Validity of self‐reported sleep bruxism among myofascial temporomandibular disorder patients and controls

Abstract

Sleep bruxism (SB), primarily involving rhythmic grinding of the teeth during sleep, has been advanced as a causal or maintenance factor for a variety of orofacial problems, including temporomandibular disorders (TMD). Since laboratory polysomnographic (PSG) assessment is extremely expensive and time-consuming, most research testing this belief has relied on patient self-report of SB. The current case-control study examined the accuracy of those self-reports relative to laboratory-based PSG assessment of SB in a large sample of women suffering from chronic myofascial TMD (n=124) and a demographically matched control group without TMD (n=46). A clinical research coordinator administered a structured questionnaire to assess self-reported SB. Participants then spent two consecutive nights in a sleep laboratory. Audiovisual and electromyographic data from the second night were scored to assess whether participants met criteria for presence of 2 or more (2+) rhythmic masticatory muscle activity episodes accompanied by grinding sounds, moderate SB, or severe SB, using previously validated research scoring standards. Contingency tables were constructed to assess positive and negative predictive values, sensitivity and specificity, and 95% confidence intervals surrounding the point estimates. Results showed that self-report significantly predicted 2+ grinding sounds during sleep for TMD cases. However, self-reported SB failed to significantly predict presence or absence of either moderate or severe SB as assessed by PSG, for both cases and controls. These data show that self-report of tooth grinding awareness is highly unlikely to be a valid indicator of true SB. Studies relying on self-report to assess SB must be viewed with extreme caution.

Evaluation of genetic factors involved in nocturnal electromyographic activity of masticatory muscles in twins

“…First, its low sensitivity and specificity cause There was no significant difference in the distribution of EMG activity per hour between males and females. The percentage of subjects who had more than 25 episodes of EMG activity per hour was 6.6 % [14,24]. Since sleep bruxism may involve not only grinding but also clenching of teeth, sleep bruxism might be soundless.…”

“…However, the theories that propose a genetic predisposition to sleep bruxism stem mostly from studies based on self-administered questionnaires. A polysomnographic study reported that self-report is highly unlikely to be a valid indicator of true sleep bruxism because of its low sensitivity and specificity estimated at less than 70 and 50 %, respectively [14]. The other twin study evaluated bruxism based on facet patterns and showed rate of concordance being higher in monozygotic twins than in dizygotic twins [15].…”

Sleep Bruxism-Tooth Grinding Prevalence, Characteristics and Familial Aggregation: A Large Cross-Sectional Survey and Polysomnographic Validation

“…We recognize that self-reports have a limited capacity to detect true presence of SB in blood relatives. 3,34 In conclusion, due to the large population surveyed, this study should represent a landmark in the field of sleep bruxism and should open the door for future studies on comorbidities between SB, sleep maintenance, gender, and chronic pain. This study should also present an argument in favor of future investigations of the genetics of SB.…”

Agreement between two different approaches to assess parent-reported sleep bruxism in children

“…The sensibility and accuracy of parents' report of sleep bruxism are low, however, it shows excellent specificity when compared with polysomnographic findings 16 . The reliability of the questionnaire-based assessment of SB has been questioned 16 and its use has been of concern to several authors, both in studies involving adults 17,18 and children 3,16 . Despite its obvious limitations, the parental reports of SB remain important for epidemiological studies with large samples.…”