Article

Sleep bruxism: validity of clinical research diagnostic criteria in a controlled polysomnographic study.

Faculté de médecine dentaire, Université de Montréal, Centre-Ville, Canada.
Journal of Dental Research (Impact Factor: 4.14). 02/1996; 75(1):546-52. DOI: 10.1177/00220345960750010601
Source: PubMed

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.

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Available from: Gilles J Lavigne, Jun 14, 2014
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    • "Regular Research Paper expected that the pace of SB activity would be correlated with that of chewing activity. The gold standard for the assessment of RMMA activity during sleep is polysomnography, which allows bruxism episodes to be analysed in relation to several bioelectric, video and audio signals in a controlled experimental environment , thus limiting the confounding of bruxism scoring due to the presence of various types of orofacial activities during sleep (Lavigne et al., 1996). However, polysomnography is expensive and requires a specialized clinic. "
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    ABSTRACT: The masticatory central pattern generator (CPG) may be implicated in the pathophysiology of sleep bruxism (SB). The aim of this study was to compare rhythmic masticatory muscle activity (RMMA) occurring during sleep related to SB with that of natural voluntary chewing in a sample of sleep bruxers. It was hypothesized that the pace of RMMA during sleep is correlated with the chewing pace. Electromyographic (EMG) surface activity was recorded unilaterally from the masseter muscle of 13 participants diagnosed with SB (mean age ± standard deviation =26.1 ± 9.0 years) by means of portable recorders. For each participant, recordings were carried out in the natural environment setting, always including the dinner time and the entire sleeping period. The time-frequency features of RMMA episodes were extracted automatically offline using a previously validated algorithm. Comparisons between chewing and SB activity indicated that chewing RMMA episodes almost doubled sleep RMMA in duration and power. The mean frequency of SB episodes was 1.0 ± 0.3 Hz, whereas the mean frequency of chewing episodes was 1.5 ± 0.4 Hz. The pace of SB and that of chewing were not correlated significantly (R = -0.13; P = 0.96). We conclude that sleep RMMA is not related to that of chewing. Despite both activities being accompanied by rhythmic jaw contractions, the pace-generating mechanism of SB may be independent from that of chewing.
    Journal of Sleep Research 05/2013; DOI:10.1111/jsr.12057 · 2.95 Impact Factor
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    • "Data were visually scored according to the American Academy of Sleep Medicine criteria [18] for offline analysis. Despite the absence of audio–video recordings, RMMA was scored according to standard published rules [19]. Breathing events were scored according to the American Academy of Sleep Medicine criteria for children [18] [20]. "
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    ABSTRACT: OBJECTIVES: Sleep bruxism (SB) frequently is associated with other sleep disorders and pain concerns. Our study assesses the efficacy of a mandibular advancement appliance (MAA) for SB management in adolescents reporting snoring and headache (HA). METHODS: Sixteen adolescents (mean age, 14.9±0.5) reporting SB, HA (>1d/wk), or snoring underwent four ambulatory polysomnographies for baseline (BSL) and while wearing MAA during sleep. MAA was worn in three positions (free splints [FS], neutral position [NP], and advanced to 50% of maximum protrusion [A50]) for 1week each in random order (FS-NP-A50 or NP-A50-FS; titration order, NP-A50). Reports of HA were assessed with pain questionnaires. RESULTS: Overall, sleep variables did not differ across the four nights. SB index decreased up to 60% with MAA in A50 (P=.004; analysis of variance). Snoring was measured as the percentage of sleep time spent snoring. The subgroup of snorers (n=8) showed significant improvement with MAA (-93%; P=.002). Initial HA intensity was reported at 42.7±5/100mm, showing a decreasing trend with MAA (-21% to -51%; P=.07). CONCLUSION: Short-term use of an MAA appears to reduce SB, snoring, and reports of HA. However, interactions between SB, breathing during sleep, and HA as well as the long-term effectiveness and safety of MAA in adolescents need further investigation.
    Sleep Medicine 05/2013; 14(7). DOI:10.1016/j.sleep.2013.03.009 · 3.10 Impact Factor
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    • "Confounding orofacial activities like swallowing or sleep talking cannot be identified on the basis of electromyographic recordings alone. Polysomnographic recordings would be necessary in order to identify specific sleep bruxism [44]. However, Gallo et al. [40] have shown high concordance of electromyographic and polysomnographic recordings and confirmed the reliability of electromyography to detect orofacial events. "
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    ABSTRACT: Temporomandibular disorders (TMD) have often been related to sleep bruxism and elevated nocturnal masseter muscle activity (NMMA). However, previous studies have revealed controversial results, and the role of somatization, depression and anxiety has not been studied in this context. The aim of this study was to investigate the association between NMMA and pain intensity, TMD related symptoms, somatoform symptoms, depression, and anxiety in chronic TMD. Thirty-six subjects with chronic painful TMD, 34 subjects with pain free bruxism, and 36 healthy controls recorded their nocturnal masseter muscle activity during three consecutive nights with portable devices. In addition, participants completed pain diaries and questionnaires. Diagnoses were established using the research diagnostic criteria for TMD. Subjects with chronic TMD reported a reduced general health state (p<.001), higher levels of somatoform symptoms (p<.001), depression (p<.05), and anxiety (p<.001) compared to control subjects with or without sleep bruxism. The amount of NMMA did not differ significantly between the groups. In subjects with TMD, pain intensity was not related to NMMA. However, higher NMMA was related to higher intensity of jaw related symptoms such as headache or tinnitus, and higher somatization in general. Chronic TMD is associated with elevated levels of psychopathology. These findings suggest a common link between NMMA, somatization, and symptom intensity in chronic TMD.
    Journal of psychosomatic research 10/2012; 73(4):307-12. DOI:10.1016/j.jpsychores.2012.07.008 · 2.84 Impact Factor
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