Assessment of sleep parameters during contingent electrical stimulation in subjects with jaw muscle activity during sleep: A polysomnographic study
Department of Clinical Oral Physiology, School of Dentistry, Aarhus University, Aarhus, Denmark. European Journal Of Oral Sciences
(Impact Factor: 1.49).
06/2011; 119(3):211-8. DOI: 10.1111/j.1600-0722.2011.00822.x
Jadidi F, Nørregaard O, Baad-Hansen L, Arendt-Nielsen L, Svensson P. Assessment of sleep parameters during contingent electrical stimulation in subjects with jaw muscle activity during sleep: a polysomnographic study. Eur J Oral Sci 2011; 119: 211–218. © 2011 Eur J Oral Sci
There is emerging evidence that feedback techniques based on contingent electrical stimulation (CES) have an inhibitory effect on the electromyogram (EMG) activity of jaw-closing muscles and therefore could be useful in the management of sleep bruxism. This polysomnographic (PSG) study was designed to investigate the effect of CES on PSG parameters in subjects with self-reported bruxism. Fourteen subjects underwent a full PSG investigation in the laboratory for three consecutive nights – one night of adaptation, one night without CES, and one night with CES – in a randomized order. During all sessions the EMG activity was recorded by a portable feedback device from the temporalis muscle. An electrical pulse, which was adjusted to a moderate, but non-painful, intensity, was applied to subjects during the session with CES, if jaw-muscle activity was detected. The total sleep time, the number of micro-arousals per hour of sleep, the time spent in sleep stages 3 and 4 and in rapid eye movement (REM) sleep, and the number of periodic limb movements, were not influenced by CES. The number of EMG episodes per hour of sleep during the nights with and without CES was not significantly different. The present study suggests that CES at non-painful intensities does not cause major arousal responses in any of the sleep parameters assessed in this study.
Available from: Nina Caspersen
- "The sleep quality questionnaire contains 20 questions . Its purpose is to determine the quality of sleep, frequency of snoring, and tiredness during daytime [12, 15]. Detailed information about the sleep/tiredness/snoring instrument has also been published [8, 12]. "
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ABSTRACT: Introduction. Tension-Type Headache (TTH) is the most prevalent headache often associated with impaired function and quality of life. Temporomandibular Disorders (TMD) and TTH frequently coexist; characterized by pericranial tenderness and impact on daily life. We aim to apply a standardized questionnaire for TMD to characterize and analyse an eventual relation between sleep and oral health in TTH in a controlled design. Material and Methods. 58 consecutive TTH patients and 58 healthy controls were included. The Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD) questionnaire, Oral Health Impact profile (OHIP) and questionnaires for sleep were applied. Results. TTH-patients had significantly higher pain scores (P < 0.001), decreased quality of life (P < 0.001), and higher total sleep scores (P < 0.001) compared to controls. Conclusion. For the first time we have identified a clear relation between TTH and TMD symptoms, depression, anxiety, poor sleep, and impairments of oral function in carefully classified patients. These findings indicate a close, but incomplete, overlap between TTH and TMD. Their underlying pathophysiological mechanisms need further research.
Available from: Luca Guarda-Nardini Md
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ABSTRACT: The aims of this investigation were to report the frequency of temporomandibular disorders (TMD) diagnoses and the prevalence of self-reported awake and sleep bruxism as well as to describe the possible differences between findings of two specialised centres as a basis to suggest recommendations for future improvements in diagnostic homogeneity and accuracy. A standardised Research Diagnostic Criteria for TMD (RDC/TMD) assessment was performed on patients attending both TMD Clinics, viz., at the University of Padova, Italy (n=219; 74% women) and at the University of Tel Aviv, Israel (n=397; 79% women), to assign axis I physical diagnoses and to record data on self-reported awake and sleep bruxism. Significant differences were shown between the two clinic samples as for the frequency of TMD diagnoses (chi-square, P<0·001) and the prevalence of at least one positive response to bruxism items (chi-square, P<0·001). The more widespread use of TMJ imaging techniques in one clinic sample led to a higher prevalence of multiple diagnoses, and the higher prevalence of self-reported bruxism in patients with myofascial pain alone described in the other clinic sample was not replicated, suggesting that the different adoption of clinical and imaging criteria to diagnose TMD may influence also reports on their association with bruxism. From this investigation, it emerged that the features of the study samples as well as the different interpretation of the same diagnostic guidelines may have strong influence on epidemiological reports on bruxism and TMD prevalence and on the association between the two disorders.
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To determine the effect of contingent electrical stimulation (CES) on jaw muscle activity during sleep in a double-blinded randomized controlled trial (RCT).
Materials and methods:
Eleven patients with myofascial TMD (mean age 37 years) and with a clinical diagnosis of bruxism were included. EMG activity (Grindcare®) was recorded from the anterior temporalis muscle during sleep and analyzed online. Jaw muscle activity related to clenching or grinding triggered an electrical square-wave pulse train (450 ms) adjusted to a clear, but non-painful intensity. TMD patients were randomized into two groups: active treatment with CES or no CES (placebo). Number of EMG episodes/hour sleep was the primary outcome parameter. The following variables were assessed as secondary outcome parameters; number of painful muscles, maximum pain-free jaw opening, characteristic pain intensity, depression scores and Oral Health Impact Profile scores. Numerical Rating Scale scores for self-reported pain and muscle tension were registered for at least 4 nights per week during the experiment.
The number of EMG episodes/hour sleep was significantly reduced (52 ± 12%) in the CES group during the sessions with CES (ANOVA: p = 0.021) compared to baseline. There were no significant differences in the secondary outcome parameters (ANOVA: p > 0.513) or pain or muscle tension scores between groups (p = 0.645). The average duration of sleep hours during the nights with and without CES was not significantly different (p = 0.646).
These results demonstrate a significant inhibitory effect of CES on jaw muscle EMG activity during sleep in a RCT, but with no effects on self-reported pain.
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