Topical Review: Sleep Bruxism, Headaches, and Sleep-Disordered Breathing in Children and Adolescents
Sleep bruxism, a well-known burden for dentists, is commonly observed in pediatric populations. Dentists are responsible for the detection and prevention of the detrimental consequences on the stomatognathic system that may occur in some patients with sleep bruxism. However, sleep bruxism is much more than tooth wear, since it is frequently associated with orofacial pain, headaches, and other more severe sleep disorders, such as sleep-disordered breathing. Although the mechanisms underlying the possible interactions among sleep bruxism, headaches, and sleep-disordered breathing need further research, these conditions are often concomitant. A literature search was performed to identify relevant publications related to the topic, which have been integrated in this topical review. The aim of this article was to provide a brief overview on sleep bruxism, headaches, and sleep-disordered breathing in pediatric patients and to promote a multispecialist approach (including dentists, sleep specialist physicians, and psychologists) in the diagnosis and management of these frequently associated disorders.
Available from: Lorenzo Loffredo
- "Flow-mediated dilatation (FMD) is considered a useful tool to assess endothelial dysfunction in humans  . Sleep disordered breathing (SDB) is very common in children [3e5] and includes diseases ranging from Primary Snoring (PS) to obstructive sleep apnea (OSA) . SDB is characterized by precocious cardiovascular abnormalities (e.g. "
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ABSTRACT: Oxidative stress plays a crucial role in impairing endothelial function in sleep disordered breathing (SDB) but the underlying mechanism is still undefined. The objective of this study was to evaluate the interplay between oxidative stress, assessed by serum isoprostanes (8-iso-PGF2α) and soluble NOX2-dp (sNOX2-dp), and endothelial function, assessed by flow-mediated dilation (FMD), in children with SDB and healthy controls (HC).
One-hundred forty-four children including 45 with primary snoring (PS), 22 with obstructive sleep apnea (OSA) and 67 HC were recruited in this study; in 15 out of 22 OSA children FMD, serum 8-iso-PGF2α and sNOX2-dp were assessed before and after one month post adeno-tonsillectomy (AT).
Compared with HC, OSA and PS children had significantly higher sNOX2-dp and serum 8-iso-PGF2α levels and lower FMD; compared with PS, FMD was significantly lower in OSA children. No significant difference for sNOX2-dp and serum 8-iso-PGF2α was observed between OSA and PS children. FMD was inversely correlated with sNOX2-dp levels (p < 0.001) and with serum 8-iso-PGF2α (p < 0.001). In multiple linear regression analysis, sNOX2-dp (p < 0.001) and serum 8-iso-PGF2α (p < 0.001) were the only independent predictive variables associated with FMD. AT significantly decreased sNOX2-dp and serum 8-iso-PGF2α levels (from 38.2 ± 8.8 to 22.4 ± 11.1 pg/ml, p < 0.001, and from 281.4 ± 69.7 to 226.0 ± 66.4 pg/ml, p < 0.001, respectively); conversely, FMD significantly increased after AT in OSA children (from 3.0 ± 1.5 to 8.0 ± 2.8%, p < 0.001).
This study suggests that NOX2-derived oxidative stress is involved in artery dysfunction in SDB children. Such hypothesis is reinforced by FMD improvement after AT coincidentally with oxidative stress lowering.
URL: http://www.clinicaltrials.gov. Unique identifier: NCT02247167.
Copyright © 2015. Published by Elsevier Ireland Ltd.
Available from: Anders Wänman
- "Their answers should, thus, be understood as a self-reported condition and interpreted with due caution. Overloading of jaw muscles and muscle hyperactivity during sleep are two conditions that may share common risk factors and co-morbidities and it seems reasonable to assume that these conditions may contribute to headaches  . "
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Headaches represent a significant public health problem, but the knowledge of factors specifically related to incidence and persistence of headaches is still limited. The aim of this study was to evaluate whether gender, self-reported bruxism and variations in the dental occlusion contribute to onset and persistence of frequent headaches.
Materials and methods:
The study population comprised 280 dental students, examined annually in a 2-year prospective study with a questionnaire and a clinical examination of the jaw function. In the analysis subjects were dichotomized into cases with frequent (once a week or more) or without frequent headaches (controls). The 2-year cumulative incidence was based on subjects without frequent headaches at baseline. Cases with 2-year persistent headaches reported such symptoms at all three examinations. Self-reported bruxism and factors in the dental occlusion at baseline were used as independent variables in logistic regression analyses.
The 2-year cumulative incidence of frequent headaches was 21%. Female gender (OR = 2.6; CI = 1.3-5.4), self-reported bruxism (OR = 2.3; CI = 1.2-4.4) and mandibular instability in intercuspal position (OR = 3.2; CI = 1.4-7.5) were associated with incidence of frequent headaches. Persistent headaches during the observation period were present in 12 individuals (4%) and significantly related to mandibular instability in intercuspal position (OR = 6.1; CI = 1.6-22.6).
The results indicate that female gender, self-reported bruxism and mandibular instability in intercuspal position are of importance in the development of frequent headaches. In management of these patients a multidisciplinary approach including dentists may be important and, thus, advocated.
Available from: Gilles J Lavigne
- "However, because approximately 20% of SB motor event genesis has not yet been clearly explained, this explanation is not exclusive (Carra et al., 2012b; Lavigne et al., 2011). SB may also occur concomitantly or secondary to other sleep disorders (Carra et al., 2012a,b; Kato et al., 2013a). Obstructive sleep apnea– hypopnea syndrome (OSAHS) may be a sleep disorder that is concomitant with SB (Inoko et al., 2004; Kato et al., 2013b; Okeson et al., 1991; Phillips et al., 1986; Sj€ oholm et al., 2000). "
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ABSTRACT: There is some evidence suggesting that obstructive sleep apnea-hypopnea syndrome is concomitant with sleep bruxism. The aim of this study was to investigate the temporal association between sleep apnea-hypopnea events and sleep bruxism events. In an open observational study, data were gathered from 10 male subjects with confirmed obstructive sleep apnea-hypopnea syndrome and concomitant sleep bruxism. Polysomnography and audio-video recordings were performed for 1 night in a sleep laboratory. Breathing, brain, heart and masticatory muscle activity signals were analysed to quantify sleep and sleep stage duration, and number and temporal distribution of apnea-hypopnea events and sleep bruxism events. Apnea-hypopnea events were collected within a 5-min time window before and after sleep bruxism events, with the sleep bruxism events as the pivotal reference point. Two temporal patterns were analysed: (i) the interval between apnea-hypopnea events termination and sleep bruxism events onset, called T1; and (ii) the interval between sleep bruxism events termination and apnea-hypopnea events onset, called T2. Of the intervals between sleep bruxism events and the nearest apnea-hypopnea event, 80.5% were scored within 5 min. Most intervals were distributed within a period of <30 s, with peak at 0-10 s. The T1 interval had a mean length of 33.4 s and was significantly shorter than the T2 interval (64.0 s; P < 0.05). Significantly more sleep bruxism events were scored in association with the T1 than the T2 pattern (P < 0.05). Thus, in patients with concomitant obstructive sleep apnea-hypopnea syndrome and sleep bruxism, most sleep bruxism events occurred after sleep apnea-hypopnea events, suggesting that sleep bruxism events occurring close to sleep apnea-hypopnea events is a secondary form of sleep bruxism.
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