0804 Sleep Bruxism, Awake Bruxism and Sleep Related Breathing Disorders in Adults With Down Syndrome

Abstract

Introduction To our knowledge, no studies have accessed theawake bruxism (AB) and stage by stage sleep bruxism (SB) in adults with Down syndrome. Recent works have shown that portable PSG systems are accurate for SB assessment even in the absence of audio-video recording. We aimed to evaluate the prevalence of awake bruxism, stage-by-stage sleep bruxism and Sleep Related Breathing Disorders (SRBD) in adults with Down syndrome. Methods Twenty-three adults with Down Syndrome (DS) were enrolled in this study. General health, dental status, parafunctional habits and temporomandibular symptoms were assessed. The history of SB/AB was taken from a questionnaire to the caregivers. A portable PSG type II system (Embla Embletta MPR+PG ST+Proxy, Natus, California-USA) was used to perform a full-sleep study at patients’ home. RMMA activity was defined as low (>1 and <2 episodes/h of sleep), moderate (>2 and <4 episodes/h of sleep), or high (>4 episodes/h of sleep). PSG diagnose of SB was assumed if RMMA index was >2 episodes/h of sleep. Results According to caregiver’s report, AB was present in all patients whereas only 13.1% had SB. PSG records showed a SB prevalence of 91.3%, with a mean RMMA index 40.0±30.0/h. Only 2 (8,7%) showed RMMA index of 0.0/h. SB episodes were predominant in N3 and REM sleep stage in 14 and 9 patients, respectively. All but one (95,7%) patient (isolated snoring) presented with OSA (AHI=32.8±28.6). A unique TMD symptom (pain on palpation) was present in 8,7% of the global sample. Conclusion The high prevalence of “definitive SB” together with the high prevalence of OSA and snoring point in favor to the recommendation of routine PSG in adults with DS. Furthermore, the low sensitivity of parent-oriented questionnaires reinforces the need of more accurate assessment tools in order to get a better standard of care in this particular group of patients. Support State of Sao Paulo Research Support Foundation - FAPESP grant number: 2017/06835-8

Sleep Disorders in Adults with Down Syndrome

“…However, all of these data were inferred from parent reports, which probably underestimate prevalence, as in other sleep disorders. In a recent objective study performed with young adults with DS, the prevalence of bruxism was 13.1% according to parent reports, in contrast to the 91.3% prevalence measured by PSG [ 85 ]. On the other hand, in a recent retrospective study of 418 children with DS who underwent polysomnography in a sleep center, only 13 subjects (3%) were referred due to concerns about restless leg syndrome (RLS) or periodic limb movement disorder (PLMS); 139 of the children (33.3%) presented PLMS, and 36 (55.4%) of them had ferritin levels under normal values (<50 ng/mL).…”

Prevalence of bruxism in down syndrome patients: A systematic review and meta‐analysis

“…Table 2 provides information on the eight studies 26–33 selected for analysing the prevalence of bruxism in individuals with DS. The studies include Ashworth et al 26 from England, Breslin et al 27 from the USA, Carter et al 28 from England, Giannasi et al, 29 Miamoto et al, 30 and Ruy et al 31 from Brazil, Lopez et al 32 from Mexico, and Bell et al 33 from Australia. These studies encompassed varying sample sizes and age ranges.…”

“…Bruxism was reported in children aged 3 years and older and was not dependent on a learning disability or gender. Giannasi et al 29 bruxism habit by clinical examination along with the parent's report.…”

“…Table 2 provides information on the eight studies [26][27][28][29][30][31][32][33] selected for analysing the prevalence of bruxism in individuals with DS.…”

“…The studies include Ashworth et al 26 from England, Breslin et al 27 from the USA, Carter et al 28 from England, Giannasi et al, 29 Miamoto et al, 30 and Ruy et al 31 from Brazil, Lopez et al 32 from Mexico, and Bell et al 33…”