Is sleep bruxism in obstructive sleep apnea only an oral health related problem?
Clinical muscle symptoms
Electromyographic muscle tone
Muscle tone
Obstructive sleep apnea
Polysomnography
Sleep bruxism
Temporomandibular disorder
Journal
BMC oral health
ISSN: 1472-6831
Titre abrégé: BMC Oral Health
Pays: England
ID NLM: 101088684
Informations de publication
Date de publication:
14 May 2024
14 May 2024
Historique:
received:
10
12
2023
accepted:
08
05
2024
medline:
15
5
2024
pubmed:
15
5
2024
entrez:
14
5
2024
Statut:
epublish
Résumé
The etiology of sleep bruxism in obstructive sleep apnea (OSA) patients is not yet fully clarified. This prospective clinical study aimed to investigate the connection between probable sleep bruxism, electromyographic muscle tone, and respiratory sleep patterns recorded during polysomnography. 106 patients with OSA (74 males, 31 females, mean age: 56.1 ± 11.4 years) were divided into two groups (sleep bruxism: SB; no sleep bruxism: NSB). Probable SB were based on the AASM criteria: self-report of clenching/grinding, orofacial symptoms upon awakening, abnormal tooth wear and hypertrophy of the masseter muscle. Both groups underwent clinical examination for painful muscle symptoms aligned with Temporomandibular Disorders Diagnostic Criteria (DC/TMD), such as myalgia, myofascial pain, and headache attributed to temporomandibular disorder. Additionally, non-complaint positive muscle palpation and orofacial-related limitations (Jaw Functional Limited Scale-20: JFLS-20) were assessed. A one-night polysomnography with electromyographic masseter muscle tone (EMG) measurement was performed. Descriptive data, inter-group comparisons and multivariate logistic regression were calculated. OSA patients had a 37.1% prevalence of SB. EMG muscle tone (N1-N3, REM; P = 0.001) and the number of hypopneas (P = 0.042) were significantly higher in the sleep bruxism group. While measures like apnea-hypopnea-index (AHI), respiratory-disturbance-index (RDI), apnea index (AI), hypopnea-index (HI), number of arousals, and heart rate (1/min) were elevated in sleep bruxers, the differences were not statistically significant. There was no difference in sleep efficiency (SE; P = 0.403). Non-complaint masseter muscle palpation (61.5%; P = 0.015) and myalgia (41%; P = 0.010) were significant higher in SB patients. Multivariate logistic regression showed a significant contribution of EMG muscle tone and JFLS-20 to bruxism risk. Increased EMG muscle tone and orofacial limitations can predict sleep bruxism in OSA patients. Besides, SB patients suffer more from sleep disorder breathing. Thus, sleep bruxism seems to be not only an oral health related problem in obstructive apnea. Consequently, interdisciplinary interventions are crucial for effectively treating these patients. The study was approved by the Ethics Committee of Philipps-University Marburg (reg. no. 13/22-2022) and registered at the "German Clinical Trial Register, DRKS" (DRKS0002959).
Sections du résumé
BACKGROUND
BACKGROUND
The etiology of sleep bruxism in obstructive sleep apnea (OSA) patients is not yet fully clarified. This prospective clinical study aimed to investigate the connection between probable sleep bruxism, electromyographic muscle tone, and respiratory sleep patterns recorded during polysomnography.
METHODS
METHODS
106 patients with OSA (74 males, 31 females, mean age: 56.1 ± 11.4 years) were divided into two groups (sleep bruxism: SB; no sleep bruxism: NSB). Probable SB were based on the AASM criteria: self-report of clenching/grinding, orofacial symptoms upon awakening, abnormal tooth wear and hypertrophy of the masseter muscle. Both groups underwent clinical examination for painful muscle symptoms aligned with Temporomandibular Disorders Diagnostic Criteria (DC/TMD), such as myalgia, myofascial pain, and headache attributed to temporomandibular disorder. Additionally, non-complaint positive muscle palpation and orofacial-related limitations (Jaw Functional Limited Scale-20: JFLS-20) were assessed. A one-night polysomnography with electromyographic masseter muscle tone (EMG) measurement was performed. Descriptive data, inter-group comparisons and multivariate logistic regression were calculated.
RESULTS
RESULTS
OSA patients had a 37.1% prevalence of SB. EMG muscle tone (N1-N3, REM; P = 0.001) and the number of hypopneas (P = 0.042) were significantly higher in the sleep bruxism group. While measures like apnea-hypopnea-index (AHI), respiratory-disturbance-index (RDI), apnea index (AI), hypopnea-index (HI), number of arousals, and heart rate (1/min) were elevated in sleep bruxers, the differences were not statistically significant. There was no difference in sleep efficiency (SE; P = 0.403). Non-complaint masseter muscle palpation (61.5%; P = 0.015) and myalgia (41%; P = 0.010) were significant higher in SB patients. Multivariate logistic regression showed a significant contribution of EMG muscle tone and JFLS-20 to bruxism risk.
CONCLUSION
CONCLUSIONS
Increased EMG muscle tone and orofacial limitations can predict sleep bruxism in OSA patients. Besides, SB patients suffer more from sleep disorder breathing. Thus, sleep bruxism seems to be not only an oral health related problem in obstructive apnea. Consequently, interdisciplinary interventions are crucial for effectively treating these patients.
TRIAL REGISTRATION
BACKGROUND
The study was approved by the Ethics Committee of Philipps-University Marburg (reg. no. 13/22-2022) and registered at the "German Clinical Trial Register, DRKS" (DRKS0002959).
Identifiants
pubmed: 38745301
doi: 10.1186/s12903-024-04351-1
pii: 10.1186/s12903-024-04351-1
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
565Informations de copyright
© 2024. The Author(s).
Références
Lavigne GJ, Kato T, Kolta A, Sessle BJ. Neurobiological mechanisms involved in sleep Bruxism. Crit Rev Oral Biol Med. 2003;14:30–46.
pubmed: 12764018
doi: 10.1177/154411130301400104
Lobbezoo F, Ahlberg J, Raphael KG, Wetselaar P, Glaros AG, Kato T, et al. International consensus on the assessment of bruxism: Report of a work in progress. J Oral Rehabil. 2018;45:837–44.
pubmed: 29926505
pmcid: 6287494
doi: 10.1111/joor.12663
Manfredini D, Winocur E, Guarda-Nardini L, Paesani D, Lobbezoo F. Epidemiology of Bruxism in adults: a systematic review of the literature. J Orofac Pain. 2013;27:99–110.
pubmed: 23630682
doi: 10.11607/jop.921
American Academy of Sleep Medicine. International Classification of Sleep Disorders. 3rd ed. Darien: American Academy of Sleep Medicine; 2014.
Heinzer R, Vat S, Marques-Vidal P, Marti-Soler H, Andries D, Tobback N, et al. Prevalence of sleep-disordered breathing in the general population: the HypnoLaus study. Lancet Respir Med. 2015;3:310–8.
pubmed: 25682233
pmcid: 4404207
doi: 10.1016/S2213-2600(15)00043-0
Peppard PE. Longitudinal study of moderate weight change and sleep-disordered breathing. JAMA. 2000;284:3015.
pubmed: 11122588
doi: 10.1001/jama.284.23.3015
Young T, Peppard PE, Taheri S. Excess weight and sleep-disordered breathing. J Appl Physiol. 2005;99:1592–9.
pubmed: 16160020
doi: 10.1152/japplphysiol.00587.2005
Degerli MA, Koehler U, Kesper K, Hildebrandt O, Conradt R, Koehler N, et al. Der obere Atemweg bei OSA-Patienten ist auch im Wachzustand pathologisch. Pneumologie. 2023;78:191–8.
pubmed: 37647916
Tan M, Yap A, Chua A, Wong J, Parot M, Tan K. Prevalence of Sleep Bruxism and its association with obstructive sleep apnea in adult patients: a retrospective polysomnographic investigation. J Oral Facial Pain Headache. 2019;33:269–77.
pubmed: 30371687
doi: 10.11607/ofph.2068
Sjöholm TT, Lowe AA, Miyamoto K, Fleetham JA, Ryan CF. Sleep bruxism in patients with sleep-disordered breathing. Arch Oral Biol. 2000;45:889–96.
pubmed: 10973562
doi: 10.1016/S0003-9969(00)00044-3
Martynowicz H, Gac P, Brzecka A, Poreba R, Wojakowska A, Mazur G, et al. The relationship between Sleep Bruxism and obstructive sleep apnea based on polysomnographic findings. JCM. 2019;8:1653.
pubmed: 31614526
pmcid: 6832407
doi: 10.3390/jcm8101653
Hesselbacher S, Subramanian S, Rao S, Casturi L, Surani S. Self-reported sleep bruxism and nocturnal gastroesophageal reflux disease in patients with obstructive sleep apnea: relationship to Gender and Ethnicity§. TORMJ. 2014;8:34–40.
pubmed: 25352924
pmcid: 4209499
doi: 10.2174/1874306401408010034
Wetselaar P, Manfredini D, Ahlberg J, Johansson A, Aarab G, Papagianni CE, et al. Associations between tooth wear and dental sleep disorders: A narrative overview. J Oral Rehabil. 2019;46:765–75.
pubmed: 31038764
pmcid: 6852513
doi: 10.1111/joor.12807
Chrcanovic BR, Kisch J, Larsson C. Analysis of technical complications and risk factors for failure of combined tooth-implant-supported fixed dental prostheses. Clin Implant Dent Rel Res. 2020;22:523–32.
doi: 10.1111/cid.12927
Zhou Y, Gao J, Luo L, Wang Y. Does Bruxism contribute to dental implant failure? A systematic review and meta-analysis. Clin Implant Dent Rel Res. 2016;18:410–20.
doi: 10.1111/cid.12300
Stuginski-Barbosa J, Porporatti AL, Costa YM, Svensson P, Conti PCR. Agreement of the international classification of sleep disorders Criteria with polysomnography for sleep bruxism diagnosis: A preliminary study. J Prosthet Dent. 2017;117:61–6.
pubmed: 27460312
doi: 10.1016/j.prosdent.2016.01.035
Wu J, Huang Z, Chen Y, Chen Y, Pan Z, Gu Y. Temporomandibular disorders among medical students in China: prevalence, biological and psychological risk factors. BMC Oral Health. 2021;21:549.
pubmed: 34702237
pmcid: 8549286
doi: 10.1186/s12903-021-01916-2
Thymi M, Shimada A, Lobbezoo F, Svensson P. Clinical jaw-muscle symptoms in a group of probable sleep bruxers. J Dent. 2019;85:81–7.
pubmed: 31085350
doi: 10.1016/j.jdent.2019.05.016
Sierwald I, John MT, Schierz O, Hirsch C, Sagheri D, Jost-Brinkmann P-G, et al. Association of temporomandibular disorder pain with awake and sleep bruxism in adults. J Orofac Orthop. 2015;76:305–17.
pubmed: 26123732
doi: 10.1007/s00056-015-0293-5
Baad-Hansen L, Thymi M, Lobbezoo F, Svensson P. To what extent is bruxism associated with musculoskeletal signs and symptoms? A systematic review. J Oral Rehabil. 2019;46:845–61.
pubmed: 31090938
doi: 10.1111/joor.12821
Smardz J, Martynowicz H, Michalek-Zrabkowska M, Wojakowska A, Mazur G, Winocur E, et al. Sleep Bruxism and occurrence of temporomandibular disorders-related pain: A polysomnographic study. Front Neurol. 2019;10:168.
pubmed: 30915015
pmcid: 6421294
doi: 10.3389/fneur.2019.00168
Schmitter M, Kares-Vrincianu A, Kares H, Bermejo JL, Schindler H-J. Sleep-associated aspects of myofascial pain in the orofacial area among temporomandibular disorder patients and controls. Sleep Med. 2015;16:1056–61.
pubmed: 26298779
doi: 10.1016/j.sleep.2015.03.022
Duarte J, Pauletto P, Massignan C, Bolan M, Domingos F, Hallal A, et al. Association between sleep bruxism and quality of life: A systematic review. J Oral Facial Pain Headache. 2020;34:341–52.
pubmed: 33290440
doi: 10.11607/ofph.2687
Câmara-Souza MB, de Figueredo OMC, Rodrigues Garcia RCM. Association of sleep bruxism with oral health-related quality of life and sleep quality. Clin Oral Invest. 2019;23:245–51.
doi: 10.1007/s00784-018-2431-0
Neu D, Baniasadi N, Newell J, Styczen D, Glineur R, Mairesse O. Effect of sleep bruxism duration on perceived sleep quality in middle-aged subjects. European J Oral Sciences. 2018;126:411–6.
doi: 10.1111/eos.12564
Hosoya H, Kitaura H, Hashimoto T, Ito M, Kinbara M, Deguchi T, et al. Relationship between sleep bruxism and sleep respiratory events in patients with obstructive sleep apnea syndrome. Sleep Breath. 2014;18:837–44.
pubmed: 24526386
doi: 10.1007/s11325-014-0953-5
Hollowell DE, Suratt PM. Mandible position and activation of submental and masseter muscles during sleep. J Appl Physiol. 1991;71:2267–73.
pubmed: 1778922
doi: 10.1152/jappl.1991.71.6.2267
Ohlmann B, Bömicke W, Behnisch R, Rammelsberg P, Schmitter M. Variability of sleep bruxism—findings from consecutive nights of monitoring. Clin Oral Invest. 2022;26:3459–66.
doi: 10.1007/s00784-021-04314-8
Van Der Zaag J, Lobbezoo F, Visscher CM, Hamburger HL, Naeije M. Time-variant nature of sleep bruxism outcome variables using ambulatory polysomnography: implications for recognition and therapy evaluation. J Oral Rehabil. 2008;35:577–84.
pubmed: 18699969
doi: 10.1111/j.1365-2842.2008.01893.x
Lavigne GJ, Guitard F, Rompre PH, Montplaisir JY. Variability in sleep bruxism activity over time. J Sleep Res. 2001;10:237–44.
pubmed: 11696077
doi: 10.1046/j.1365-2869.2001.00261.x
Miettinen T, Myllymaa K, Hukkanen T, Töyräs J, Sipilä K, Myllymaa S. Home polysomnography reveals a first-night effect in patients with low sleep Bruxism activity. J Clin Sleep Med. 2018;14:1377–86.
pubmed: 30092900
pmcid: 6086957
doi: 10.5664/jcsm.7278
Raphael KG, Janal MN, Sirois DA, Dubrovsky B, Wigren PE, Klausner JJ, et al. Masticatory muscle sleep background electromyographic activity is elevated in myofascial temporomandibular disorder patients. J Oral Rehabil. 2013;40:883–91.
pubmed: 24237356
pmcid: 3889636
doi: 10.1111/joor.12112
Jiménez-Silva A, Peña-Durán C, Tobar-Reyes J, Frugone-Zambra R. Sleep and awake bruxism in adults and its relationship with temporomandibular disorders: A systematic review from 2003 to 2014. Acta Odontol Scand. 2017;75:36–58.
pubmed: 27796166
doi: 10.1080/00016357.2016.1247465
Manfredini D, Lobbezoo F. Sleep bruxism and temporomandibular disorders: A scoping review of the literature. J Dent. 2021;111:103711.
pubmed: 34090993
doi: 10.1016/j.jdent.2021.103711
Wetselaar P, Lobbezoo F. The tooth wear evaluation system: a modular clinical guideline for the diagnosis and management planning of worn dentitions. J Oral Rehabil. 2016;43:69–80.
pubmed: 26333037
doi: 10.1111/joor.12340
Ohrbach R, Larsson P. The Jaw Functional Limitation Scale: Development, Reliability, and Validity of 8-Item and 20-Item Versions. J Orofac Pain. 2007;22:219–30.
Schiffman E, Ohrbach R, Truelove E, Look J, Anderson G, Goulet J-P, et al. Diagnostic criteria for temporomandibular disorders (DC/TMD) for clinical and research applications: recommendations of the international RDC/TMD consortium network* and orofacial pain special interest group†. J Oral Facial Pain Headache. 2014;28:6–27.
pubmed: 24482784
doi: 10.11607/jop.1151
Berry RB, Brooks R, Gamaldo C, Harding SM, Lloyd RM, Quan SF, et al. AASM Scoring Manual Updates for 2017 (Version 2.4). J Clin Sleep Med. 2017;13:665–6.
pubmed: 28416048
pmcid: 5406946
doi: 10.5664/jcsm.6576
Mayer G, Kesper K, Ploch T, Canisius S, Penzel T, Oertel W, et al. Quantification of tonic and phasic muscle activity in REM sleep behavior disorder. J Clin Neurophysiol. 2008;25:48–55.
pubmed: 18303560
doi: 10.1097/WNP.0b013e318162acd7
Alvarez-Estevez D, Van Velzen I, Ottolini-Capellen T, Kemp B. Derivation and modeling of two new features for the characterization of rapid and slow eye movements in electrooculographic sleep recordings. Biomed Signal Process Control. 2017;35:87–99.
doi: 10.1016/j.bspc.2017.02.014
Saito M, Yamaguchi T, Mikami S, Watanabe K, Gotouda A, Okada K, et al. Weak association between sleep bruxism and obstructive sleep apnea A sleep laboratory study. Sleep Breath. 2016;20:703–9.
pubmed: 26564168
doi: 10.1007/s11325-015-1284-x
Nashed A, Lanfranchi P, Rompré P, Carra MC, Mayer P, Colombo R, et al. Sleep bruxism is associated with a rise in arterial blood pressure. Sleep. 2012;35:529–36.
pubmed: 22467991
pmcid: 3296795
doi: 10.5665/sleep.1740
Shimada A, Castrillon EE, Svensson P. Revisited relationships between probable sleep bruxism and clinical muscle symptoms. J Dent. 2019;82:85–90.
pubmed: 30716450
doi: 10.1016/j.jdent.2019.01.013
Johns MW. A new method for measuring daytime sleepiness: the epworth sleepiness scale. Sleep. 1991;14:540–5.
pubmed: 1798888
doi: 10.1093/sleep/14.6.540
Chung F, Abdullah HR, Liao P. STOP-Bang Questionnaire. Chest. 2016;149:631–8.
pubmed: 26378880
doi: 10.1378/chest.15-0903
Alessandri-Bonetti A, Scarano E, Fiorita A, Cordaro M, Gallenzi P. Prevalence of signs and symptoms of temporo-mandibular disorder in patients with sleep apnea. Sleep Breath. 2021;25:2001–6.
pubmed: 33674964
doi: 10.1007/s11325-021-02337-9
Alessandri-Bonetti A, Bortolotti F, Moreno-Hay I, Michelotti A, Cordaro M, Alessandri-Bonetti G, et al. Effects of mandibular advancement device for obstructive sleep apnea on temporomandibular disorders: A systematic review and meta-analysis. Sleep Med Rev. 2019;48:101211.
pubmed: 31605905
doi: 10.1016/j.smrv.2019.101211
Gagnon Y, Mayer P, Morisson F, Rompré P, Lavigne G. Aggravation of respiratory disturbances by the use of an occlusal splint in apneic patients: A pilot study. Int J Prosthodont. 2004;17:447–53.
pubmed: 15382781