RESUMEN

Sleep bruxism (SB) is a repetitive jaw-muscle activity characterised by clenching or grinding of the teeth during sleep. Sleep bruxism activity is characterised by rhythmic masticatory muscle activity (RMMA). Many but not all RMMA episodes are associated with sleep arousal. The aim of this study was to evaluate whether transient oxygen saturation level change can be temporally associated with genesis of RMMA/SB. Sleep laboratory or home recordings data from 22 SB (tooth grinding history in the absence of reported sleep-disordered breathing) and healthy subjects were analysed. A total of 143 RMMA/SB episodes were classified in four categories: (i) no arousal + no body movement; (ii) arousal + no body movement; (iii) no arousal + body movement; (iv) arousal + body movement. Blood oxygen levels (SaO2 ) were assessed from finger oximetry signal at the baseline (before RMMA), and during RMMA. Significant variation in SaO2 over time (P = 0·001) was found after RMMA onset (+7 to +9 s). No difference between categories (P = 0·91) and no interaction between categories and SaO2 variation over time (P = 0·10) were observed. SaO2 of six of 22 subjects (27%) remained equal or slight increase after the RMMA/SB onset (+8 s) compared to baseline; 10 subjects (45%) slightly decreased (drop 0·01-1%) and the remaining (27%) decreased between 1% and 2%. These preliminary findings suggest that a subgroup of SB subjects had (i) a minor transient hypoxia potentially associated with the onset of RMMA episodes, and this (ii) independently of concomitant sleep arousal or body movements.

Asunto(s)

Hipoxia/complicaciones , Músculos Masticadores/fisiología , Oxígeno/sangre , Bruxismo del Sueño/complicaciones , Adolescente , Adulto , Nivel de Alerta/fisiología , Estudios de Casos y Controles , Niño , Femenino , Humanos , Masculino , Movimiento/fisiología , Oximetría , Periodicidad , Polisomnografía/métodos , Estudios Retrospectivos , Fases del Sueño/fisiología , Adulto Joven

RESUMEN

Clinicians and investigators need a simple and reliable recording device to diagnose or monitor sleep bruxism (SB). The aim of this study was to compare recordings made with an ambulatory electromyographic telemetry recorder (TEL-EMG) with those made with standard sleep laboratory polysomnography with synchronised audio-visual recording (PSG-AV). Eight volunteer subjects without current history of tooth grinding spent one night in a sleep laboratory. Simultaneous bilateral masseter EMG recordings were made with a TEL-EMG and standard PSG. All types of oromotor activity and rhythmic masseter muscle activity (RMMA), typical of SB, were independently scored by two individuals. Correlation and intra-class coefficient (ICC) were estimated for scores on each system. The TEL-EMG was highly sensitive to detect RMMA (0·988), but with low positive predictive value (0·231) because of a high rate of oromotor activity detection (e.g. swallowing and scratching). Almost 72% of false-positive oromotor activity scored with the TEL-EMG occurred during the transient wake period of sleep. A non-significant correlation between recording systems was found (r = 0·49). Because of the high frequency of wake periods during sleep, ICC was low (0·47), and the removal of the influence of wake periods improved the detection reliability of the TEL-EMG (ICC = 0·88). The TEL-EMG is sensitive to detect RMMA in normal subjects. However, it obtained a high rate of false-positive detections because of the presence of frequent oromotor activities and transient wake periods of sleep. New algorithms are needed to improve the validity of TEL-EMG recordings.

Asunto(s)

Músculo Masetero/fisiología , Monitoreo Ambulatorio/métodos , Periodicidad , Sueño/fisiología , Adulto , Electromiografía/métodos , Femenino , Humanos , Masculino , Persona de Mediana Edad , Polisomnografía/métodos , Reproducibilidad de los Resultados , Sensibilidad y Especificidad , Telemetría , Adulto Joven

RESUMEN

BACKGROUND: Anatomical changes associated with edentulism are thought to disturb seniors' sleep. OBJECTIVES: (1) To determine sleep quality and daytime sleepiness of edentulous elders. (2) To examine the association between oral health-related quality of life and sleep quality. METHODS: Data were collected at a 1-year follow-up from 173 healthy edentulous elders who had participated in a randomised controlled trial and randomly received two types of mandibular prosthesis. Subjective sleep quality was assessed using the Pittsburgh Sleep Quality Index (PSQI, range 0-21), with higher scores indicating poorer sleep quality. The Epworth Sleepiness Scale (ESS) was used to measure the level of perceived daytime sleepiness, and scores ≥10 indicated sleepiness. RESULTS: The mean global PSQI and ESS scores were 4.7 ± 3.5 and 5.3 ± 3.9. There were no differences in sleep quality or sleepiness between those who wore their dentures at night and those who did not. Elders with frequent denture problems were sleepier during the day than those with fewer problems (p = 0.0034). General health (p = 0.02) and oral health-related quality of life (p = 0.001) are significant predictors of sleep quality. CONCLUSION: Healthy edentulous elders, independent of nocturnal wearing of their prosthesis, are good sleepers. Maintaining high oral health quality of life could contribute to better sleep.

Asunto(s)

Dentadura Completa , Boca Edéntula/rehabilitación , Sueño/fisiología , Anciano , Anciano de 80 o más Años , Estudios Transversales , Prótesis Dental de Soporte Implantado , Retención de Dentadura/instrumentación , Dentadura Completa Inferior , Dentadura Completa Superior , Prótesis de Recubrimiento , Femenino , Estudios de Seguimiento , Estado de Salud , Humanos , Vida Independiente , Masculino , Boca Edéntula/fisiopatología , Salud Bucal , Calidad de Vida , Apnea Obstructiva del Sueño/clasificación , Fases del Sueño/fisiología , Trastornos del Sueño-Vigilia/clasificación , Ronquido/clasificación

RESUMEN

OBJECTIVES: The superiority of mandibular two-implant overdentures (IODs) over conventional complete dentures (CDs) in terms of quality of life is still questioned. Furthermore, the stability and magnitude of the treatment effect over time remain uncertain. This follow-up study aimed to determine the stability and magnitude of the effect of IODs on oral health-related quality of life (OHRQoL). MATERIAL AND METHODS: 172 participants (mean age 71 ± 4.5 years) randomly received CDs or IODs, both opposed by conventional maxillary dentures. OHRQoL was measured using the Oral Health Impact Profile (OHIP-20) at baseline, 1 and 2 years post-treatment. Repeated measures ANOVAs were conducted to assess the effects of time and treatment on the total OHIP and its individual domain scores. RESULTS: A statistically significant improvement in OHRQoL was seen for both treatment groups (P < 0.001). This improvement was maintained over the 2 year assessment. At both follow-ups, participants wearing IODs reported significantly better total OHIP scores than those wearing CDs (P < 0.001), with a 1.5 times larger magnitude of effect. In the CD group, baseline OHIP scores influenced the post-treatment scores (P < 0.001). This effect was not found in the IOD group. CONCLUSIONS: The effect of mandibular two-IODs on OHRQoL is stable over a 2-year period. The large magnitude of effect of this treatment supports its clinical significance.

Asunto(s)

Prótesis Dental de Soporte Implantado , Prótesis de Recubrimiento , Salud Bucal , Calidad de Vida , Anciano , Demografía , Femenino , Humanos , Estudios Longitudinales , Masculino , Mandíbula , Estudios Prospectivos , Encuestas y Cuestionarios , Resultado del Tratamiento

RESUMEN

Rhythmic masticatory muscle activity (RMMA) is the characteristic electromyographic pattern of sleep bruxism (SB), a sleep-related motor disorder associated with sleep arousal. Sleep arousals are generally organised in a clustered mode known as the cyclic alternating pattern (CAP). CAP is the expression of sleep instability between sleep maintaining processes (phase A1) and stronger arousal processes (phases A2 and A3). This study aimed to investigate the role of sleep instability on RMMA/SB occurrence by analysing CAP and electroencephalographic (EEG) activities. The analysis was performed on the sleep recordings of 8 SB subjects and 8 controls who received sensory stimulations during sleep. Baseline and experimental nights were compared for sleep variables, CAP, and EEG spectral analyses using repeated measure ANOVAs. Overall, no differences in sleep variables and EEG spectra were found between SB subjects and controls. However, SB subjects had higher sleep instability (more phase A3) than controls (P= 0·05). The frequency of phase A3 was higher in the pre-REM sleep periods (P < 0·001), where peaks in RMMA/SB activity were also observed (P = 0·05). When sleep instability was experimentally increased by sensory stimuli, both groups showed an enhancement in EEG theta and alpha power (P = 0·04 and 0·02, respectively) and significant increases in sleep arousal and all CAP variables. No change in RMMA/SB index was found within either groups (RMMA/SB occurred in all SB subjects and only one control during the experimental night). These findings suggest that CAP phase A3 may act as a permissive window rather than a generator of RMMA/SB activity in predisposed individuals.

Asunto(s)

Nivel de Alerta/fisiología , Periodicidad , Bruxismo del Sueño/fisiopatología , Fases del Sueño/fisiología , Adulto , Estudios de Casos y Controles , Electroencefalografía/métodos , Femenino , Humanos , Masculino , Polisomnografía/métodos , Adulto Joven

RESUMEN

UNLABELLED: Sense of coherence (SOC) is an individual-based coping characteristic and believed to influence a person's ability to adapt to life stressors, such as edentulism and using complete denture. Thus, SOC may mediate the effect of prosthetic treatment on quality of life. OBJECTIVES: 1. To simultaneously test the effect of type of treatment and sense of coherence on oral health related quality of life (OHRQoL) in edentate elders and to identify any interaction. 2. To report the level of sense of coherence among a sample of edentate elders. METHODS: Data were collected and analysed cross-sectionally at a 1-year follow-up from 173 edentulous elders who had randomly received mandibular-implant overdentures or conventional dentures, both opposed by new conventional maxillary dentures. The dependent outcome variable, oral health related quality of life, was measured using the Oral Health Impact Profile (OHIP-20). Independent variables included SOC and prosthesis type, as well as socio-demographic variables. SOC was evaluated using the 13-item likert scale of The Orientation to Life questionnaire. RESULTS: The group mean SOC score was 70.28 (SD=9.6). Married or coupled people had significantly higher SOC scores than those who were separated, single or divorced (p=0.04). General linear model analyses demonstrated that there was a statistically significant main effect for type of prosthesis, F(1.169)=0.71, p=0.008, with no interaction with SOC. CONCLUSION: The results of this study suggest that, in edentulous elders, SOC does not mediate the effect of the type of prosthetic treatment on oral health related quality of life.

Asunto(s)

Adaptación Psicológica , Prótesis Dental de Soporte Implantado/psicología , Dentadura Completa Inferior/psicología , Boca Edéntula/psicología , Salud Bucal , Calidad de Vida , Anciano , Anciano de 80 o más Años , Estudios Transversales , Prótesis de Recubrimiento , Escolaridad , Femenino , Humanos , Modelos Lineales , Masculino , Estado Civil , Perfil de Impacto de Enfermedad , Factores Socioeconómicos , Encuestas y Cuestionarios

RESUMEN

Spinal deformities, and particularly scoliosis, are the most frequent forms of orthopedic deformities in children and adolescents. About 1-6% of the population has scoliosis. This disorder leads to severe spinal deformities and predominantly affects adolescent girls.Although the multifactorial origin of adolescent idiopathic scoliosis (AIS) is broadly recognized, the genetic causes of AIS are still largely unknown. Our previous studies suggested a generalized dysfunction of melatonin transduction (the hormone that is primarily produced in the brain and epiphysis). In the meantime we have demonstrated that such a defect of signal transduction is caused by chemical alterations, which inactivate the function of the inhibitory G protein-coupled melatonin receptors. This discovery has led to the development of the first blood test to detect children without symptoms who are at risk of developing scoliosis. Since a single function (cellular reaction to melatonin) is determined, the unique advantage of this test is that it can be performed without knowledge of mutations in defective genes that could provoke the onset of AIS.

Asunto(s)

Análisis Químico de la Sangre/métodos , Tamizaje Masivo/métodos , Melatonina/sangre , Escoliosis/sangre , Escoliosis/diagnóstico , Biomarcadores/sangre , Predisposición Genética a la Enfermedad/genética , Humanos , Escoliosis/fisiopatología

RESUMEN

To our knowledge, the large spectrum of sleep motor activities (SMA) present in the head and neck region has not yet been systematically estimated in normal and sleep bruxism (SB) subjects. We hypothesized that in the absence of audio-video signal recordings, normal and SB subjects would present a high level of SMA that might confound the scoring specificity of SB. A retrospective analysis of several SMA, including oro-facial activities (OFA) and rhythmic masticatory muscle activities (RMMA), was made from polygraphic and audio-video recordings of 21 normal subjects and 25 SB patients. Sleep motor activities were scored, blind to subject status, from the second night of sleep recordings. Discrimination of OFA included the following types of activities: lip sucking, head movements, chewing-like movements, swallowing, head rubbing and scratching, eye opening and blinking. These were differentiated from RMMA and tooth grinding. The frequency of SMA per hour of sleep was lower in normal subjects in comparison with SB patients (P < 0.001). Up to 85% of all SMA in normal subjects were related to OFA while 30% of SMA in SB patients were related to OFA scoring (P < 0.001). The frequency of RMMA was seven times higher in SB patients than in normal subjects (P < 0.001). Several SMA can be observed in normal and SB subjects. In the absence of audio-video signal recordings, the discrimination of various types of OFA is difficult to achieve and may lead to erroneous estimation of SB-related activities.

Asunto(s)

Músculos Faciales/fisiología , Músculos Masticadores/fisiología , Actividad Motora/fisiología , Periodicidad , Bruxismo del Sueño/fisiopatología , Actigrafía/métodos , Adulto , Deglución/fisiología , Femenino , Humanos , Masculino , Estudios Retrospectivos , Grabación de Cinta de Video , Adulto Joven

RESUMEN

The etiology of denture stomatitis remains controversial. Trauma due to unstable dentures has been suggested as an etiological factor. Therefore, we tested the hypothesis that the prevalence of denture stomatitis is reduced when mandibular dentures are stabilized by implants. Data were collected at a one-year follow-up from 173 edentulous elders who had randomly received mandibular implant overdentures or conventional dentures. The diagnosis of denture stomatitis was determined according to the Newton classification. Elders wearing conventional dentures were almost 5 times more likely to have denture stomatitis than those wearing mandibular two-implant overdentures (P < 0.0001, Fisher's exact test). Adjusted odds ratios showed that only the type of the prosthesis (AOR = 4.54, 95% CI 2.20 to 9.40) and nocturnal wear (AOR = 3.03, 95% CI 1.24 to 7.40) predict the frequency of denture stomatitis. Thus, implant overdentures may reduce oral mucosal trauma and control denture stomatitis.

Asunto(s)

Prótesis Dental de Soporte Implantado/efectos adversos , Dentadura Completa Inferior/efectos adversos , Prótesis de Recubrimiento/efectos adversos , Mucosa Bucal/lesiones , Estomatitis Subprotética/etiología , Anciano , Anciano de 80 o más Años , Distribución de Chi-Cuadrado , Estudios Transversales , Femenino , Estudios de Seguimiento , Humanos , Arcada Edéntula/fisiopatología , Arcada Edéntula/rehabilitación , Masculino , Mandíbula , Maxilar , Oportunidad Relativa , Factores Socioeconómicos , Estadísticas no Paramétricas

RESUMEN

Sleep bruxism research diagnostic criteria (SB-RDC) have been applied since 1996. This study was performed to validate these criteria and to challenge the hypothesis that pain is associated with lower frequencies of orofacial activities. Polygraphic recordings were made of 100 individuals presenting with a clinical diagnosis of sleep bruxism and 43 control individuals. TwoStep Cluster analyses (SPSS) were performed with sleep bruxism variables to reveal groupings among sleep bruxers and control individuals. Participants completed questionnaires during screening, diagnosis, and recording sessions. Cluster analysis identified three subgroups of sleep bruxers. Interestingly, 45 of the 46 sleep bruxers with values below SB-RDC were classified in the low-frequency cluster. These individuals were more likely to complain of pain and fatigue of masticatory muscles than were the higher-frequency sleep bruxers (odds ratios > 3.9, p < 0.01). Sleep bruxers were distributed among three heterogeneous groups. Sleep bruxers with low frequencies of orofacial activities were more at risk of reporting pain.

Asunto(s)

Dolor Facial/etiología , Bruxismo del Sueño/clasificación , Bruxismo del Sueño/complicaciones , Adulto , Análisis de Varianza , Estudios de Casos y Controles , Análisis por Conglomerados , Electrodiagnóstico , Femenino , Humanos , Masculino , Músculos Masticadores/fisiopatología , Bruxismo del Sueño/diagnóstico , Estadísticas no Paramétricas , Encuestas y Cuestionarios

RESUMEN

Sleep bruxism (SB) subjects show a higher incidence of rhythmic masticatory muscle activity (RMMA) than control subjects. RMMA is associated with sleep micro-arousals. This study aims to: (i) assess RMMA/SB episodes in relation to sleep cycles; (ii) establish if RMMA/SB and micro-arousals occur in relation to the slow wave activity (SWA) dynamics; (iii) analyze the association between RMMA/SB and autonomic cardiac activity across sleep cycles. Two nights of polygraphic recordings were made in three study groups (20 subjects each): moderate to high SB, low SB and control. RMMA episodes were considered to occur in clusters when several groups of RMMA or non-specific oromotor episodes were separated by less than 100 s. Correlations between sleep, RMMA/SB index and heart rate variability variables were assessed for the first four sleep cycles of each study group. Statistical analyses were done with SYSTAT and SPSS. It was observed that 75.8% of all RMMA/SB episodes occurred in clusters. Micro-arousal and SB indexes were highest during sleep cycles 2 and 3 (P < 0.001). Within each cycle, micro-arousal and RMMA/SB indexes showed an increase before each REM sleep (P

Asunto(s)

Nivel de Alerta/fisiología , Corazón/inervación , Bruxismo del Sueño/fisiopatología , Bruxismo del Sueño/psicología , Sistema Nervioso Simpático/fisiopatología , Adulto , Estudios de Casos y Controles , Electrocardiografía , Femenino , Humanos , Masculino , Caracteres Sexuales , Trastornos del Despertar del Sueño/complicaciones , Trastornos del Despertar del Sueño/fisiopatología , Trastornos del Despertar del Sueño/psicología , Bruxismo del Sueño/complicaciones , Fases del Sueño/fisiología

RESUMEN

The efficacy of occlusal splints in diminishing muscle activity and tooth-grinding damage remains controversial. The objective of this study was to compare the efficacy and safety of an occlusal splint (OS) vs. a palatal control device (PCD). Nine subjects with sleep bruxism (SB) participated in this randomized study. Sleep laboratory recordings were made on the second night to establish baseline data. Patients then wore each of the splints in the sleep laboratory for recording nights three and four, two weeks apart, according to a crossover design. A statistically significant reduction in the number of SB episodes per hour (decrease of 41%, p = 0.05) and SB bursts per hour (decrease of 40%, p < 0.05) was observed with the two devices. Both oral devices also showed 50% fewer episodes with grinding noise (p = 0.06). No difference was observed between the devices. Moreover, no changes in respiratory variables were observed. Both devices reduced muscle activity associated with SB.

Asunto(s)

Ferulas Oclusales , Aparatos Ortodóncicos , Polisomnografía , Bruxismo del Sueño/terapia , Adulto , Análisis de Varianza , Estudios Cruzados , Deglución/fisiología , Femenino , Humanos , Masculino , Análisis por Apareamiento , Ventilación Pulmonar/fisiología , Seguridad , Síndromes de la Apnea del Sueño/terapia , Fases del Sueño/fisiología , Ronquido/terapia , Estadísticas no Paramétricas , Resultado del Tratamiento

RESUMEN

OBJECTIVES: Although patients with sleep bruxism (SB) show a higher incidence of rhythmic masticatory muscle activity (RMMA) during sleep than matched normal controls, they are good sleepers. Sleep macrostructure (e.g. total sleep time, sleep latency, number of awakenings or sleep stage shifts and sleep stage duration) is similar between groups. Differences in sleep microstructure between SB patients and normals have been investigated only in few studies. The aim of the present study was to quantify number of microarousals, K-complexes, K-alphas, EEG spindles, and the density of slow wave activity, in both groups, in order to better understand the pathophysiology of SB. METHODS: Ten normal sleepers were matched for age and gender with 10 patients who exhibited frequent tooth-grinding during sleep. Using quantitative polysomnographic measures, we compared the above-mentioned sleep variables in both groups. Data are presented as indices for total sleep and for consecutive non-rapid eye movement (non-REM) episodes over non-REM to rapid eye movement (REM) cycles and per hour of sleep. RESULTS: SB patients showed 6 times more RMMA episodes per hour of sleep than normals (P<0.001), with a higher frequency in the second and third non-REM to REM cycles. SB patients presented 42.7% fewer K-complexes per hour of stage 2 sleep, but only normals showed a decline from the first to fourth non-REM episode. Only 24% of SB-RMMA episodes were associated with K-complexes in 60 s. The number of K-alphas was 61% lower in SB patients, no change across non-REM episodes was noted. While no difference in electroencephalographic (EEG) spindles or slow wave activity (SWA) was observed between groups, EEG spindles increased and SWA decreased linearly over consecutive non-REM to REM cycles. CONCLUSIONS: According to our observations, good sleep in SB patients is characterized by a low incidence of K-complexes or K-alphas and by the absence of any difference in other sleep microstructure variables or SWA.

Asunto(s)

Electroencefalografía , Bruxismo del Sueño/diagnóstico , Bruxismo del Sueño/fisiopatología , Adulto , Nivel de Alerta/fisiología , Femenino , Humanos , Masculino , Masticación , Polisomnografía , Sueño/fisiología , Sueño REM/fisiología

RESUMEN

Sleep bruxism (SB) is an oral activity associated with jaw movements and tooth grinding. Sleep bruxism is believed to be highly variable over time, with subjects showing no activity on some nights and intense activity on others. Assessment of SB variability in individual patients is necessary for clinical trials designed to estimate the efficacy of SB management strategies. The present study analysed SB night-to-night variability over time in nine moderate to severe SB patients. Excluding the first night for habituation, a total of 37 nights were analysed, with a range of 2-8 nights per subject. The interval between the first and the last recording was between 2 months and 7.5 years. The outcomes were the number of SB episodes per hour, number of SB bursts per hour and number of SB episodes with grinding noise. The within subject variability of the three SB oromotor outcomes was evaluated using standard deviation (SD) and coefficient of variation. To verify the diagnosis of subjects over time, the values of the oromotor outcomes were compared with a standard research diagnostic cut-off: (1) Number of SB episodes per hour >4, (2) Number of SB bursts per hour >25, (3) Number of SB episodes with noise per night >1 (Lavigne et al. 1996). The mean coefficient of variation for the nine subjects was 25.3% for SB episodes per hour, 30.4% for SB bursts per hour and 53.5% for episodes with noise. Linear regression showed that the number of SB episodes per hour of stages 1 and 2 explains a large proportion of the variability. The SB diagnosis remained constant over time for every subject: 35 nights over 37 respected criteria 1 and 2, while grinding was present every night. These results indicate that while the SB diagnostic remains relatively constant over time in moderate to severe sleep bruxers, individual variability could be important in some SB patients.

Asunto(s)

Bruxismo/diagnóstico , Adulto , Bruxismo/epidemiología , Ritmo Circadiano/fisiología , Electroencefalografía , Electrooculografía , Femenino , Humanos , Masculino , Músculo Masetero/fisiología , Periodicidad , Estudios Retrospectivos , Índice de Severidad de la Enfermedad , Sueño REM/fisiología , Factores de Tiempo

RESUMEN

Rhythmic Masticatory Muscle Activity (RMMA) is frequently observed during sleep in normal subjects and sleep bruxers. We hypothesized that some normal subjects exhibit RMMA at a lower frequency than sleep bruxers. Polysomnographic data from 82 normal subjects were compared with data from 33 sleep bruxers. RMMA episodes were defined as three or more consecutive bursts of masseter EMG activity, with or without tooth-grinding. Such episodes were observed in nearly 60% of normal subjects. A lower frequency of episodes was noted in normal subjects than in bruxers. Sleep organization was similar between groups. Bruxers had twice as many masseter muscle bursts per episode and episodes of higher amplitude compared with controls with RMMA. The high prevalence of RMMA observed in normal subjects suggests that this activity is related to certain sleep-related physiological functions, including autonomic activation.

Asunto(s)

Músculo Masetero/fisiología , Bruxismo del Sueño/fisiopatología , Sueño/fisiología , Adolescente , Adulto , Factores de Edad , Anciano , Estudios de Casos y Controles , Electromiografía , Femenino , Humanos , Masculino , Músculo Masetero/fisiopatología , Persona de Mediana Edad , Actividad Motora , Músculos del Cuello/fisiología , Músculos del Cuello/fisiopatología , Polisomnografía , Estadísticas no Paramétricas

RESUMEN

AIMS: First, to evaluate possible orofacial morphologic differences between sleep bruxers and non-bruxers, and second, to determine possible correlations between morphologic factors and striatal D2 receptor expression in persons with sleep-related oromotor activities. METHODS: Twenty subjects were included in this study; half of them had polysomnographically confirmed oromotor values above the cutoff points for sleep bruxism. For all participants, 26 standard occlusal measures were recorded clinically and from dental study casts. In addition, 25 standard angular and linear measures were taken from standardized cephalometric films, and variables were derived to evaluate dental and skeletal relationships. Fourteen of the 20 participants had also participated in a previous study that included iodine-123-iodobenzamide (I-123-IBZM) and single-photon emission-computed tomography (SPECT). For them, the side-to-side difference in striatal D2 receptor binding was determined as the neurochemical outcome measure. RESULTS: Following the classical Bonferroni adjustment for multiple testing, no morphologic differences were found between the sleep bruxers and the non-bruxers. In addition, none of the morphologic variables were significantly associated with the neuroimaging data. CONCLUSION: Taking into account the low power of this retrospective, exploratory study, the results suggest that the orofacial morphology of sleep bruxers does not differ from that of non-bruxers. In addition, morphologic factors are probably not involved in the asymmetry in striatal D2 receptor distribution that was previously observed in association with sleep bruxism.

Asunto(s)

Cefalometría , Cuerpo Estriado/metabolismo , Oclusión Dental , Receptores de Dopamina D2/metabolismo , Bruxismo del Sueño/fisiopatología , Adulto , Distribución de Chi-Cuadrado , Cuerpo Estriado/diagnóstico por imagen , Arco Dental/anatomía & histología , Huesos Faciales/anatomía & histología , Femenino , Humanos , Yodobencenos , Masculino , Maloclusión/clasificación , Mandíbula/anatomía & histología , Maxilar/anatomía & histología , Modelos Dentales , Nariz/anatomía & histología , Polisomnografía , Radiofármacos , Estudios Retrospectivos , Silla Turca/anatomía & histología , Bruxismo del Sueño/diagnóstico por imagen , Bruxismo del Sueño/metabolismo , Estadística como Asunto , Estadísticas no Paramétricas , Tomografía Computarizada de Emisión de Fotón Único , Dimensión Vertical

RESUMEN

Many etiological factors have been suggested for sleep bruxism. Among these, elevated mental and physical alertness has been proposed to characterize sleep bruxers. The present study tests the hypothesis that, during the day-time, sleep bruxers are more vigilant and more prone to react to a motor command than are control subjects. Seven sleep bruxers, diagnosed polysomnographically according to validated research criteria, were matched for age and gender to seven control subjects. A simple reaction time task was selected to assess daytime vigilance and motor responsiveness. The following physiological measures were recorded: reaction time, error rate, electroencephalography, electrocardiography, electromyography, and video detection of body movements. Analysis of these variables showed no differences between groups. During the test, bruxers and controls showed a parallel decrease in EEG vigilance and heart rate over time. Frequency of orofacial and body movements was the same in both groups, and no clenching activity was observed during the experimental test. Subjects' visual analog scale ratings revealed that both controls and bruxers were more competitive after the test than before, and bruxers were slightly more anxious than controls before and after the test. Together, the results indicate that sleep bruxers are neither more vigilant nor more prone to react to a motor command during the daytime than are control subjects.

Asunto(s)

Nivel de Alerta/fisiología , Ritmo Circadiano/fisiología , Actividad Motora/fisiología , Bruxismo del Sueño/fisiopatología , Adulto , Análisis de Varianza , Electrocardiografía/estadística & datos numéricos , Electroencefalografía/estadística & datos numéricos , Electromiografía/estadística & datos numéricos , Femenino , Humanos , Masculino , Músculos Masticadores/fisiología , Selección de Paciente , Tiempo de Reacción/fisiología , Bruxismo del Sueño/psicología , Estadísticas no Paramétricas

RESUMEN

Cigarette smoking has been associated with sleep disturbances. However, little is known about how smoking affects restless legs syndrome (RLS) and sleep bruxism, two movement disorders associated with sleep. From a nationwide survey of 2,019 Canadian adults, we estimated the prevalence of smoking to be 36%. Although there was no difference between smokers and nonsmokers for RLS prevalence, almost twice as many smokers (12%) as nonsmokers (7%) were aware of experiencing sleep bruxism. The estimated risk of a smoker suffering from RLS was nonsignificant. On the other hand, the risk of a smoker grinding his or her teeth was moderate (odds ratio = 1.9). Analysis of sleep laboratory findings revealed no differences in motor RLS and periodic leg movements in sleep (PLMS) indices between smoking and nonsmoking patients; after adjustment for age, there were no differences in sleep efficiency, latency, number of awakenings, or the arousal index for the RLS/PLMS patients. Among those suffering from bruxism, smokers had more tooth-grinding episodes than did nonsmokers (35.0 vs. 7.0; p = 0.056); none of the sleep variables differentiated sleep bruxism smokers from nonsmokers. It appears that cigarette smoking does not influence RLS/PLMS, whereas the risk that smoking and tooth grinding are concomitant is moderate. Smoking was not significantly associated with more motor activity in RLS/PLMS, but more grinding was noted in sleep bruxism.

Asunto(s)

Bruxismo/etiología , Síndrome de las Piernas Inquietas/etiología , Fumar/efectos adversos , Adulto , Anciano , Concienciación , Bruxismo/epidemiología , Canadá/epidemiología , Estudios Transversales , Femenino , Encuestas Epidemiológicas , Humanos , Incidencia , Masculino , Persona de Mediana Edad , Oportunidad Relativa , Síndrome de las Piernas Inquietas/epidemiología , Factores de Riesgo , Fumar/epidemiología

RESUMEN

In a controlled polysomnographic (PSG) study that we recently performed in our laboratory, we noticed that some patients with a chief complaint of sleep bruxism reported concomitant non-myofascial pain in their masticatory muscles. To study the influence of such pain on the pattern of bruxism motor activity, we re-assessed the 2nd out of 2 consecutive PSG and masseter electromyographic (EMG) recordings of 7 bruxers without pain and 6 bruxers with concomitant jaw muscle pain. Among others, the selection of these patients was based on reports of current jaw muscle pain intensity, using 100-mm visual analogue scales. In our sample of bruxism patients with pain, levels of pain intensity did not differ significantly between bedtime and awakening in the morning. Although there were no significant differences between both subgroups of bruxers in the number of bruxism bursts per episode and the root-mean-squared EMG level per bruxism burst, bruxers with pain had 40% less bruxism episodes per hour of sleep. This suggests that non-myofascial jaw muscle pain decreases the number of initiations of bruxism episodes, but leaves their contents unaffected.

Asunto(s)

Bruxismo/fisiopatología , Electromiografía , Dolor Facial/fisiopatología , Músculo Masetero/fisiopatología , Sueño/fisiología , Adulto , Estudios de Casos y Controles , Enfermedad Crónica , Femenino , Humanos , Masculino , Evaluación de Resultado en la Atención de Salud , Dimensión del Dolor , Proyectos Piloto , Polisomnografía , Estudios Retrospectivos , Factores de Tiempo , Vigilia/fisiología

RESUMEN

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.

Asunto(s)

Bruxismo/diagnóstico , Polisomnografía , Sueño/fisiología , Adulto , Bruxismo/complicaciones , Bruxismo/fisiopatología , Estudios de Casos y Controles , Electromiografía , Músculos Faciales/fisiopatología , Dolor Facial/etiología , Femenino , Predicción , Humanos , Pierna/fisiología , Modelos Logísticos , Masculino , Músculos Masticadores/fisiopatología , Actividad Motora/fisiología , Boca/fisiopatología , Valor Predictivo de las Pruebas , Reproducibilidad de los Resultados , Sensibilidad y Especificidad , Fases del Sueño/fisiología , Abrasión de los Dientes/etiología