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

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Abstract

Objectives

This study investigated the temporal relationships between apnea–hypopnea (AH) and sleep bruxism (SB) events and correlated SB to various respiratory/sleep indexes in adult patients with concomitant obstructive sleep apnea (OSA) and SB.

Materials and methods

Nocturnal PSG data of 147 consecutive OSA patients were examined for comorbid SB. Among the 49 subjects with coexisting OSA and SB, 26 were randomly selected for in-depth appraisal of temporal patterns which were classified as T1 (unrelated activities), T2 (AH events occur before SB events), T3 (SB events occur before AH events), and T4 (AH and SB events occur simultaneously). Data were analyzed using Mann–Whitney U tests and Spearman’s correlation (α = 0.05).

Results

The majority (84.5%) of AH events were unrelated to SB events. Of the 15.5% of related activities, T2 and T3 patterns occurred in 14.1% and 1.4%, respectively. SB events/index, the percentage of unrelated/related AH-SB events, and T2-T3 episodes were not associated with gender, age, body mass (BMI), and apnea–hypopnea (AHI) index. SB events were related to total sleep time (rs = 0.44), but no significant associations were discerned between SB and AH index.

Conclusions

As most AH events were unrelated to SB events, OSA and SB are probably epiphenomena in adult patients with concomitant conditions. Where AH-SB events were related, the T2 temporal pattern, where SB events were subsequent to AH events, featured predominantly alluding to a specific form of secondary SB triggered by sleep micro-arousals.

Clinical relevance

AH and SB events are probably epiphenomena in adult patients with coexisting OSA and SB. Even so, OSA patients should be routinely screened for SB and vice versa considering their frequent comorbidity.

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Data availability

The data that support the findings of this study are not openly available and are available from the corresponding author upon reasonable request. Data are located in controlled access data storage at Ng Teng Fong General Hospital.

References

  1. Melo G, Duarte J, Pauletto P et al (2019) Bruxism: an umbrella review of systematic reviews. J Oral Rehabil 46:666–690

    PubMed  Google Scholar 

  2. Senaratna CV, Perret JL, Lodge CJ et al (2017) Prevalence of obstructive sleep apnea in the general population: a systematic review. Sleep Med Rev 34:70–81

    Article  PubMed  Google Scholar 

  3. Lobbezoo F, Ahlberg J, Glaros AG et al (2013) Bruxism defined and graded: an international consensus. J Oral Rehabil 40:2–4

    Article  PubMed  Google Scholar 

  4. da Costa Lopes AJ, Cunha TCA, Monteiro MCM, Serra-Negra JM, Cabral LC, Júnior PCS (2020) Is there an association between sleep bruxism and obstructive sleep apnea syndrome? A systematic review. Sleep Breath 24:913–921

    Article  PubMed  Google Scholar 

  5. Pauletto P, Polmann H, Conti Réus J et al (2022) Sleep bruxism and obstructive sleep apnea: association, causality or spurious finding? A scoping review. Sleep 45:073. https://doi.org/10.1093/sleep/zsac073

    Article  Google Scholar 

  6. Manfredini D, Guarda-Nardini L, Marchese-Ragona R, Lobbezoo F (2015) Theories on possible temporal relationships between sleep bruxism and obstructive sleep apnea events An expert opinion. Sleep Breath 19:1459–1465

    Article  PubMed  Google Scholar 

  7. Lavigne GJ, Rompré PH, Montplaisir JY (1996) Sleep bruxism: validity of clinical research diagnostic criteria in a controlled polysomnographic study. J Dent Res 75:546–552

    Article  PubMed  Google Scholar 

  8. Malhotra RK, Kirsch DB, Kristo DA et al (2018) American Academy of Sleep Medicine board of directors. Polysomnography for Obstructive Sleep Apnea should include arousal-based scoring: An American Academy of Sleep Medicine Position Statement. J Clin Sleep Med 14:1245–1247

    Article  PubMed  PubMed Central  Google Scholar 

  9. Yap AU, Chua AP (2016) Sleep bruxism: current knowledge and contemporary management. J Conserv Dent 19:383–389

    Article  PubMed  PubMed Central  Google Scholar 

  10. Lobbezoo F, Naeije M (2001) Bruxism is mainly regulated centrally, not peripherally. J Oral Rehabil 28:1085–1091

    Article  PubMed  Google Scholar 

  11. Lobbezoo F, Visscher CM, Ahlberg J, Manfredini D (2014) Bruxism and genetics: a review of the literature. J Oral Rehabil 41:709–714

    Article  PubMed  Google Scholar 

  12. Tan MWY, Yap AU, Chua AP, Wong JCM, Parot MVJ, Tan KBC (2019) Prevalence of sleep bruxism and its association with obstructive sleep apnea in adult patients: a retrospective polysomnographic investigation. J Oral Facial Pain Headache 33:269–277

    Article  PubMed  Google Scholar 

  13. Faul F, Erdfelder E, Lang AG, Buchner A (2007) G*Power 3: a flexible statistical power analysis program for the social, behavioral, and biomedical sciences. Behav Res Methods 39:175–191

    Article  PubMed  Google Scholar 

  14. Johns MW (1991) A new method for measuring daytime sleepiness: the Epworth sleepiness scale. Sleep 14:540–545

    Article  PubMed  Google Scholar 

  15. Chou KT, Chang YT, Chen YM, Su KC et al (2011) The minimum period of polysomnography required to confirm a diagnosis of severe obstructive sleep apnoea. Respirology 16:1096–1102

    Article  PubMed  Google Scholar 

  16. American Academy of Sleep Medicine (2016) Manual for the scoring of sleep and associated events: rules, terminology and technical specifications (Version 2.3). AASM, Illinois

    Google Scholar 

  17. Berry RB, Budhiraja R, Gottlieb DJ et al (2012) Rules for scoring respiratory events in sleep: update of the 2007 AASM manual for the scoring of sleep and associated events. Deliberations of the Sleep Apnea definitions Task Force of the American Academy of Sleep Medicine. J Clin Sleep Med 8:597–619

    Article  PubMed  PubMed Central  Google Scholar 

  18. Ernst G, Sabán M, Schiavone M, Blanco M, Salvado A, Borsini E (2020) Prevalence and characteristics of obstructive sleep apneas according to severity. Medicina (B Aires) 80:479–486

    PubMed  Google Scholar 

  19. Raphael KG, Janal MN, Sirois DA et al (2013) Masticatory muscle sleep background electromyographic activity is elevated in myofascial temporomandibular disorder patients. J Oral Rehabil 40:883–891

    Article  PubMed  PubMed Central  Google Scholar 

  20. Saito M, Yamaguchi T, Mikami S et al (2014) Temporal association between sleep apnea-hypopnea and sleep bruxism events. J Sleep Res 23:196–203

    Article  Google Scholar 

  21. Khoury S, Rouleau GA, Rompré PH, Mayer P, Montplaisir JY, Lavigne GJ (2008) A significant increase in breathing amplitude precedes sleep bruxism. Chest 134:332–337

    Article  PubMed  Google Scholar 

  22. Maluly M, Dal Fabbro C, Andersen ML, Herrero Babiloni A, Lavigne GJ, Tufik S (2020) Sleep bruxism and its associations with insomnia and OSA in the general population of Sao Paulo. Sleep Med 75:141–148

    Article  PubMed  Google Scholar 

  23. de Holanda TA, Castagno CD, Barbon FJ, Costa YM, Goettems ML, Boscato N (2020) Sleep architecture and factors associated with sleep bruxism diagnosis scored by polysomnography recordings: a case-control study. Arch Oral Biol 112:104685

    Article  PubMed  Google Scholar 

  24. Martynowicz H, Gac P, Brzecka A et al (2019) The relationship between sleep bruxism and obstructive sleep apnea based on polysomnographic findings. J Clin Med 8:1653

    Article  PubMed  PubMed Central  Google Scholar 

  25. Yap AU, Cao Y, Zhang MJ, Lei J, Fu KY (2021) Age-related differences in diagnostic categories, psychological states and oral health-related quality of life of adult temporomandibular disorder patients. J Oral Rehabil 48:361–368

    Article  Google Scholar 

  26. WHO expert consultation (2004) Appropriate body-mass index for Asian populations and its implications for policy and intervention strategies. Lancet 363:157–163

    Article  Google Scholar 

  27. Dancey CP, Reidy J (2017) Statistics without maths for psychology, 7th edn. Pearson, London

    Google Scholar 

  28. Colonna A, Cerritelli L, Lombardo L et al (2022) Temporal relationship between sleep-time masseter muscle activity and apnea-hypopnea events: a pilot study. J Oral Rehabil 49:47–53

    Article  PubMed  Google Scholar 

  29. Martynowicz H, Wieczorek T, Macek P et al (2022) The effect of continuous positive airway pressure and mandibular advancement device on sleep bruxism intensity in obstructive sleep apnea patients. Chron Respir Dis 19:14799731211052300

    Article  PubMed Central  Google Scholar 

  30. Sjöholm TT, Lowe AA, Miyamoto K, Fleetham JA, Ryan CF (2000) Sleep bruxism in patients with sleep-disordered breathing. Arch Oral Biol 45:889–896

    Article  PubMed  Google Scholar 

  31. Lim LL, Tham KW, Fook-Chong SM (2008) Obstructive sleep apnoea in Singapore: polysomnography data from a tertiary sleep disorders unit. Ann Acad Med Singap 37:629–636

    Article  PubMed  Google Scholar 

  32. Zein JG, Tawk MM, Dernaika T, Kinasewitz GT, Orr WC (2005) The clinical significance of spontaneous arousals index during polysomnography. Chest 128:380S

    Article  Google Scholar 

  33. Tay DKL, Pang KP (2018) Clinical phenotype of South-East Asian temporomandibular disorder patients with upper airway resistance syndrome. J Oral Rehabil 45:25–33

    Article  PubMed  Google Scholar 

  34. Smardz J, Wieckiewicz M, Wojakowska A et al (2022) Incidence of sleep bruxism in different phenotypes of obstructive sleep apnea. J Clin Med 11:4091

    Article  PubMed  PubMed Central  Google Scholar 

  35. Schames SE, Schames J, Schames M, Chagall-Gungur SS (2012) Sleep bruxism, an autonomic self-regulating response by triggering the trigeminal cardiac reflex. J Calif Dent Assoc 40:670–676

    Article  PubMed  Google Scholar 

  36. Oksenberg A, Arons E (2002) Sleep bruxism related to obstructive sleep apnea: the effect of continuous positive airway pressure. Sleep Med 3:513–515

    Article  PubMed  Google Scholar 

  37. Carra MC, Macaluso GM, Rompré PH et al (2010) Clonidine has a paradoxical effect on cyclic arousal and sleep bruxism during NREM sleep. Sleep 33:1711–1716

    Article  PubMed  PubMed Central  Google Scholar 

  38. Yap AU (1998) Effects of stabilization appliances on nocturnal parafunctional activities in patients with and without signs of temporomandibular disorders. J Oral Rehabil 25:64–68

    Article  PubMed  Google Scholar 

  39. Schellenberg JB, Maislin G, Schwab RJ (2000) Physical findings and the risk for obstructive sleep apnea. The importance of oropharyngeal structures. Am J Respir Crit Care Med 162:740–748

    Article  PubMed  Google Scholar 

  40. Hang LW, Huang CS, Cheng WJ (2021) Clinical characteristics of Asian patients with sleep apnea with low arousal threshold and sleep structure change with continuous positive airway pressure. Sleep Breath 25:1309–1317

    Article  PubMed  Google Scholar 

  41. Wieckiewicz M, Bogunia-Kubik K, Mazur G et al (2020) Genetic basis of sleep bruxism and sleep apnea-response to a medical puzzle. Sci Rep 10:7497

    Article  PubMed  PubMed Central  Google Scholar 

  42. Castroflorio T, Bargellini A, Rossini G, Cugliari G, Deregibus A (2017) Sleep bruxism and related risk factors in adults: a systematic literature review. Arch Oral Biol 83:25–32

    Article  PubMed  Google Scholar 

  43. Guo H, Wang T, Niu X et al (2018) The risk factors related to bruxism in children: a systematic review and meta-analysis. Arch Oral Biol 86:18–34

    Article  PubMed  Google Scholar 

  44. Woo HJ, Lim JH, Ahn JC et al (2020) Characteristics of obstructive sleep apnea patients with a low body mass index: emphasis on the obstruction site determined by drug-induced sleep endoscopy. Clin Exp Otorhinolaryngol 13:415–421

    Article  PubMed  PubMed Central  Google Scholar 

  45. Kim SJ, Ahn HW, Hwang KJ, Kim SW (2020) Respiratory and sleep characteristics based on frequency distribution of craniofacial skeletal patterns in Korean adult patients with obstructive sleep apnea. PLoS ONE 15:e0236284

    Article  PubMed  PubMed Central  Google Scholar 

  46. Kim DH, Lee SH, Lee SH (2020) Sleep bruxism episodes in patients with obstructive sleep apnea syndrome determined by in-laboratory polysomnography. Appl Sci 10:8587

    Article  Google Scholar 

  47. Yo SW, Joosten SA, Wimaleswaran H et al (2022) Body position during laboratory and home polysomnography compared to habitual sleeping position at home. J Clin Sleep Med 18(9):2103–2111. https://doi.org/10.5664/jcsm.9990

  48. Winck M, Drummond M, Viana P, Pinho JC, Winck JC (2017) Sleep bruxism associated with obstructive sleep apnoea syndrome - a pilot study using a new portable device. Rev Port Pneumol 23:22–26

    PubMed  Google Scholar 

  49. Zhang XB, Zen HQ, Lin QC, Chen GP, Chen LD, Chen H (2014) TST, as a polysomnographic variable, is superior to the apnea hypopnea index for evaluating intermittent hypoxia in severe obstructive sleep apnea. Eur Arch Otorhinolaryngol 271:2745–2750

    Article  PubMed  Google Scholar 

  50. Dumais IE, Lavigne GJ, Carra MC, Rompré PH, Huynh NT (2015) Could transient hypoxia be associated with rhythmic masticatory muscle activity in sleep bruxism in the absence of sleep-disordered breathing? A preliminary report. J Oral Rehabil 42:810–818

    Article  PubMed  Google Scholar 

  51. Tauman R, O’Brien LM, Barbé F, Iyer VG, Gozal D (2006) Reciprocal interactions between spontaneous and respiratory arousals in adults with suspected sleep-disordered breathing. Sleep Med 7:229–234

    Article  PubMed  Google Scholar 

  52. Ohlmann B, Bömicke W, Behnisch R, Rammelsberg P, Schmitter M (2022) Variability of sleep bruxism-findings from consecutive nights of monitoring. Clin Oral Investig 26:3459–3466

    Article  PubMed  Google Scholar 

  53. Smardz J, Martynowicz H, Wojakowska A et al (2020) The meaning of the masticatory muscle tonic-type electromyographic pathway correlated with sleep bruxism and sleep-related breathing disorders - a polysomnographic study. Sleep Med 68:131–137

    Article  PubMed  Google Scholar 

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Acknowledgements

The authors would like to thank Shaffinaz Abdullah Rahman for her assistance with the research.

Author information

Authors and Affiliations

  1. Department of Dentistry, Ng Teng Fong General Hospital, National University Health System, 1 Jurong East Street 21, Singapore, 609606, Singapore

    Adrian Ujin Yap & Madeleine Wan Yong Tan

  2. Faculty of Dentistry, National University of Singapore, Singapore, Singapore

    Adrian Ujin Yap

  3. National Dental Research Institute Singapore, National Dental Centre Singapore, Singapore, Singapore

    Adrian Ujin Yap

  4. Duke-NUS Medical School, Singapore, Singapore

    Adrian Ujin Yap

  5. Saw See Hock School of Public Health, National University of Singapore, Singapore, Singapore

    Sharon Hui Xuan Tan

  6. Department of Medicine, Ng Teng Fong General Hospital, National University Health System, Singapore, Singapore

    Ai Ping Chua

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  1. Adrian Ujin Yap
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  4. Ai Ping Chua
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Contributions

Yap AU: Conceptualization, methodology, validation, formal analysis, investigation, resources, data curation, visualization, supervision, project administration, writing—original draft.

Tan MWY: Conceptualization, methodology, software, validation, formal analysis, investigation, resources, data curation, project administration, writing—review and editing.

Tan SHX: Methodology, software, validation, formal analysis, resources, data curation, visualization, writing—review and editing.

Chua AP: Conceptualization, methodology, validation, formal analysis, investigation, resources, data curation, supervision, project administration, writing—review and editing.

Corresponding author

Correspondence to Madeleine Wan Yong Tan.

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The authors declare no competing interests.

Ethics approval and consent to participate

This study was approved by the National Healthcare Group Domain Specific Review Board (reference number: 201600223) with the waiver of consent.

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The authors declare no competing interests.

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Yap, A.U., Tan, M.W.Y., Tan, S.H.X. et al. Sleep bruxism events: an epiphenomenon of severe obstructive sleep apnea?. Clin Oral Invest 27, 4633–4642 (2023). https://doi.org/10.1007/s00784-023-05089-w

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  • DOI: https://doi.org/10.1007/s00784-023-05089-w

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