Is camera recording crucial for the correct diagnosis of sleep bruxism in polysomnography?

Smardz, Joanna; Więckiewicz, Mieszko; Michałek-Zrąbkowska, Monika; Gać, Paweł; Poręba, Rafał; Wojakowska, Anna; Błaszczyk, Bartłomiej; Mazur, Grzegorz; Martynowicz, Helena

doi:10.1111/jsr.13858

Cited by 7 publications

(9 citation statements)

References 29 publications

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“…It is very important to investigate the factors and effects of the combination of these two conditions. Epidemiological studies suggested that OSA patients are more likely to have SB (8), and this is supported by the findings of polysomnographic (PSG) studies showing that between 9 and 70% of OSA patients also have SB (10-14) and the body position-related OSA phenotype has higher SB and severe SB incidence (15). Genetic predisposition to OSA-SB relationship was also proposed previously (16).…”

Section: Introductionmentioning

confidence: 74%

“…We cannot deny the possibility that OSA phenotypes can be heterogenous or biased with a small sample size. Although this study analyzed arousal threshold as one of physiological factors for defining the phenotypes, other physiological factors (loop gain etc.,) and the anatomical factors (e.g., craniofacial morphology) as well as the effect of body position (i.e., position related OSA) (15) were not considered for the analysis. In addition, the severity of most patients in this study were mild to moderate levels.…”

Section: Study Limitationsmentioning

confidence: 99%

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Relationships between respiratory and oromotor events differ between motor phenotypes in patients with obstructive sleep apnea

et al. 2023

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PurposeThe present study investigated the relationship between sleep bruxism (SB) and obstructive sleep apnea (OSA) in relation to the sleep architecture.MethodsWe conducted a cross-sectional study. Polysomnographic recordings were performed on 36 patients. Sleep, respiratory, and oromotor variables, such as rhythmic masticatory muscle activity (RMMA) and non-specific masticatory muscle activity (NSMA), were compared between OSA patients with or without SB. A correlation analysis of the frequency of respiratory and oromotor events in NREM and REM sleep was performed. The frequency of oromotor events following respiratory events was also assessed.ResultsThe proportion of REM sleep was higher in OSA patients with SB than in those without SB (p = 0.02). The apnea-hypopnea index (AHI) did not significantly differ between the two groups; however, AHI was approximately 8-fold lower during REM sleep in OSA patients with SB (p = 0.01) and the arousal threshold was also lower (p = 0.04). Although the RMMA index was higher in OSA patients with than in those without SB (p < 0.01), the NSMA index did not significantly differ. The percentage of RMMA following respiratory events was significantly higher in OSA patients with than in those without SB, whereas that of NSMA did not significantly differ. The frequency of oromotor events throughout the whole night positively correlated with AHI. However, regardless of the sleep state, AHI did not correlate with the RMMA index, but positively correlated with the NSMA index.ConclusionIn consideration of the limitations of the present study, the results obtained indicate that OSA patients with SB have a unique phenotype of OSA and also emphasize the distinct relationship of respiratory events with RMMA and NSMA.

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Section: Introductionmentioning

confidence: 74%

Section: Study Limitationsmentioning

confidence: 99%

Relationships between respiratory and oromotor events differ between motor phenotypes in patients with obstructive sleep apnea

et al. 2023

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“…A concordance between the EMG-EKG portable device and the PSG (gold standard) design was used with six participants without OSA and sixteen with OSA. The sample of OSA patients was segmented by the degree of severity in three groups: Mild OSA = 7 (AHI = 5-14.9/h), Moderate OSA = 3 (AHI = 15-29.9/h), Severe OSA = 6 (AHI ≥ 30/h) [78].…”

Section: Sample Selectionmentioning

confidence: 99%

“…In the SB and OSA group, the diagnosis was confirmed by PSG performed by a sleep expert, following blind masking concerning the clinical examination. The AHI (episodes of AH per hour) was used to categorize OSA groups by severity level, according to published criteria [34,78]. PSG Sleep Bruxism Analysis SB events were estimated through rhythmic (RMMA; Figure 2) and non-rhythmic masticatory muscle activity (MMA) recorded with EMG on the masseter muscles (surface electrodes).…”

Section: Psg Recordingsmentioning

confidence: 99%

Diagnostic Accuracy of a Portable Electromyography and Electrocardiography Device to Measure Sleep Bruxism in a Sleep Apnea Population: A Comparative Study

Cid-Verdejo,

Domínguez Gordillo,

Sánchez-Romero

et al. 2023

Clocks & Sleep

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Background: The gold standard for diagnosing sleep bruxism (SB) and obstructive sleep apnea (OSA) is polysomnography (PSG). However, a final hypermotor muscle activity often occurs after apnea episodes, which can confuse the diagnosis of SB when using portable electromyography (EMG) devices. This study aimed to compare the number of SB episodes obtained from PSG with manual analysis by a sleep expert, and from a manual and automatic analysis of an EMG and electrocardiography (EKG) device, in a population with suspected OSA. Methods: Twenty-two subjects underwent a polysomnographic study with simultaneous recording with the EMG-EKG device. SB episodes and SB index measured with both tools and analyzed manually and automatically were compared. Masticatory muscle activity was scored according to published criteria. Patients were segmented by severity of OSA (mild, moderate, severe) following the American Academy of Sleep Medicine (AASM) criteria. ANOVA and the Bland–Altman plot were used to quantify the agreement between both methods. The concordance was calculated through the intraclass correlation coefficient (ICC). Results: On average, the total events of SB per night in the PSG study were (8.41 ± 0.85), lower than the one obtained with EMG-EKG manual (14.64 ± 0.76) and automatic (22.68 ± 16.02) analysis. The mean number of SB episodes decreases from the non-OSA group to the OSA group with both PSG (5.93 ± 8.64) and EMG-EKG analyses (automatic = 22.47 ± 18.07, manual = 13.93 ± 11.08). However, this decrease was minor in proportion compared to the automatic EMG-EKG analysis mode (from 23.14 to 22.47). The ICC based on the number of SB episodes in the segmented sample by severity degree of OSA along the three tools shows a moderate correlation in the non-OSA (0.61) and mild OSA (0.53) groups. However, it is poorly correlated in the moderate (0.24) and severe (0.23) OSA groups: the EMG-EKG automatic analysis measures 14.27 units more than PSG. The results of the manual EMG-EKG analysis improved this correlation but are not good enough. Conclusions: The results obtained in the PSG manual analysis and those obtained by the EMG-EKG device with automatic and manual analysis for the diagnosis of SB are acceptable but only in patients without OSA or with mild OSA. In patients with moderate or severe OSA, SB diagnosis with portable electromyography devices can be confused due to apneas, and further study is needed to investigate this.

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“…There exists a theoretical “temporal” mechanism against OSA in concomitant SB and OSA where, during bruxism episodes, mandible protrusion maintains the patency of the upper airway tract [ 29 , 30 ]. COMISA syndrome consists of OSA and insomnia alone but it has not been estimated as to whether SB could have any connection in COMISA using a gold standard method to diagnose sleep disorders such as polysomnography with video-recording [ 31 ].…”

Section: Introductionmentioning

confidence: 99%

Sleep Bruxism and Sleep Structure in Comorbid Insomnia and Obstructive Sleep Apnea (COMISA) Syndrome: A Polysomnographic Study

Blaszczyk,

Meira e Cruz,

Waliszewska-Prosol

et al. 2024

JCM

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Introduction: Comorbid insomnia and obstructive sleep apnea (COMISA) is not a well-identified sleep disorder, despite having a significant impact on health. This study investigates the relationship between sleep bruxism (SB) and sleep architecture in patients with COMISA, obstructive sleep apnea (OSA), and in those without any sleep disorders. Methods: 119 patients were included in the study and divided into three groups: OSA, COMISA, and a control group. Polysomnographic (PSG) examination provided parameters related to sleep architecture, OSA, and characteristics of SB. Results: The bruxism episode index (BEI) and other SB parameters were not found to be statistically different between the three groups (p > 0.05). There was no statistical difference in measured sleep architecture between the COMISA and OSA groups (p > 0.05). In comparison to the control group, participants in the COMISA group were found to have an increased apnea–hypopnea index (AHI), oxygen desaturation index (ODI), respiratory disturbance index (RDI), all arousals (AA), and respiratory arousals (RA) (p < 0.05). Among COMISA patients, AA and RA were shown to have a positive linear correlation with the number of bradycardia events per hour (r = 0.49, r = 0.48, p < 0.05). Conclusions: SB does not occur in patients with COMISA more frequently than in patients with OSA or those without any sleep disorders. PSG parameters are not specific for COMISA; therefore, in order to differentiate this disorder from OSA alone, a comprehensive patient assessment has to be performed.

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Is camera recording crucial for the correct diagnosis of sleep bruxism in polysomnography?

Cited by 7 publications

References 29 publications

Relationships between respiratory and oromotor events differ between motor phenotypes in patients with obstructive sleep apnea

Relationships between respiratory and oromotor events differ between motor phenotypes in patients with obstructive sleep apnea

Diagnostic Accuracy of a Portable Electromyography and Electrocardiography Device to Measure Sleep Bruxism in a Sleep Apnea Population: A Comparative Study

Sleep Bruxism and Sleep Structure in Comorbid Insomnia and Obstructive Sleep Apnea (COMISA) Syndrome: A Polysomnographic Study

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