Effects of continuous positive airway pressure and mandibular advancement appliance therapy on sleep bruxism in adults with obstructive sleep apnea: a pilot study

Abstract

Study objectives This study aimed to investigate the effects of continuous positive airway pressure (CPAP) and mandibular advancement appliance (MAA) therapy on rhythmic masticatory muscle activity (RMMA), a biomarker of sleep bruxism (SB), and to compare the effects of CPAP with MAA in adults with obstructive sleep apnea (OSA). Methods This cohort study included individuals with OSA who received treatment with CPAP or MAA. Polysomnographic recordings with and without therapy were performed in each individual. Statistical analyses were performed with repeated measures ANOVA. Results A total of 38 individuals with OSA were enrolled, 13 on CPAP and 25 with MAA, mean age 52.6 ± 10.6 years, 32 men, mean baseline apnea-hypopnea index (AHI) 26.5 ± 15.2 events/hour, mean RMMA index 3.5 ±events/hour. In the total group, the RMMA index decreased significantly with CPAP and MAA therapies (P < 0.05). The changes in the RMMA index with therapy did not differ significantly between CPAP and MAA (P > 0.05). The RMMA index decreased in 60% of the individuals with OSA, and the changes ranged widely, with a median of 52% and an interquartile range of 107%. Conclusions Both CPAP and MAA therapies significantly reduce SB in individuals with OSA. However, the interindividual differences in the effects of these therapies on SB are large. Clinical Trial Registration:https://trialsearch.who.int (NL8516); April 08, 2020

A Case Series of Sleep Bruxism Treated With Nasal Continuous Positive Airway Pressure: Craniofacial Feature and Polysomnographic Findings

“…A recent study on OSA concomitant with SB showed that CPAP was as effective as MAD in reducing bruxism and more effective in reducing respiratory events. 7 Our cases confirm that CPAP therapy could be an essential treatment option for patients with SB and OSA, especially when the effect of oral appliance therapy is inadequate. In addition, the common craniofacial features among our patients, such as dolichocephalic face and a high palate, suggest that CPAP could be effective, especially in patients with these craniofacial features.…”

“…A recent study suggested that PSG with the bilateral temporalis or masseter muscles, or both, is valid for SB recording. 7 Although SB was not confirmed by PSG in Case 3, he had a clear history of SB and reported clinical improvement of SB and related jaw pain by CPAP, suggesting that CPAP can also be used as an alternative even in probable SB, which has not been proven in PSG.…”

“…Several case reports and clinical studies have reported the clinical utility of continuous positive airway pressure (CPAP) as a new therapeutic modality for treating SB in patients with OSA. 6,7 However, no detailed case descriptions, including craniofacial structure information of patients with SB and longterm clinical courses, have been reported. Here, we present three cases of probable SB with OSA and similar facial morphology that did not respond to conventional treatments but were treated successfully with CPAP (Table 1).…”