1
|
Thomas DC, Manfredini D, Patel J, George A, Chanamolu B, Pitchumani PK, Sangalli L. Sleep bruxism: The past, the present, and the future-evolution of a concept. J Am Dent Assoc 2024; 155:329-343. [PMID: 38363252 DOI: 10.1016/j.adaj.2023.12.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2023] [Revised: 12/26/2023] [Accepted: 12/26/2023] [Indexed: 02/17/2024]
Abstract
BACKGROUND The concept of sleep bruxism (SB) has evolved exponentially over the past several decades. Many theories and hypotheses have been proposed as to the definition, pathophysiology, and management of SB, from the early 1960s through the present. The role of peripheral factors, such as dental occlusion, in the pathogenesis of SB has been discarded. TYPES OF STUDIES REVIEWED The authors searched several electronic databases (ie, PubMed, Google Scholar, Web of Science, Embase, and Ovid MEDLINE) for studies on bruxism. The search was conducted from January 1961 through May 2023 and yielded 4,612 articles, of which 312 were selected for comprehensive review after eliminating duplicates and nonfocused articles. RESULTS There has been an evident progressive shift from the role of peripheral factors, such as dental occlusion, to more central factors, such as the involvement of a central pattern generator as well as the autonomic nervous system, in the genesis of bruxing movements. There is continued robust interest in the dental community to elucidate the contributing factors involved in SB. CONCLUSIONS AND PRACTICAL IMPLICATIONS The neurophysiology of SB appears to be leaning more toward central rather than peripheral factors. There is increasing evidence of the role of the autonomic nervous system, genetics, and comorbidities in the genesis of SB. The scientific literature seems to refute the role of dental occlusion in the causation of bruxing movements. As per the literature, there has been a paradigm shift in the definition and genesis of SB and its possible dental implications and management, which also highlights the need for succinct scientific studies in this regard.
Collapse
|
2
|
Chen S, Li Q, Zou X, Zhong Z, Ouyang Q, Wang M, Luo Y, Yao D. Effects of CPAP Treatment on Electroencephalographic Activity in Patients with Obstructive Sleep Apnea Syndrome During Deep Sleep with Consideration of Cyclic Alternating Pattern. Nat Sci Sleep 2022; 14:2075-2089. [PMID: 36440180 PMCID: PMC9697441 DOI: 10.2147/nss.s382305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Accepted: 11/08/2022] [Indexed: 11/22/2022] Open
Abstract
Objective To investigate whether continuous positive airway pressure (CPAP) treatment would change EEG activities associated with cyclic alternating pattern (CAP subtype A1, A2, and A3) and non-CAP (NCAP) during non-rapid eye movement sleep stage 3 (N3) in patients with obstructive sleep apnea (OSA). Methods The effects of CPAP treatment on the percentages of sleep stage N3 occupied by the CAP and NCAP, power of EEG waves in the CAP and NCAP were examined in 18 patients with moderate-to-severe OSA undergoing polysomnographic recordings. Results Apnea and hypopnea index during sleep stage N3 was positively correlated with ratios of phases A2 and A3 duration to total phase A duration [Phase (A2+A3) /Phase A] and negatively correlated with phase A1/phase A. With CPAP treatment, percentages of sleep stage N3 occupied by total CAPs and subtypes A2 and A3, as well as CAP A2 and CAP A3 indexes were significantly decreased while percentages of sleep stage N3 occupied by NCAP (NCAP/N3) and CAP A1 index were significantly increased. In addition, CPAP treatment significantly decreased percentage of respiratory events associated CAPs and increased percentage of non-respiratory related CAPs. Moreover, absolute and relative delta power was significantly increased during phase A1, unchanged during phase A2 and phase B2, and significantly decreased during phases B1, A3 and B3. The absolute power of faster frequency EEG waves in CAPs showed a general trend of decrease. The absolute and relative power of delta waves with amplitudes ≥75 μV, but not <75 μV, was significantly increased. Conclusion CPAP treatment improves the sleep quality in OSA patients mainly by increasing delta power and decreasing power of higher frequency waves during phase A1, and decreasing CAP A2 and A3 indexes as well as increasing NCAP/N3 and power of delta waves with amplitudes ≥75 μV during NCAP.
Collapse
Affiliation(s)
- Shuliang Chen
- Neurological Institute of Jiangxi Province and Department of Neurology, Jiangxi Provincial People's Hospital and The First Affiliated Hospital of Nanchang Medical College, Jiangxi, People’s Republic of China
- Queen Mary College, Nanchang University, Jiangxi, People’s Republic of China
| | - Qi Li
- Neurological Institute of Jiangxi Province and Department of Neurology, Jiangxi Provincial People's Hospital and The First Affiliated Hospital of Nanchang Medical College, Jiangxi, People’s Republic of China
| | - Xueliang Zou
- Jiangxi Mental Hospital, Nanchang University, Jiangxi, People’s Republic of China
| | - Zhijun Zhong
- Neurological Institute of Jiangxi Province and Department of Neurology, Jiangxi Provincial People's Hospital and The First Affiliated Hospital of Nanchang Medical College, Jiangxi, People’s Republic of China
| | - Qian Ouyang
- Neurological Institute of Jiangxi Province and Department of Neurology, Jiangxi Provincial People's Hospital and The First Affiliated Hospital of Nanchang Medical College, Jiangxi, People’s Republic of China
| | - Mengmeng Wang
- Neurological Institute of Jiangxi Province and Department of Neurology, Jiangxi Provincial People's Hospital and The First Affiliated Hospital of Nanchang Medical College, Jiangxi, People’s Republic of China
| | - Yaxing Luo
- Neurological Institute of Jiangxi Province and Department of Neurology, Jiangxi Provincial People's Hospital and The First Affiliated Hospital of Nanchang Medical College, Jiangxi, People’s Republic of China
| | - Dongyuan Yao
- Neurological Institute of Jiangxi Province and Department of Neurology, Jiangxi Provincial People's Hospital and The First Affiliated Hospital of Nanchang Medical College, Jiangxi, People’s Republic of China
| |
Collapse
|
3
|
Zhong Z, Li Q, Zou X, Ouyang Q, Zeng Q, Hu Y, Wang M, Luo Y, Yao D. Influence of Sleep Bruxism on QTc Interval and QT Variability in Patients with OSA: a pilot study. J Oral Rehabil 2022; 49:495-504. [PMID: 35158405 DOI: 10.1111/joor.13314] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Revised: 01/29/2022] [Accepted: 02/08/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND Obstructive sleep apnea (OSA) is associated with increases in QT interval corrected for heart rate (QTc interval) and QT variability index (QTVI) and sleep bruxism (SB) is prevalent in OSA patients. OBJECTIVES To examine whether QTc interval and QT variability were changed during episodes of RMMAs/SB in SB patients with and without OSA. METHODS The RR and QTc intervals, and QTVI during RMMAs with or without accompanied limb movements (RMMAs/LMs) in 10 normal controls and 10 SB patients without OSA and during apneic and recovery periods of OSA in 10 SB patients with OSA were analyzed. RESULTS In the SB patients without OSA and controls, QTc intervals and QTVI were significantly increased during RMMAs/LMs compared with those during the 10 s periods (from 10th to 20th s) before the onset and after the offset of RMMAs/LMs, and significantly increased during RMMAs/LMs with awakenings compared with those with microarousals and no arousals. Moreover, QTc interval and QTVI were positively correlated with the duration of RMMAs/LMs. Moreover, in the SB patients with OSA, QTc interval and QTVI during the recovery period of OSA events were significantly longer and higher than those during the apneic period regardless of accompanied RMMAs/LMs, and QTc interval and QTVI during the apneic and recovery periods accompanied with RMMAs/LMs were significantly longer and higher than those without accompanied RMMAs/LMs. CONCLUSION OSA and RMMAs/LMs events were associated with longer QTc intervals and higher QTVI, and RMMAs/LMs might contribute to these changes associated with OSA events accompanied with RMMAs/LMs.
Collapse
Affiliation(s)
- Zhijun Zhong
- Neurological Institute of Jiangxi Province and Department of Neurology, Jiangxi Provincial People's Hospital, Nanchang Medical College and Nanchang University, Jiangxi, PR China
| | - Qi Li
- Department of Neurology, the Third Affiliated Hospital, Nanchang University, Jiangxi, PR China
| | - Xueliang Zou
- Jiangxi Mental Hospital, Nanchang University, Jiangxi, PR China
| | - Qian Ouyang
- Neurological Institute of Jiangxi Province and Department of Neurology, Jiangxi Provincial People's Hospital, Nanchang Medical College and Nanchang University, Jiangxi, PR China
| | - Qinghong Zeng
- Neurological Institute of Jiangxi Province and Department of Neurology, Jiangxi Provincial People's Hospital, Nanchang Medical College and Nanchang University, Jiangxi, PR China.,School of Pharmaceutical Sciences, Nanchang University, Jiangxi, PR China
| | - Yinyin Hu
- Neurological Institute of Jiangxi Province and Department of Neurology, Jiangxi Provincial People's Hospital, Nanchang Medical College and Nanchang University, Jiangxi, PR China.,School of Pharmaceutical Sciences, Nanchang University, Jiangxi, PR China
| | - Mengmeng Wang
- Neurological Institute of Jiangxi Province and Department of Neurology, Jiangxi Provincial People's Hospital, Nanchang Medical College and Nanchang University, Jiangxi, PR China.,School of Pharmaceutical Sciences, Nanchang University, Jiangxi, PR China
| | - Yaxing Luo
- Neurological Institute of Jiangxi Province and Department of Neurology, Jiangxi Provincial People's Hospital, Nanchang Medical College and Nanchang University, Jiangxi, PR China.,School of Pharmaceutical Sciences, Nanchang University, Jiangxi, PR China
| | - Dongyuan Yao
- Neurological Institute of Jiangxi Province and Department of Neurology, Jiangxi Provincial People's Hospital, Nanchang Medical College and Nanchang University, Jiangxi, PR China
| |
Collapse
|
4
|
Zhong Z, Xu M, Zou X, Ouyang Q, Zhang L, Yu B, Wang K, Yao D. Changes in heart rate related to rhythmic masticatory muscle activities and limb movements in patients with sleep bruxism. J Oral Rehabil 2019; 47:170-179. [PMID: 31697853 DOI: 10.1111/joor.12900] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2019] [Revised: 10/05/2019] [Accepted: 10/29/2019] [Indexed: 12/19/2022]
Abstract
Most sleep bruxism (SB) episodes are accompanied by an increase in sympathetic tone and heart rate (HR). To characterise heart rate (HR) changes in relation to rhythmic masticatory muscle activities (RMMAs) in SB patients, polysomnographic recordings were performed on 10 SB patients and 11 normal controls. The duration of movement events, amplitude and duration of HR increases, and time to reach HR peak associated with RMMAs and limb movements (LMs) were determined, and the relationships of the parameters of HR increases with types of movements and RMMAs were analysed. All of the parameters of HR increases associated with three types of movements (RMMAs, RMMAs + LMs and LMs) and masseter activities (phasic, tonic and mixed) were significantly different (two-way ANOVA, P < .001 for all) in both SB patients and controls. The duration of RMMAs/LMs was positively correlated with the parameters (SB patients: R2 = .24-.85, P < .0001; controls: R2 = .23-.68, P < .0001). The amplitude of HR increases was also positively correlated with respiration changes in the SB patients (R2 = .3258, P < .0001) and controls (R2 = .09469, P < .05). The proportions of phasic RMMAs associated with awakenings, microarousals and no cortical arousals were significantly different and so were the proportions of tonic and mixed RMMAs (Friedman's tests, P < .05-.001). The HR increases associated with RMMAs may be intrinsic to the cortical arousal response and autonomic activation, and differences in HR increases associated with different types of movements and RMMAs might be related to the changes in respiration and differences in cortical arousal levels.
Collapse
Affiliation(s)
- Zhijun Zhong
- Neurological Institute of Jiangxi Province and Department of Neurology, Jiangxi Provincial People's Hospital, Nanchang, China.,School of Pharmaceutical Sciences, Nanchang University, Jiangxi, China
| | - Miao Xu
- Neurological Institute of Jiangxi Province and Department of Neurology, Jiangxi Provincial People's Hospital, Nanchang, China.,School of Pharmaceutical Sciences, Nanchang University, Jiangxi, China
| | - Xueliang Zou
- Jiangxi Mental Hospital, Nanchang University, Jiangxi, China
| | - Qian Ouyang
- Neurological Institute of Jiangxi Province and Department of Neurology, Jiangxi Provincial People's Hospital, Nanchang, China.,School of Pharmaceutical Sciences, Nanchang University, Jiangxi, China
| | - Ling Zhang
- Neurological Institute of Jiangxi Province and Department of Neurology, Jiangxi Provincial People's Hospital, Nanchang, China.,School of Pharmaceutical Sciences, Nanchang University, Jiangxi, China
| | - Bin Yu
- Jiangxi Mental Hospital, Nanchang University, Jiangxi, China
| | - Kelun Wang
- Department of Health Science & Technology, Center for Sensory-Motor Interaction, Aalborg University, Aalborg, Denmark
| | - Dongyuan Yao
- Neurological Institute of Jiangxi Province and Department of Neurology, Jiangxi Provincial People's Hospital, Nanchang, China.,School of Pharmaceutical Sciences, Nanchang University, Jiangxi, China
| |
Collapse
|