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Sleep bruxism associated with obstructive sleep apnoea syndrome – A pilot study using a new portable device
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"apellidos" => "Pérez-Padilla" ] ] ] ] ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173511516301439?idApp=UINPBA00004E" "url" => "/21735115/0000002300000001/v1_201701210027/S2173511516301439/v1_201701210027/en/main.assets" ] "itemAnterior" => array:19 [ "pii" => "S2173511516300884" "issn" => "21735115" "doi" => "10.1016/j.rppnen.2016.07.002" "estado" => "S300" "fechaPublicacion" => "2017-01-01" "aid" => "1188" "copyright" => "Sociedade Portuguesa de Pneumologia" "documento" => "article" "crossmark" => 1 "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/" "subdocumento" => "fla" "cita" => "Rev Port Pneumol. 2017;23:17-21" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 1428 "formatos" => array:3 [ "EPUB" => 200 "HTML" => 618 "PDF" => 610 ] ] "en" => array:11 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Original article</span>" "titulo" => "Cystic fibrosis – Comparison between patients in paediatric and adult age" "tienePdf" => "en" "tieneTextoCompleto" => "en" "tieneResumen" => "en" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "17" "paginaFinal" => "21" ] ] "contieneResumen" => array:1 [ "en" => true ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "V. Santos, A.V. Cardoso, C. Lopes, P. Azevedo, F. Gamboa, A. Amorim" "autores" => array:6 [ 0 => array:2 [ "nombre" => "V." "apellidos" => "Santos" ] 1 => array:2 [ "nombre" => "A.V." "apellidos" => "Cardoso" ] 2 => array:2 [ "nombre" => "C." "apellidos" => "Lopes" ] 3 => array:2 [ "nombre" => "P." "apellidos" => "Azevedo" ] 4 => array:2 [ "nombre" => "F." "apellidos" => "Gamboa" ] 5 => array:2 [ "nombre" => "A." 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"apellidos" => "Winck" "email" => array:1 [ 0 => "mi_winck@hotmail.com" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "M." "apellidos" => "Drummond" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 2 => array:3 [ "nombre" => "P." "apellidos" => "Viana" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "aff0015" ] ] ] 3 => array:3 [ "nombre" => "J.C." "apellidos" => "Pinho" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 4 => array:3 [ "nombre" => "J.C." "apellidos" => "Winck" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] ] "afiliaciones" => array:3 [ 0 => array:3 [ "entidad" => "Faculdade de Medicina Dentária da Universidade do Porto, Porto, Portugal" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Faculdade de Medicina da Universidade do Porto, Porto, Portugal" "etiqueta" => "b" "identificador" => "aff0010" ] 2 => array:3 [ "entidad" => "Centro Hospitalar São João, Porto, Portugal" "etiqueta" => "c" "identificador" => "aff0015" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1705 "Ancho" => 3076 "Tamanyo" => 264644 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Nox-T3 image.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Sleep bruxism (SB) is a very frequent sleep-related movement disorder, characterized by the grinding of teeth and rhythmic masticatory muscle activity that may contribute to increased risk of hypertension and eventually cardiovascular disease.<a class="elsevierStyleCrossRef" href="#bib0135"><span class="elsevierStyleSup">1</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">Obstrutive sleep apnea syndrome (OSAS) is also a highly prevalent sleep disorder, strongly associated with major cardiovascular complications.<a class="elsevierStyleCrossRef" href="#bib0140"><span class="elsevierStyleSup">2</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">In 1986 Phillips et al.<a class="elsevierStyleCrossRef" href="#bib0145"><span class="elsevierStyleSup">3</span></a> demonstrated a positive relationship between sleep apnea and tooth-clenching episodes, likely to result from the frequent arousals following apneic episodes. In fact, more recent studies show that 35% of tooth grinders also present snoring and 16.7% present OSAS and close to 30% of OSAS patients complain of bruxism.<a class="elsevierStyleCrossRef" href="#bib0150"><span class="elsevierStyleSup">4</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">Polysomonographic criteria remain the gold standard for SB,<a class="elsevierStyleCrossRef" href="#bib0155"><span class="elsevierStyleSup">5</span></a> however new valid portable instrumental diagnostic approaches are emerging.<a class="elsevierStyleCrossRef" href="#bib0160"><span class="elsevierStyleSup">6</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">The aim of our pilot study was to evaluate the presence and relationship of SB in a population of OSAS using a new cardio-respiratory polygraphy device that can monitor audio and EMG of the masseter muscles.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Methods</span><p id="par0030" class="elsevierStylePara elsevierViewall">Inclusion criteria: all consecutive patients aged between 18 and 90 years, referred for suspicion of OSAS and SB. Exclusion criteria: cognitive disability, avoidance of performance of the home sleep study and other diseases that increase the risk of SB.<a class="elsevierStyleCrossRef" href="#bib0165"><span class="elsevierStyleSup">7</span></a> Every single patient answered a questionnaire including six bruxism questions<a class="elsevierStyleCrossRef" href="#bib0170"><span class="elsevierStyleSup">8</span></a> and filled in a general sleep disorders questionnaire (SDQ).<a class="elsevierStyleCrossRef" href="#bib0175"><span class="elsevierStyleSup">9</span></a> Patients with both OSA symptoms and at least one positive question on the bruxism questionnaire<a class="elsevierStyleCrossRef" href="#bib0170"><span class="elsevierStyleSup">8</span></a> were selected.</p><p id="par0035" class="elsevierStylePara elsevierViewall">In three cases we performed orofacial examination checking for clinical signs associated with SB.<a class="elsevierStyleCrossRefs" href="#bib0180"><span class="elsevierStyleSup">10,11</span></a></p><p id="par0040" class="elsevierStylePara elsevierViewall">The diagnosis of OSAS and bruxism was based on home portable cardiorespiratory polygraphy (Nox-T3 device, ResMed), that included monitoring of heart rate, nasal airflow, snoring, chest wall and abdominal excursion, oxygen saturation and body position. This device also recorded audio and bilateral masseter EMG (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>). Patients were classified as bruxers according to the following criteria<a class="elsevierStyleCrossRefs" href="#bib0155"><span class="elsevierStyleSup">5,12</span></a>: SB index of >2.0 events was used to define sleep bruxism (mild bruxism was defined as ≥2.0/h and severe bruxism as ≥4.0/h)<a class="elsevierStyleCrossRef" href="#bib0195"><span class="elsevierStyleSup">13</span></a>; a minimum of 2 audible tooth-grinding episodes confirmed with audio recordings (coincident with the EMG bursts) corroborated the diagnosis.<a class="elsevierStyleCrossRef" href="#bib0155"><span class="elsevierStyleSup">5</span></a></p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0045" class="elsevierStylePara elsevierViewall">Bruxism episodes were classified as: phasic, tonic or mixed based on the AASM criteria.<a class="elsevierStyleCrossRef" href="#bib0200"><span class="elsevierStyleSup">14</span></a> To be considered bruxism, EMG activity had to be at least twice the amplitude of the background EMG. Moreover EMG bursts should not be separated by >3<span class="elsevierStyleHsp" style=""></span>s to be considered part of the same episode.</p><p id="par0050" class="elsevierStylePara elsevierViewall">Relationship between SB episodes and respiratory events were analyzed through the apnoea to bruxism index defined by the number of episodes per hour of sleep (phasic, tonic and mixed) where apnoea was scored after each episode of bruxism.</p><p id="par0055" class="elsevierStylePara elsevierViewall">Sleep technicians carried out a manual analysis of the recordings, scoring respiratory events according with established criteria.<a class="elsevierStyleCrossRef" href="#bib0205"><span class="elsevierStyleSup">15</span></a></p><p id="par0060" class="elsevierStylePara elsevierViewall">The Noxturnal software offered automatic bruxism analysis of both phasic and tonic events along with bruxism reports, developed by the manufacturer according to the standards set out in the Principles and Practices of Sleep Medicine, 4th edition (Nox Medical's Noxturnal Software Version 3.1.1).<a class="elsevierStyleCrossRef" href="#bib0210"><span class="elsevierStyleSup">16</span></a> The same technician double checked the automatically analyzed events by consulting the audio recordings, which made the scoring result more precise.</p><p id="par0065" class="elsevierStylePara elsevierViewall">Patients were diagnosed with OSAS if they had an apnoea/hypopnea index (AHI) of ≥15<span class="elsevierStyleHsp" style=""></span>events/h or ≥5<span class="elsevierStyleHsp" style=""></span>events/h plus symptoms. Severity was defined according to AHI: AHI<span class="elsevierStyleHsp" style=""></span>><span class="elsevierStyleHsp" style=""></span>5/h, 15/h and 30/h, which were respectively considered mild, moderate and severe OSAS.<a class="elsevierStyleCrossRef" href="#bib0205"><span class="elsevierStyleSup">15</span></a></p><p id="par0070" class="elsevierStylePara elsevierViewall">When enrolling, all patients provided written informed consent and the study was approved by the Ethical Committee of Centro Hospitalar São João (CES no. 278.14).</p><p id="par0075" class="elsevierStylePara elsevierViewall">Demographic data, information on smoking habits, medical background and sleep history were also collected. Subjective sleepiness was measured using the Epworth Sleepiness Scale (ESS),<a class="elsevierStyleCrossRef" href="#bib0215"><span class="elsevierStyleSup">17</span></a> height, weight, neck circumference and arterial blood pressure were also measured.</p><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Statistical analysis</span><p id="par0080" class="elsevierStylePara elsevierViewall">Quantitative data were described by the calculation of the mean and standard deviation. Qualitative variables were expressed in number of events and were compared with Chi-square test. Spearman correlation was performed to measure the linear correlation between metric variables.</p><p id="par0085" class="elsevierStylePara elsevierViewall">Statistical analysis was performed using software Statistical Package for the Social Science v. 22.0 (SPSS 22) and the statistical significance was set at <span class="elsevierStyleItalic">p</span> value<span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>0.05.</p></span></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Results</span><p id="par0090" class="elsevierStylePara elsevierViewall">During the study period (March–June 2015), 46 patients were referred for suspected OSAS but without any positive questions on the bruxism questionnaire.<a class="elsevierStyleCrossRef" href="#bib0170"><span class="elsevierStyleSup">8</span></a> From 11 with OSAS suspicion and least one positive question on the bruxism questionnaire we studied 9 who were confirmed to have OSAS (<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>).</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0095" class="elsevierStylePara elsevierViewall">The majority of patients were male, overweight, with a mean age of 46.3<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>11.3 years and mildly sleepy. 29% had arterial hypertension and one third were smokers. Six patients (66.7%) had mild and 3 (33.4%) had moderate OSAS.</p><p id="par0100" class="elsevierStylePara elsevierViewall">The mean SB index was 5.12/h<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>3.6 and 77.8% of patients had criteria for SB (22.2% mild and 55.6% severe). Phasic events predominated (72.7%) with an index of 3.7/h<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>3.0. Tonic events index was 1.3/h<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>1.0 and mixed 0.1/h<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>0.3. We found a mean of 10.7<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>9.2 tooth grinding episodes per night. All patients except two (77.8%) had more than two audible tooth-grinding episodes confirmed with audio. These two patients were the ones with the lowest SB index (1.0 and 1.4 per hour). Only in one patient could we not detect tooth grinding episodes. There was a statistically significant positive correlation between tooth grinding episodes and SB index and phasic event index (<span class="elsevierStyleItalic">R</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.879, <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.002 and <span class="elsevierStyleItalic">R</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.866, <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.003 respectively, Spearman correlation).</p><p id="par0105" class="elsevierStylePara elsevierViewall">Looking at the bruxism questionnaire 55.6% of the patients had criteria for bruxism. None of the patients with mild polygraphic bruxism criteria had subjective bruxism criteria, but 80% of patients with severe polygraphic bruxism had subjective bruxism criteria.</p><p id="par0110" class="elsevierStylePara elsevierViewall">All the patients with polygraphic bruxism in which orofacial examination was possible (<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>3) had tooth wear.</p><p id="par0115" class="elsevierStylePara elsevierViewall">Mean apnoea to bruxism index was 0.4/h, meaning that only a minority of SB events were not secondary to OSAS (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>). We could not find any significant correlation between AHI and bruxism index or phasic bruxism index (<span class="elsevierStyleItalic">R</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>−0.632 and <span class="elsevierStyleItalic">R</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>−0.611, <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>><span class="elsevierStyleHsp" style=""></span>0.05, Pearson correlation).</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Discussion</span><p id="par0120" class="elsevierStylePara elsevierViewall">In this pilot study we show that OSAS patients had a very high SB prevalence (77.8%) using a new home polygraphy system with EMG recording.</p><p id="par0125" class="elsevierStylePara elsevierViewall">In our small sample of OSAS patients, SB was highly prevalent, higher than in the previous studies by Sjöholm et al.<a class="elsevierStyleCrossRef" href="#bib0190"><span class="elsevierStyleSup">12</span></a> and Hosoya et al.<a class="elsevierStyleCrossRef" href="#bib0220"><span class="elsevierStyleSup">18</span></a> using PSG, where the authors found SB in a sample of 21 and 67 patients with OSAS, respectively 47.6% and 47.8% of cases. In fact we cannot exclude some recruitment bias that may have selected more symptomatic cases. Moreover due to the skills needed to perform home polygraphy with masseter EMG, patients studied were relatively younger than the typical OSA population.</p><p id="par0130" class="elsevierStylePara elsevierViewall">We cannot exclude the fact that other confounding orofacial activities are not easy to discriminate from actual sleep bruxism and so the SB indices may be overestimates.<a class="elsevierStyleCrossRef" href="#bib0225"><span class="elsevierStyleSup">19</span></a> However as we used audio simultaneously, the patients with our positive criteria for the detection of sleep bruxism for portable EMG recording system (SB index<span class="elsevierStyleHsp" style=""></span>><span class="elsevierStyleHsp" style=""></span>2/h) coincided with the patients who had had the two audible tooth-grinding episodes according to Lavigne et al.<a class="elsevierStyleCrossRef" href="#bib0155"><span class="elsevierStyleSup">5</span></a></p><p id="par0135" class="elsevierStylePara elsevierViewall">The portable device that we used (Nox-T3) is a new system that can increase diagnostic accuracy by adding audio to the EMG signals. Other portable systems, like the Bruxoff<span class="elsevierStyleSup">®</span><a class="elsevierStyleCrossRefs" href="#bib0160"><span class="elsevierStyleSup">6,20</span></a> providing a simultaneous recording of EMG signals from both the masseter muscles as well as heart frequency, have also shown higher sensitivity and specificity.<a class="elsevierStyleCrossRef" href="#bib0235"><span class="elsevierStyleSup">21</span></a> Nevertheless we have to acknowledge that to assess sleep bruxism events with higher specificity, polysomnography (PSG) with audio–video recordings is considered the gold standard by the AASM.<a class="elsevierStyleCrossRef" href="#bib0200"><span class="elsevierStyleSup">14</span></a> However PSG has certain limitations: one is that a change in the sleep environment may influence the actual behavior of bruxism; another is the cost of PSG which may impact on the need for multiple-night recording to understand the entities of sleep bruxism.<a class="elsevierStyleCrossRef" href="#bib0240"><span class="elsevierStyleSup">22</span></a></p><p id="par0140" class="elsevierStylePara elsevierViewall">Several previous studies have reported that among the three types of SB (phasic, mixed, and tonic), the highest frequency is the phasic type is the highest and the lowest the tonic type.<a class="elsevierStyleCrossRefs" href="#bib0245"><span class="elsevierStyleSup">23,24</span></a> Our findings concur with those studies: the frequency of the phasic type of SB was the highest but we could not find any correlation with AHI.</p><p id="par0145" class="elsevierStylePara elsevierViewall">We could analyze the temporal relationship of SB and respiratory events, confirming that the majority of SB occurred after the onset of the OSA events, suggesting Sleep bruxism maybe secondary to OSA.<a class="elsevierStyleCrossRef" href="#bib0255"><span class="elsevierStyleSup">25</span></a> It remains to be confirmed whether the treatment of OSA may also treat SB as has been shown in a case report.<a class="elsevierStyleCrossRef" href="#bib0260"><span class="elsevierStyleSup">26</span></a></p><p id="par0150" class="elsevierStylePara elsevierViewall">Although the available evidence to support any non-PSG technique as a stand-alone diagnostic tool in SB is still scarce, newer systems like the one we tested are very promising but need to be further confirmed in future investigations.</p><p id="par0155" class="elsevierStylePara elsevierViewall">This study shows a close relationship of SB and OSAS, suggesting that OSAS patients are at high risk of SB and conversely bruxers should be also screened for OSAS.</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Ethical disclosures</span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Protection of human and animal subjects</span><p id="par0160" class="elsevierStylePara elsevierViewall">The authors declare that no experiments were performed on humans or animals for this study.</p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Confidentiality of data</span><p id="par0165" class="elsevierStylePara elsevierViewall">The authors declare that they have followed the protocols of their work center on the publication of patient data.</p></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0055">Right to privacy and informed consent</span><p id="par0170" class="elsevierStylePara elsevierViewall">The authors have obtained the written informed consent of the patients or subjects mentioned in the article. The corresponding author is in possession of this document.</p></span></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0060">Conflicts of interest</span><p id="par0175" class="elsevierStylePara elsevierViewall">The authors have no conflicts of interest to declare.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:9 [ 0 => array:3 [ "identificador" => "xres792787" "titulo" => "Abstract" "secciones" => array:1 [ 0 => array:1 [ "identificador" => "abst0005" ] ] ] 1 => array:2 [ "identificador" => "xpalclavsec791276" "titulo" => "Keywords" ] 2 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 3 => array:3 [ "identificador" => "sec0010" "titulo" => "Methods" "secciones" => array:1 [ 0 => array:2 [ "identificador" => "sec0015" "titulo" => "Statistical analysis" ] ] ] 4 => array:2 [ "identificador" => "sec0020" "titulo" => "Results" ] 5 => array:2 [ "identificador" => "sec0025" "titulo" => "Discussion" ] 6 => array:3 [ "identificador" => "sec0030" "titulo" => "Ethical disclosures" "secciones" => array:3 [ 0 => array:2 [ "identificador" => "sec0035" "titulo" => "Protection of human and animal subjects" ] 1 => array:2 [ "identificador" => "sec0040" "titulo" => "Confidentiality of data" ] 2 => array:2 [ "identificador" => "sec0045" "titulo" => "Right to privacy and informed consent" ] ] ] 7 => array:2 [ "identificador" => "sec0050" "titulo" => "Conflicts of interest" ] 8 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2016-01-08" "fechaAceptado" => "2016-07-06" "PalabrasClave" => array:1 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec791276" "palabras" => array:3 [ 0 => "Sleep bruxism" 1 => "Obstructive sleep apnea syndrome" 2 => "Masseter EMG" ] ] ] ] "tieneResumen" => true "resumen" => array:1 [ "en" => array:2 [ "titulo" => "Abstract" "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Sleep bruxism (SB) and obstructive sleep apnoea syndrome (OSAS) share common pathophysiologic pathways.</p><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">We aimed to study the presence and relationship of SB in a OSAS population.</p><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Patients referred with OSAS suspicion and concomitant SB complains were evaluated using a specific questionnaire, orofacial evaluation and cardio-respiratory polygraphy that could also monitor audio and EMG of the masseter muscles.</p><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">From 11 patients studied 9 had OSAS. 55.6% were male, mean age was 46.3<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>11.3 years, and apnea hypopnea index of 11.1<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>5.7/h. Through specific questionnaire 55.6% had SB criteria. Orofacial examination (only feasible in 3) confirmed tooth wear in all. 77.8% had polygraphic SB criteria (SB index<span class="elsevierStyleHsp" style=""></span>><span class="elsevierStyleHsp" style=""></span>2/h). Mean SB index was 5.12<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>3.6/h, phasic events predominated (72.7%). Concerning tooth grinding episodes, we found a mean of 10.7<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>9.2 per night. All OSAS patients except two (77.8%) had more than two audible tooth-grinding episodes. These two patients were the ones with the lowest SB index (1.0 and 1.4 per hour). Only in one patient could we not detect tooth grinding episodes. There was a statistically significant positive correlation between tooth grinding episodes and SB index and phasic event index (<span class="elsevierStyleItalic">R</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.755, <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.019 and <span class="elsevierStyleItalic">R</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.737, <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.023 respectively, Pearson correlation).</p><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Mean apnoea to bruxism index was 0.4/h, meaning that only a minority of SB events were not secondary to OSAS. We could not find any significant correlation between AHI and bruxism index or phasic bruxism index (<span class="elsevierStyleItalic">R</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>−0.632 and <span class="elsevierStyleItalic">R</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>−0.611, <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>><span class="elsevierStyleHsp" style=""></span>0.05, Pearson correlation).</p><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">This pilot study shows that SB is a very common phenomenon in a group of mild OSAS patients, probably being secondary to it in the majority of cases. The new portable device used may add diagnostic accuracy and help to tailor therapy in this setting.</p></span>" ] ] "multimedia" => array:3 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1705 "Ancho" => 3076 "Tamanyo" => 264644 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Nox-T3 image.</p>" ] ] 1 => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 1977 "Ancho" => 2500 "Tamanyo" => 288947 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Example of a SB event secondary to OSAS.</p>" ] ] 2 => array:8 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at1" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:1 [ "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Demographics \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Total (<span class="elsevierStyleItalic">N</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>9) \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry " colspan="2" align="left" valign="top">Age (years) – <span class="elsevierStyleItalic">N</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>9</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Mean (SD) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">46.3 (11.3) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Min–Max \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">33–67 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="2" align="left" valign="top">Gender (%) – <span class="elsevierStyleItalic">N</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>9</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Male \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">55.6 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="2" align="left" valign="top">Body mass index (kg/m<span class="elsevierStyleSup">2</span>) – <span class="elsevierStyleItalic">N</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>9</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Mean (SD) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">28.0 (4.4) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Min–Max \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">24.2–39.0 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="2" align="left" valign="top">Epworth sleepiness scale – <span class="elsevierStyleItalic">N</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>9</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Mean (SD) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">9.1 (5.5) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Min–Max \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">1–15 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="2" align="left" valign="top">Apnoea–hypopnea index (events/h) – <span class="elsevierStyleItalic">N</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>9</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Mean (SD) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">11.1 (5.7) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Min–Max \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">5–22.6 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="2" align="left" valign="top">Oxygen desaturation index (events/h) – <span class="elsevierStyleItalic">N</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>8</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Mean (SD) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">13.1 (10.5) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Min–Max \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">1.7–30.6 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="2" align="left" valign="top">Neck circumference (cm) – <span class="elsevierStyleItalic">N</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>8</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Mean (SD) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">40.0 (3.0) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Min–Max \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">36–46 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Arterial hypertension % – <span class="elsevierStyleItalic">N</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>7 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">28.6 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Smokers/ex-smokers/non-smokers \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">33.3/33.3/33.3 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1325769.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Demographics.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:26 [ 0 => array:3 [ "identificador" => "bib0135" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Sleep bruxism is associated with a rise in arterial blood pressure" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "A. Nashed" 1 => "P. Lanfranchi" 2 => "P. Rompré" 3 => "M.C. Carra" 4 => "P. Mayer" 5 => "R. Colombo" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.5665/sleep.1740" "Revista" => array:6 [ "tituloSerie" => "Sleep" "fecha" => "2012" "volumen" => "35" "paginaInicial" => "529" "paginaFinal" => "536" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22467991" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0140" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Prevalence of sleep-disordered breathing in the general population: the HypnoLaus study" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "R. Heinzer" 1 => "S. Vat" 2 => "P. Marques-Vidal" 3 => "H. Marti-Soler" 4 => "D. Andries" 5 => "N. 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| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 11 | 10 | 21 |
| 2024 October | 34 | 41 | 75 |
| 2024 September | 36 | 32 | 68 |
| 2024 August | 57 | 47 | 104 |
| 2024 July | 38 | 34 | 72 |
| 2024 June | 27 | 29 | 56 |
| 2024 May | 42 | 46 | 88 |
| 2024 April | 33 | 35 | 68 |
| 2024 March | 41 | 26 | 67 |
| 2024 February | 28 | 23 | 51 |
| 2024 January | 31 | 34 | 65 |
| 2023 December | 26 | 30 | 56 |
| 2023 November | 33 | 55 | 88 |
| 2023 October | 31 | 58 | 89 |
| 2023 September | 30 | 42 | 72 |
| 2023 August | 22 | 19 | 41 |
| 2023 July | 33 | 36 | 69 |
| 2023 June | 30 | 11 | 41 |
| 2023 May | 44 | 28 | 72 |
| 2023 April | 27 | 15 | 42 |
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