The clinical validity of diagnostic criteria for sleep orofacial motor activity--more specifically, bruxism--has never been tested. Polysomnographic recordings from 18 bruxers and 18 asymptomatic subjects, selected according to American Sleep Disorders Association criteria, were analyzed (1) to discriminate sleep bruxism from other orofacial motor activities and (2) to calculate sensitivity, specificity, and predictive values of research criteria. Clinical observations and reports revealed that all 18 bruxers reported frequent tooth-grinding during sleep. Tooth wear was noted in 16 out of 18 bruxers and jaw discomfort reported by six of them. These findings were present in none of the controls. The analysis of polysomnographic data showed that the asymptomatic subjects presented a mean of 1.7 +/- 0.3 bruxism episodes per hour of sleep (sustained or repetitive bursting activity in jaw closer muscles), while bruxers had a significantly higher level of activity: 5.4 +/- 0.6. Controls exhibited 4.6 +/- 0.3 bruxism bursts per episode and 6.2 (from 0 to 23) bruxism bursts per hour of sleep, whereas bruxers showed, respectively, 7.0 +/- 0.7 and 36.1 (5.8 to 108). Bruxism-like episodes with at least two grinding sounds were noted in 14 of the 18 bruxers and in one control. The two groups exhibited no difference in any of the sleep parameters. Based on the present findings, the following polysomnographic diagnostic cut-off criteria are suggested: (1) more than 4 bruxism episodes per hour, (2) more than 6 bruxism bursts per episode and/or 25 bruxism bursts per hour of sleep, and (3) at least 2 episodes with grinding sounds. When the polysomnographic bruxism-related variables were combined under logistic regression, the clinical diagnosis was correctly predicted in 81.3% of the controls and 83.3% of the bruxers. The validity of these clinical research criteria needs now to be challenged in a larger population, over time, and in subjects presenting various levels of severity of sleep bruxism.

Sleep Bruxism-Tooth Grinding Prevalence, Characteristics and Familial Aggregation: A Large Cross-Sectional Survey and Polysomnographic Validation

“…8,21 The following research criteria were used to validate the presence of SB: > 4 RMMA episode/h of sleep, > 25 EMG bursts/h of sleep and > 1 episode with grinding noise. The diagnosis of SB was confirmed in 111 subjects.…”

Effects of Botulinum Toxin on Jaw Motor Events during Sleep in Sleep Bruxism Patients: A Polysomnographic Evaluation

“…Jaw motor episodes related to the diagnosis of SB were scored as rhythmic masticatory muscle activity (RMMA) that included phasic (3 EMG bursts with durations of 0.25-2.0 sec), mixed types (both phasic and tonic bursts), and isolated tonic bursts (EMG bursts lasting > 2.0 sec). 24,25 These episodes were separated by intervals > 3 sec. However, scoring criteria for RMMA episodes were modified because BoNT is known to decrease the amplitude of EMG burst in the injected muscles.…”

“…Since it was difficult to detect the isolated tonic bursts by audio-video recordings, we used the threshold criteria for tonic episodes in the baseline and follow-up nights: EMG amplitude with 20% MVC on the baseline night was used. 19,24 For RMMA episodes, the number of episodes per hour of sleep (RMMA index), bursts per hour, the number of bursts per episode, the number of episodes with sound, and the mean duration were calculated. In addition to these episodes, OFAs including lip sucking, head movement, chewing-like activity, swallowing, and eye opening were scored using audiovideo.…”

Development of wireless bruxism monitoring device based on pressure-sensitive polymer composite

“…Generally, bruxism diagnosis is to monitor masticatory muscle activity using surface electromyography (EMG) [7][8][9]. However, the surface EMG signal is affected by factors such as electrode position, posture and skin resistance.…”