RESUMO
Masticatory muscle activity during sleep has been considered independent of variations in the structural characteristics of the dental occlusion. However, scientific evidence contradicting an occlusal causal role is missing. The purpose of this study was to test the null hypothesis that sleep bruxism (SB) is independent of the presence of occlusal interferences. A total of 17 healthy female subjects (mean [SD] age 24.9 [4.1] years) presenting with SB, and randomly divided into two groups, were evaluated after receiving either elimination of occlusal interferences (Test group) or elimination of sharp margins without change in occlusal contacts (Control group). Audio-video polysomnography (PSG) recordings were undertaken before and after treatment (mean [SD] duration 14.4 [3.8] months). Two subjects in each group (< 2 rhythmic masticatory muscle activity [RMMA]/h) were excluded for statistical analysis. During the total sleep time (TST), the Test group exhibited a higher reduction in frequency of episodes per hour than the Control group (p < 0.05). The reduction in duration of episodes was also higher in the Test group during the TST. The Test group presented an increase in sleep stage N3 (p < 0.05) at the final PSG when compared with the initial PSG, and a higher percentage of N3 (p < 0.05) at the final PSG when compared to the Control group. Elimination of occlusal interferences resulted in a significant reduction of masseter and temporal muscle activity during sleep in females presenting with SB. Based on these results, the null hypothesis is rejected. The hypothesis of occlusal interferences as a risk factor for SB is still patent.
Assuntos
Bruxismo do Sono , Humanos , Feminino , Adulto Jovem , Adulto , Bruxismo do Sono/complicações , Bruxismo do Sono/terapia , Ajuste Oclusal , Eletromiografia , Músculos da Mastigação/fisiologia , Músculo MasseterRESUMO
COVID-19 has probably contributed as a risk factor for sleep disturbance. Actigraphy has been used to evaluate sleep complaints in self-isolated populations and frontline doctors during the COVID-19 pandemic. This systematic review aims to summarize the impact of the COVID-19 pandemic on sleep through wrist actigraphy, estimating sleep latency, total sleep time, awakening-after-sleep onset, and sleep efficiency. Searches were conducted of observational studies on the PubMed, Embase, Scopus, Web of Science, and PEDro databases from 1 December 2019 to 31 December 2022. Ninety articles were found, and given the eligibility criteria, fifteen were selected. Six studies were classified by the National Health and Medical Research Council as evidence level IV, two studies as level III-3, and seven studies as level III-2. According to the ACROBAT-NRSI instrument, three studies were classified as having a "serious" risk of bias, two as having "critical" risk, four as having "moderate" risk, and six as having "low" risk. In the selected publications, various populations were evaluated via actigraphy during the COVID-19 pandemic, with reports of "poor" sleep quality. Actigraphy may be a relevant tool to assess individual day-night rhythms and provide recommendations under enduring pandemic conditions. Moreover, as actigraphy presents objective data for sleep evaluations, it is suggested that this method be used in similar pandemics and that actigraphy be included as part of the sleep hygiene strategy.
RESUMO
PURPOSE: Obstructive sleep apnea (OSA) is a common sleep disorder in Parkinson's disease (PD), but the relationship between these two conditions remains uncertain. Upper airway (UA) dysfunction in PD is well documented in some patients and is believed to be a reflex of the motor involvement of laryngopharyngeal muscles. The aim of this study is to determine whether UA dysfunction and laryngopharyngeal motor dysfunction (LMD) are involved in the obstructive phenomenon of OSA in PD. METHODS: Forty-eight PD patients underwent polysomnography for OSA diagnosis, functional evaluation of the UA by spirometry and a clinical protocol for analysis of laryngopharyngeal muscles and physical examination. RESULTS: Thirty-one participants (64.6%) fulfilled the criteria for OSA according to the International Classification of Sleep Disorders- third edition (at least respiratory disturbance index of five or higher per hour of sleep plus specific symptoms). UA obstruction was observed in 25% of participants and LMD in 60.4%. Among the clinical indicators of LMD, hypophonia was the most common (58.3%). Participants with LMD had a threefold greater chance of presenting with OSA than those without LMD did (OR = 3.49; 95% CI, 1.01-12.1; p = 0.044). Individuals with LMD had more UA dysfunction (37.9 vs 10.5%, p = 0.037), higher scores on UPDRS III (20 vs 15, p = 0.0005) and the Hoehn-Yahr scale (2.5 vs 2.0, p = 0.008), and higher frequencies of postural changes (51.7 vs 21.1%, p = 0.033) and motor phenomena (65.5 vs 31.6%, p = 0.021). Obesity, snoring, neck circumference, and the Mallampati score did not correlate with OSA in PD. CONCLUSION: LMD should be considered a factor that is involved in the obstructive phenomenon of UA in patients with OSA and PD.
Assuntos
Hipofaringe/fisiopatologia , Doença de Parkinson/fisiopatologia , Apneia Obstrutiva do Sono/fisiopatologia , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Polissonografia , EspirometriaRESUMO
Sleep disorders are common during the clinical course of the main neurodegenerative diseases. Among these disorders, obstructive sleep apnea has been extensively studied in the last decade and recent knowledge regarding its relationship with the neurodegenerative process points a bidirectional relationship. Neurodegenerative diseases can lead to functional changes in the respiratory system that facilitate the emergence of apnea. On the other hand, obstructive sleep apnea itself can lead to acceleration of neuronal death due to intermittent hypoxia. Considering that obstructive sleep apnea is a potentially treatable condition, its early identification and intervention could have a positive impact on the management of patients with neurodegenerative diseases.
Os distúrbios do sono são comuns ao longo do curso clínico das principais doenças neurodegenerativas. Dentre estes, a apneia obstrutiva do sono tem sido muito estudada na última década e avanços no conhecimento sobre sua relação com o processo neurodegenerativo tem apontando para uma relação bidirecional. As doenças neurodegenerativas podem levar a alterações funcionais no sistema respiratório que facilitam o surgimento da apneia, assim como, a própria apneia obstrutiva do sono, ao causar hipóxia intermitente, parece acarretar na aceleração do processo de morte neuronal. Considerando que a apneia obstrutiva do sono é uma condição potencialmente tratável, sua identificação e intervenção precoces podem ter impacto positivo no manejo de pacientes com doenças neurodegenerativas.