Ambulatory polysomnography for the assessment of sleep bruxism

Department of Prosthodontics and Material Sciences, University of Muenster, Muenster, Germany.
Journal of Oral Rehabilitation (Impact Factor: 1.68). 09/2008; 35(8):572-6. DOI: 10.1111/j.1365-2842.2008.01902.x
Source: PubMed


Ambulatory polysomnography (PSG) is introduced as a new method for assessing sleep bruxism. Nocturnal recordings of masseter electromyography (EMG), electro-encephalography, electro-oculography, electrocardiography, thoracic effort and body position allow for the detection of typical nocturnal masseter activity as well as the determination of sleep stages. Twelve patients with a clinical diagnosis of bruxism were assessed with the ambulatory PSG, all of them fulfilled diagnostic PSG criteria according to Kato et al. (Dent Clin North Am. 2001; 45: 657-684). Per hour of sleep patients showed 34.2 (+/-10.6) EMG bursts and 5.6 (+/-1.3) sleep bruxism episodes. Because of the ability to determine sleep stages and the application in the home environment the ambulatory PSG represents a cost-saving alternative to sleep laboratory investigations that might be especially useful in field studies and clinical application.

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Available from: Stephan Doering, Aug 31, 2015
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    • "Sleep bruxism was diagnosed according to (Kato et al., 2001), who presented diagnostic criteria for ambulatory electromyography ⁄ electrocardiography (EMG ⁄ ECG) recordings and for polysomnography in a sleep laboratory, respectively. We combined the criteria of these two approaches for use in ambulatory polysomnography, as reported previously (Doering et al., 2008). Patients with SB had more than four bruxism episodes or more than 25 EMG bursts per hour of sleep. "
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    ABSTRACT: Sleep bruxism is assumed to be triggered by a dysfunctional subcortical and cortical network. This study investigates sensorimotor cortical activation in patients with sleep bruxism during clenching and chewing. Nine polysomnographically diagnosed patients and nine healthy control subjects underwent magnetoencephalography (MEG). During clenching and chewing, patients with bruxism revealed significantly larger event-related desynchronization in the somatomotor area (Brodmann area 4) than healthy subjects. Group differences in the muscle activity were ruled out by electromyography (EMG) assessments during MEG. This result might be regarded as a consequence of increased sensorimotor cortical representation of the tongue and chewing musculature due to an enhanced parafunctional muscle activity in bruxers potentially triggered by occlusal factors. Alternatively, a secondary activation of cortical structures during sleep bruxism in the context of an activated network of subcortical and cortical structures might lead to increased cortical representation of the chewing musculature via use dependent plasticity.
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    ABSTRACT: Several issues remain to be clarified in the future research and management of SB. It is important to differentiate SB from other normal sleep orofacial activities and concomitant sleep disorders. Other orofacial activities may obscure the diagnosis of SB and may give an ambiguous clinical picture when evaluating treatment efficacy. Laboratory recordings provide a more specific diagnosis. Most of the clinical signs (e.g., tooth wear, masseter hypertrophy) are not exclusive to SB but could be concomitant with other habits or activities during wakefulness. No pathologic features in the central nervous system, such as a dysfunction of the dopaminergic system, have been observed in SB patients. Recent neurophysiologic studies have suggested that SB is a powerful microarousal event associated with central and autonomic nervous system activity during sleep. The additive contribution of psychosocial stress cannot be overlooked. There have been no recent major breakthroughs in SB management. Cognitive and behavioral managements, which include stress management, lifestyle changes, or improved coping mechanisms, may be beneficial. Oral splint appliances are useful to protect teeth from damage. A few medications (e.g., benzodiazepines, muscle relaxants) may be helpful for a short-term period, particularly when there is secondary pain, but controlled studies are needed to assess their efficacy, safety, and patient acceptance and tolerance.
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