Is the population properly informed about sleep disorders?

Determinants of probable sleep bruxism in a pediatric mixed dentition population: a multivariate analysis of mouth vs. nasal breathing, tongue mobility, and tonsil size

OBJECTIVES

This study aims to identify structural and functional craniofacial characteristics that correlate with higher incidence of 'probable' sleep bruxism in children.

METHODS

From March 2018 until March 2019, a cross-sectional clinical study was performed with ninety-six healthy children ages 6-12 years who presented for routine dental examination at the UCLA pediatric dental clinic. Variables of interest included: (1) assessment of probable bruxism based on parental awareness on the frequency of tooth grinding during sleep and clinical signs of bruxism based on tooth wear; (2) parental reports of mouth breathing while awake and asleep, snoring during sleep, difficulty breathing and/or gasping for air during sleep; (3) parental reports of psychosocial distress; (4) assessment of tonsil hypertrophy, tongue mobility, and nasal obstruction. Three pediatric dental residents were calibrated to perform the clinical data collection. All dental residents were graduated dentists with licensure and at least one year of experience examining children. The methodology to take the specific measurements administered in the manuscript were calibrated between the data-collectors under the supervision of a board-certified pediatric dentist and orthodontist (AY).

RESULTS

The mean age of individuals was 8.9 (SD = 1.9) years with a gender distribution of 46 males and 50 females. There were 23 out of the 96 (24%) individuals who met the diagnostic criteria for probable sleep bruxism (PSB). Sleep Disturbance Scale for Children (SDSC) scores were significantly elevated among children positive for PSB, indicating that they are at higher risk for sleep disturbances (PSB-positive: 45.1 ± 13.0, PSB-negative: 34.8 ± 5.5; p < 0.0001). Impaired nasal breathing, parental reports of mouth breathing when awake or asleep, restricted tongue mobility, and tonsillar hypertrophy were found to be significant risk factors for PSB. Exploratory analysis further suggests a synergistic effect between tonsil hypertrophy, restricted tongue mobility, and nasal obstruction. The incidence of probable sleep bruxism among individuals without any of the exam findings of tonsillar hypertrophy, restricted tongue mobility, and nasal obstruction was 5/58 (8.6%), whereas the incidence of PSB among individuals with all three exam findings was 10/11 (90.9%), p < 0.0001. Among the 23 individuals with PSB, however, there were n = 5 (21.7%) who did not have any of the three exam findings, suggesting an additional role of psychosocial distress, postural maladaptation, malocclusion, or other factors in the etiology of sleep bruxism.

CONCLUSION

This study shows that tonsil hypertrophy, restricted tongue mobility, and nasal obstruction may have a synergistic association on the presentation of PSB. Dentists should evaluate for tonsillar hypertrophy, restricted tongue mobility, and nasal obstruction in the evaluation of PSB, as these exam findings are highly prevalent in the majority of cases.

Knowledge about obstructive sleep apnea among medical undergraduate students: A long way to go!

OBJECTIVE

The aim is to study the knowledge and attitude of medical undergraduate students regarding obstructive sleep apnea (OSA).

MATERIALS AND METHODS

This cross-sectional study involved 324 medical undergraduate students in clinical semesters. Knowledge and attitude regarding adult OSA were assessed using the obstructive sleep apnea knowledge and attitude (OSAKA), and to evaluate the same about childhood OSA, OSAKA-KIDS was used.

RESULTS

Results showed that the study population was not informed about OSA among adults as well as kids. Most of the participants could recognize that snoring was a common symptom of adult OSA but failed to identify the association between childhood OSA and hyperactivity. The participants had a good knowledge about the pathophysiology of OSA. More than 80% of students reported that OSA is an important disorder and that these patients should be identified.

CONCLUSION

Medical undergraduates are poorly informed about OSA.

Correlation between Parental-Reported Tooth Grinding and Sleep Disorders: Investigation in a Cohort of 741 Consecutive Children

Purpose

A possible relationship between sleep bruxism (SB) and several sleep disorders has been suggested in children, which could influence sleep quality and quality of life. This study aims to assess such correlations in a large sample of school children.

Methods

Parents of 741 consecutive children aged between 8 and 12 years filled the Sleep Disturbance Scale for Children (SDSC). It evaluated 45 items grouped in 8 components: duration of night-time sleep, sleep latency, bedtime problems, sleep quality, night awakenings, nocturnal symptoms, morning symptoms, and daytime sleepiness. An item evaluating parental-reported tooth grinding was also included. Correlation analysis was performed between parental-reported tooth grinding and all the other items.

Results

A significant correlation between parental-reported tooth grinding and several sleep disorders concerning bedtime problems, night awakenings, nocturnal symptoms, and morning symptoms has been found. In general, correlation strength of significant pairs was low, ranging from 0.092 (sleep apnea) to 0.234 (movement while falling asleep).

Conclusions

Parental-reported tooth grinding in children is correlated, even if weakly, with some sleep disorders concerning the sphere of bedtime problems, night awakenings, nocturnal symptoms, breathing symptoms, and morning symptoms. Further studies are needed to confirm these findings, with particular regard to the consistency of correlation outcomes between the parental reports and the sleep laboratory measures.

Risk factors associated with reported bruxism among children and adolescents with Down Syndrome

Objective: Identify factors associated with the prevalence of reported bruxism in children/adolescents with Down Syndrome (DS). Methods: The study included 112 children/adolescents with DS and their parents/caregivers. Oral habits, pacifier/finger sucking, upper respiratory infections (<six months), and breathing type (nasal/buccal) were diagnosed. Reported bruxism was recorded through parents' report ("Does your child have audible teeth grinding?"). Results: Children/adolescents 8-12 years of age were 1.15 times more likely to belong to the group with reported bruxism (1.42-3.14). Children/adolescents 5-7 years of age were 3.38 times more likely to belong to the group with reported bruxism (1.26-9.03). Children/adolescents classified as mouth breathers were 2.87 times more likely to belong to the group with reported bruxism (1.18-6.98). Conclusion: Age and mouth breathing were associated with reported bruxism. Earlier interventions should be provided in order to limit and minimize possible damage that can affect childrens' quality of life.

Health promotion in obstructive sleep apnea syndrome

Introduction Obstructive sleep apnea syndrome (OSAS), which is commonly underdiagnosed, has a high occurrence in the world population. Health education concerning sleep disorders and OSAS should be implemented. Objectives The objective was to identify studies related to preventive actions on sleep disorders, with emphasis on OSAS. Data Synthesis A literature review was conducted using Lilacs, Medline, PubMed, and Scopus by combining the following keywords: "Health Promotion," "Sleep Disorders," "Primary Prevention," "Health Education," and "Obstructive Sleep Apnea Syndromes." Initially, 1,055 papers, from 1968 to 2013, were located, with the majority from the Scopus database. The inclusion criteria were applied, and four articles published between 2006 and 2012 were included in the present study. Conclusions The studies on preventive actions in sleep disorders, with emphasis on OSAS, involved the general population and professionals and students in the health field and led to increased knowledge on sleep disorders and more appropriate practices.