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Pollis M, Lobbezoo F, Colonna A, Manfredini D. Relationship between sleep bruxism and obstructive sleep apnoea: A population-based survey. Aust Dent J 2024. [PMID: 39227305 DOI: 10.1111/adj.13036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/14/2024] [Indexed: 09/05/2024]
Abstract
OBJECTIVE Sleep bruxism (SB) and obstructive sleep apnoea (OSA) seem to be mutually associated. This study investigates the relationship between current SB and OSA-related symptoms and the difference in OSA-related symptoms between groups based on a history of SB. METHODS An online survey was drafted to report the presence of SB and OSA in sample of 243 individuals (M = 129;F = 114;mean(SD)age = 42.4 ± 14.4 years). The Subject-Based Assessment strategy recommended in the 'Standardized Tool for the Assessment of Bruxism' (STAB) was adopted to assess SB. To evaluate OSA-related symptoms, Epworth Sleepiness Scale (ESS) and STOP-BANG questionnaires were adopted. Correlations between current SB and OSA-related symptoms were evaluated by Spearman test. ESS and STOP-BANG scores were compared by Mann-Whitney U test in individuals with and a without positive SB history. RESULTS Current SB and SB history were reported by 45.7% and 39.1% of the sample, respectively. 73.7%, 21% and 5.3% of the responders showed a low, intermediate and high risk of OSA, respectively. Neither significant correlations between current SB and OSA nor significant differences between SB groups emerged. CONCLUSIONS This study did neither find any significant correlation between self-report of current SB and OSA nor significant differences in ESS and STOP-BANG scores between groups based on SB history.
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Affiliation(s)
- M Pollis
- Department of Medical Biotechnology, School of Dentistry, University of Siena, Siena, Italy
| | - F Lobbezoo
- Department of Orofacial Pain and Dysfunction, Academic Centre of Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - A Colonna
- Department of Medical Biotechnology, School of Dentistry, University of Siena, Siena, Italy
| | - D Manfredini
- Department of Medical Biotechnology, School of Dentistry, University of Siena, Siena, Italy
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Kuang B, Lobbezoo F, Li D, Hilgevoord AAJ, de Vries N, Aarab G. The effect of sleep position on sleep bruxism in adults with obstructive sleep apnea. J Oral Rehabil 2024; 51:1207-1212. [PMID: 38572841 DOI: 10.1111/joor.13696] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Accepted: 03/25/2024] [Indexed: 04/05/2024]
Abstract
BACKGROUND Most of the respiratory events in adults with obstructive sleep apnea (OSA) occurs in supine position. It has been reported that the contraction of masseter muscles is dependent on the occurrence of arousals rather than on the occurrence of respiratory events. OBJECTIVES This study had two aims: (1) to compare the rhythmic masticatory muscle activity (RMMA) index in supine position (RMMA_sup) and in non-supine positions (RMMA_nsup) in adults with OSA; and (2) to determine the associations between RMMA index in both supine position and non-supine positions on the one hand, and several demographic and polysomnographic variables on the other hand. METHODS One hundred OSA participants (36 females and 64 males; mean age = 50.3 years (SD = 10.5)) were selected randomly from among patients with a full-night polysomnographic recording. RMMA_sup index and RMMA_nsup index were compared using Mann-Whitney U-test. Multivariate linear regression analyses were used to predict RMMA index both in supine and non-supine positions based on several demographic and polysomnographic variables. RESULTS In patients with OSA, the RMMA_sup index was significantly higher than the RMMA_nsup index (p < .001). RMMA_sup index was significantly associated with the arousal index (p = .002) and arousal index in supine position (p < .001). RMMA_nsup index was only significantly associated with the arousal index in non-supine positions (p = .004). CONCLUSION Within the limitations of this study, RMMAs occur more frequently in supine position than in non-supine positions in patients with OSA. In both sleep positions, RMMAs are associated with arousals.
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Affiliation(s)
- Boyuan Kuang
- Department of Orofacial Pain and Dysfunction, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
- Department of Clinical Neurophysiology, OLVG, Amsterdam, the Netherlands
- Taikang Bybo Dental, Beijing, China
| | - Frank Lobbezoo
- Department of Orofacial Pain and Dysfunction, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Deshui Li
- Department of Orofacial Pain and Dysfunction, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
- Department of Clinical Neurophysiology, OLVG, Amsterdam, the Netherlands
- Department of Orthodontics, School and Hospital of Stomatology, Shandong University, Jinan, China
| | | | - Nico de Vries
- Department of Orofacial Pain and Dysfunction, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
- Department of Otorhinolaryngology, OLVG, Amsterdam, the Netherlands
- Faculty of Medicine and Health Sciences, Department of Otorhinolaryngology, Head and Neck Surgery, Antwerp University Hospital (UZA), Edegem, Belgium
| | - Ghizlane Aarab
- Department of Orofacial Pain and Dysfunction, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
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Vennard H, Buchan E, Davies P, Gibson N, Lowe D, Langley R. Paediatric sleep diagnostics in the 21st century: the era of "sleep-omics"? Eur Respir Rev 2024; 33:240041. [PMID: 38925792 PMCID: PMC11216690 DOI: 10.1183/16000617.0041-2024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2024] [Accepted: 04/16/2024] [Indexed: 06/28/2024] Open
Abstract
Paediatric sleep diagnostics is performed using complex multichannel tests in specialised centres, limiting access and availability and resulting in delayed diagnosis and management. Such investigations are often challenging due to patient size (prematurity), tolerability, and compliance with "gold standard" equipment. Children with sensory/behavioural issues, at increased risk of sleep disordered breathing (SDB), often find standard diagnostic equipment difficult.SDB can have implications for a child both in terms of physical health and neurocognitive development. Potential sequelae of untreated SDB includes failure to thrive, cardiopulmonary disease, impaired learning and behavioural issues. Prompt and accurate diagnosis of SDB is important to facilitate early intervention and improve outcomes.The current gold-standard diagnostic test for SDB is polysomnography (PSG), which is expensive, requiring the interpretation of a highly specialised physiologist. PSG is not feasible in low-income countries or outwith specialist sleep centres. During the coronavirus disease 2019 pandemic, efforts were made to improve remote monitoring and diagnostics in paediatric sleep medicine, resulting in a paradigm shift in SDB technology with a focus on automated diagnosis harnessing artificial intelligence (AI). AI enables interrogation of large datasets, setting the scene for an era of "sleep-omics", characterising the endotypic and phenotypic bedrock of SDB by drawing on genetic, lifestyle and demographic information. The National Institute for Health and Care Excellence recently announced a programme for the development of automated home-testing devices for SDB. Scorer-independent scalable diagnostic approaches for paediatric SDB have potential to improve diagnostic accuracy, accessibility and patient tolerability; reduce health inequalities; and yield downstream economic and environmental benefits.
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Affiliation(s)
- Hannah Vennard
- College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, UK
- Department of Paediatric Respiratory and Sleep Medicine, Royal Hospital for Children, Glasgow, UK
| | - Elise Buchan
- Department of Paediatric Respiratory and Sleep Medicine, Royal Hospital for Children, Glasgow, UK
| | - Philip Davies
- Department of Paediatric Respiratory and Sleep Medicine, Royal Hospital for Children, Glasgow, UK
| | - Neil Gibson
- Department of Paediatric Respiratory and Sleep Medicine, Royal Hospital for Children, Glasgow, UK
| | - David Lowe
- College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, UK
| | - Ross Langley
- College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, UK
- Department of Paediatric Respiratory and Sleep Medicine, Royal Hospital for Children, Glasgow, UK
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Luukinen M, Pitkänen H, Leppänen T, Töyräs J, Islind AS, Kainulainen S, Korkalainen H. Variation in the Photoplethysmogram Response to Arousal From Sleep Depending on the Cause of Arousal and the Presence of Desaturation. IEEE JOURNAL OF TRANSLATIONAL ENGINEERING IN HEALTH AND MEDICINE 2024; 12:328-339. [PMID: 38444399 PMCID: PMC10914203 DOI: 10.1109/jtehm.2024.3349916] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Revised: 12/07/2023] [Accepted: 12/22/2023] [Indexed: 03/07/2024]
Abstract
OBJECTIVE The aim of this study was to assess how the photoplethysmogram frequency and amplitude responses to arousals from sleep differ between arousals caused by apneas and hypopneas with and without blood oxygen desaturations, and spontaneous arousals. Stronger arousal causes were hypothesized to lead to larger and faster responses. METHODS AND PROCEDURES Photoplethysmogram signal segments during and around respiratory and spontaneous arousals of 876 suspected obstructive sleep apnea patients were analyzed. Logistic functions were fit to the mean instantaneous frequency and instantaneous amplitude of the signal to detect the responses. Response intensities and timings were compared between arousals of different causes. RESULTS The majority of the studied arousals induced photoplethysmogram responses. The frequency response was more intense ([Formula: see text]) after respiratory than spontaneous arousals, and after arousals caused by apneas compared to those caused by hypopneas. The amplitude response was stronger ([Formula: see text]) following hypopneas associated with blood oxygen desaturations compared to those that were not. The delays of these responses relative to the electroencephalogram arousal start times were the longest ([Formula: see text]) after arousals caused by apneas and the shortest after spontaneous arousals and arousals caused by hypopneas without blood oxygen desaturations. CONCLUSION The presence and type of an airway obstruction and the presence of a blood oxygen desaturation affect the intensity and the timing of photoplethysmogram responses to arousals from sleep. CLINICAL IMPACT The photoplethysmogram responses could be used for detecting arousals and assessing their intensity, and the individual variation in the response intensity and timing may hold diagnostically significant information.
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Affiliation(s)
- Mieli Luukinen
- Department of Technical PhysicsUniversity of Eastern Finland70211KuopioFinland
- Diagnostic Imaging CenterKuopio University Hospital70210KuopioFinland
| | - Henna Pitkänen
- Department of Technical PhysicsUniversity of Eastern Finland70211KuopioFinland
- Diagnostic Imaging CenterKuopio University Hospital70210KuopioFinland
| | - Timo Leppänen
- Department of Technical PhysicsUniversity of Eastern Finland70211KuopioFinland
- Diagnostic Imaging CenterKuopio University Hospital70210KuopioFinland
- School of Electrical Engineering and Computer ScienceThe University of QueenslandBrisbaneQLD4072Australia
| | - Juha Töyräs
- Department of Technical PhysicsUniversity of Eastern Finland70211KuopioFinland
- School of Electrical Engineering and Computer ScienceThe University of QueenslandBrisbaneQLD4072Australia
- Science Service CenterKuopio University Hospital70210KuopioFinland
| | | | - Samu Kainulainen
- Department of Technical PhysicsUniversity of Eastern Finland70211KuopioFinland
- Diagnostic Imaging CenterKuopio University Hospital70210KuopioFinland
| | - Henri Korkalainen
- Department of Technical PhysicsUniversity of Eastern Finland70211KuopioFinland
- Diagnostic Imaging CenterKuopio University Hospital70210KuopioFinland
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Zhu Y, Toyota R, Shiraishi Y, Katagiri A, Yamada M, Higashiyama M, Toyoda H, Lavigne G, Kato T. Sleep architecture as a candidate for phenotyping sleep bruxism: A narrative physiological review. J Oral Rehabil 2024; 51:87-102. [PMID: 37114936 DOI: 10.1111/joor.13482] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Revised: 03/20/2023] [Accepted: 04/22/2023] [Indexed: 04/29/2023]
Abstract
BACKGROUND Sleep bruxism (SB), an oral behaviour in otherwise healthy individuals, is characterised by frequent rhythmic masticatory muscle activity (RMMA) during sleep. RMMA/SB episodes occur over various sleep stages (N1-N3 and rapid eye movement (REM)), sleep cycles (non-REM to REM), and frequently with microarousals. It currently remains unclear whether these characteristics of sleep architecture are phenotype candidates for the genesis of RMMA/SB. OBJECTIVES This narrative review investigated the relationship between sleep architecture and the occurrence of RMMA as a SB phenotype candidate. METHODS PubMed research was performed using keywords related to RMMA/SB and sleep architecture. RESULTS In non-SB and SB healthy individuals, RMMA episodes were most frequent in the light non-REM sleep stages N1 and N2, particularly during the ascending phase of sleep cycles. The onset of RMMA/SB episodes in healthy individuals was preceded by a physiological arousal sequence of autonomic cardiovascular to cortical activation. It was not possible to extract a consistent sleep architecture pattern in the presence of sleep comorbidities. The lack of standardisation and variability between subject complexified the search for specific sleep architecture phenotype(s). CONCLUSION In otherwise healthy individuals, the genesis of RMMA/SB episodes is largely affected by oscillations in the sleep stage and cycle as well as the occurrence of microarousal. Furthermore, a specific sleep architecture pattern cannot be confirmed in the presence of sleep comorbidity. Further studies are needed to delineate sleep architecture phenotype candidate(s) that contribute to the more accurate diagnosis of SB and treatment approaches using standardised and innovative methodologies.
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Affiliation(s)
- Yiwen Zhu
- Department of Oral Physiology, Osaka University Graduate School of Dentistry, Suita, Japan
| | - Risa Toyota
- Department of Prosthodontics, Gerodontology and Oral Rehabilitation, Osaka University, Suita, Japan
| | - Yuki Shiraishi
- Department of Orthodontics and Dentofacial Orthopedics, Osaka University Graduate School of Dentistry, Suita, Japan
| | - Ayano Katagiri
- Department of Oral Physiology, Osaka University Graduate School of Dentistry, Suita, Japan
| | - Masaharu Yamada
- Department of Oral Physiology, Osaka University Graduate School of Dentistry, Suita, Japan
- Department of Dental Anesthesiology, Osaka University Graduate School of Dentistry, Suita, Japan
| | - Makoto Higashiyama
- Department of Oral Physiology, Osaka University Graduate School of Dentistry, Suita, Japan
| | - Hiroki Toyoda
- Department of Oral Physiology, Osaka University Graduate School of Dentistry, Suita, Japan
| | - Gilles Lavigne
- Faculte de medecine dentaire, Universite de Montreal, Montreal, Quebec, Canada
| | - Takafumi Kato
- Department of Oral Physiology, Osaka University Graduate School of Dentistry, Suita, Japan
- United Graduate School of Child Development, Osaka University, Suita, Japan
- Sleep Medicine Center, Osaka University Hospital, Suita, Japan
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Conti PCR, Cunha CO, Conti ACDCF, Bonjardim LR, Barbosa JS, Costa YM. Secondary bruxism: A valid diagnosis or just a coincidental finding of additional masticatory muscle activity? A narrative review of literature. J Oral Rehabil 2024; 51:74-86. [PMID: 37688286 DOI: 10.1111/joor.13592] [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: 10/07/2022] [Revised: 08/08/2023] [Accepted: 08/24/2023] [Indexed: 09/10/2023]
Abstract
INTRODUCTION Bruxism is defined as a repetitive masticatory muscle activity that can manifest it upon awakening (awake bruxism-AB) or during sleep (sleep bruxism-SB). Some forms of both, AB and SB can be associated to many other coexistent factors, considered of risk for the initiation and maintenance of the bruxism. Although controversial, the term 'secondary bruxism' has frequently been used to label these cases. The absence of an adequate definition of bruxism, the non-distinction between the circadian manifestations and the report of many different measurement techniques, however, are important factors to be considered when judging the literature findings. The use (and abuse) of drugs, caffeine, nicotine, alcohol and psychoactive substances, the presence of respiratory disorders during sleep, gastroesophageal reflux disorders and movement, neurological and psychiatric disorders are among these factors. The scarcity of controlled studies and the complexity and interactions among all aforementioned factors, unfortunately, does not allow to establish any causality or temporal association with SB and AB. The supposition that variables are related depends on different parameters, not clearly demonstrated in the available studies. OBJECTIVES This narrative review aims at providing oral health care professionals with an update on the co-risk factors and disorders possibly associated with bruxism. In addition, the authors discuss the appropriateness of the term 'secondary bruxism' as a valid diagnostic category based on the available evidence. CONCLUSION The absence of an adequate definition of bruxism, the non-distinction between the circadian manifestations and the report of many different measurement techniques found in many studies preclude any solid and convincing conclusion on the existence of the 'secondary' bruxism.
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Affiliation(s)
- Paulo Cesar R Conti
- Department of Prosthodontics and Periodontics, Bauru School of Dentistry, University of São Paulo, Bauru, Brazil
- Bauru Orofacial Group, University of São Paulo, Bauru, Brazil
| | - Carolina Ortigosa Cunha
- Department of Prosthodontics and Periodontics, Bauru School of Dentistry, University of São Paulo, Bauru, Brazil
- Bauru Orofacial Group, University of São Paulo, Bauru, Brazil
| | - Ana Cláudia de Castro F Conti
- Bauru Orofacial Group, University of São Paulo, Bauru, Brazil
- Department of Orthodontics and Pediatric Dentistry, Bauru School of Dentistry, University of São Paulo, Bauru, Brazil
| | - Leonardo R Bonjardim
- Bauru Orofacial Group, University of São Paulo, Bauru, Brazil
- Department of Biologic Sciences, Bauru School of Dentistry, University of São Paulo, Bauru, Brazil
| | | | - Yuri Martins Costa
- Bauru Orofacial Group, University of São Paulo, Bauru, Brazil
- Department of Biosciences, Piracicaba Dental School, University of Campinas, Piracicaba, Brazil
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Haraki S, Tsujisaka A, Shiraishi Y, Toyota R, Katagiri A, Toyoda H, Ishigaki S, Taniike M, Kato T. Reciprocal first night effect on rhythmic and non-rhythmic oromotor episodes in moderate to severe primary sleep bruxism: A retrospective physiological study. J Oral Rehabil 2024; 51:131-142. [PMID: 37077152 DOI: 10.1111/joor.13474] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Revised: 03/23/2023] [Accepted: 03/30/2023] [Indexed: 04/21/2023]
Abstract
BACKGROUND Sleep on the first night in a sleep laboratory is characterized by a lower sleep quality and frequency of rhythmic masticatory muscle activity (RMMA) than that on the second night in moderate to severe sleep bruxism (SB) patients. OBJECTIVE The aims of this study was to clarify the physiological factors contributing to the first night effect on oromotor activity during sleep and investigate whether physiological factors involved in the first night effect differed between rhythmic and non-rhythmic oromotor activities. METHODS Polysomnographic data collected on two consecutive nights from 15 moderate to severe SB subjects (F 7: M 8; age: 23.2 ± 1.3 [mean ± SD] years) were retrospectively analysed. Sleep variables, RMMA and non-specific masticatory muscle activity (NSMA) were scored in relation to episode types (i.e. phasic or tonic and cluster or isolated), sleep architecture and transient arousals. The relationships between nightly differences in oromotor and sleep variables were assessed. The distribution of oromotor events, arousals, cortical electroencephalographic power, RR intervals and heart rate variability were examined in relation to sleep cycle changes. These variables were compared between the first and second nights and between RMMA and NSMA. RESULTS Sleep variables showed a lower sleep quality on Night 1 than on Night 2. In comparisons with Night 1, the RMMA index increased by 18.8% (p < .001, the Wilcoxon signed-rank test) on Night 2, while the NSMA index decreased by 17.9% (p = .041). Changes in the RMMA index did not correlate with those in sleep variables, while changes in the NSMA index correlated with those in arousal-related variables (p < .001, Spearman's rank correlation). An increase in the RMMA index on Night 2 was found for the cluster type and stage N1 related to sleep cyclic fluctuations in cortical and cardiac activities. In contrast, the decrease in the NSMA index was associated with increases in the isolated type and the occurrence of stage N2 and wakefulness regardless of the sleep cycle. CONCLUSION Discrepancies in first night effect on the occurrence of RMMA and NSMA represent unique sleep-related processes in the genesis of oromotor phenotypes in SB subjects.
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Affiliation(s)
- Shingo Haraki
- Department of Fixed Prosthodontics, Osaka University Graduate School of Dentistry, Osaka, Japan
| | - Akiko Tsujisaka
- Department of Fixed Prosthodontics, Osaka University Graduate School of Dentistry, Osaka, Japan
| | - Yuki Shiraishi
- Department of Orthodontics and Dentofacial Orthopedics, Osaka University Graduate School of Dentistry, Osaka, Japan
| | - Risa Toyota
- Department of Prosthodontics, Gerodontology and Oral Rehabilitation, Osaka University Graduate School of Dentistry, Osaka, Japan
| | - Ayano Katagiri
- Department of Oral Physiology, Osaka University Graduate School of Dentistry, Osaka, Japan
| | - Hiroki Toyoda
- Department of Oral Physiology, Osaka University Graduate School of Dentistry, Osaka, Japan
| | - Shoichi Ishigaki
- Department of Fixed Prosthodontics, Osaka University Graduate School of Dentistry, Osaka, Japan
| | - Masako Taniike
- United Graduate School of Child Development, Osaka University, Osaka, Japan
- Osaka University Hospital, Sleep Medicine Center, Osaka, Japan
| | - Takafumi Kato
- Department of Oral Physiology, Osaka University Graduate School of Dentistry, Osaka, Japan
- United Graduate School of Child Development, Osaka University, Osaka, Japan
- Osaka University Hospital, Sleep Medicine Center, Osaka, Japan
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Li D, Kuang B, Lobbezoo F, de Vries N, Hilgevoord A, Aarab G. Sleep bruxism is highly prevalent in adults with obstructive sleep apnea: a large-scale polysomnographic study. J Clin Sleep Med 2023; 19:443-451. [PMID: 36448332 PMCID: PMC9978428 DOI: 10.5664/jcsm.10348] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Revised: 10/13/2022] [Accepted: 10/14/2022] [Indexed: 12/05/2022]
Abstract
STUDY OBJECTIVES The aim was to determine the prevalence and risk factors of sleep bruxism (SB) and to investigate the relationships between SB episodes, arousals, and respiratory events in adults with obstructive sleep apnea (OSA). METHODS This prospective study included 914 adults with OSA (305 females, 609 males; age = 53 years [interquartile range = 17]; apnea-hypopnea index = 13.9 events/h [interquartile range = 21]). The diagnosis of SB was made when the rhythmic masticatory muscle activity (RMMA) index was at least 2 episodes/h of sleep based on a full polysomnographic recording. Binary logistic regression was performed to identify risk factors for SB. Network analysis was performed to determine the relations between RMMA, respiratory event, sleep arousal, and other factors. Further, the percentage of RMMA time-related to arousal was calculated. RESULTS The prevalence of SB in adults with OSA was 49.7%. Male sex, lower body mass index, and higher percentage of N1 sleep increased the odds of having SB (odds ratios = 1.425, 0.951, and 1.032, respectively; all P < .05). Network analysis showed that there were no direct associations between RMMA and apnea-hypopnea index, nor between RMMA and arousal, although 85.7% of RMMA was time-related to arousals. CONCLUSIONS Nearly half of adults with OSA have comorbid SB. Male sex, lower body mass index, and a higher percentage of light sleep increase the risk of having SB. Although RMMAs do not directly correlate with respiratory events and arousals, most RMMAs are time-related to arousals in adults with OSA. CLINICAL TRIAL REGISTRATION Registry: Netherlands Trial Register; Name: A Large Sample Polysomnographic Study on Sleep Bruxism; URL: https://trialsearch.who.int/Trial2.aspx?TrialID=NL8516; Identifier: NL8516. CITATION Li D, Kuang B, Lobbezoo F, de Vries N, Hilgevoord A, Aarab G. Sleep bruxism is highly prevalent in adults with obstructive sleep apnea: a large-scale polysomnographic study. J Clin Sleep Med. 2023;19(3):443-451.
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Affiliation(s)
- Deshui Li
- Department of Orofacial Pain and Dysfunction, Academic Centre for Dentistry Amsterdam, University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Department of Clinical Neurophysiology, OLVG West, Amsterdam, The Netherlands
- Department of Orthodontics, School and Hospital of Stomatology, Shandong University, Jinan, China
| | - Boyuan Kuang
- Department of Orofacial Pain and Dysfunction, Academic Centre for Dentistry Amsterdam, University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Department of Clinical Neurophysiology, OLVG West, Amsterdam, The Netherlands
- Taikang Bybo Dental, Shanghai, China
| | - Frank Lobbezoo
- Department of Orofacial Pain and Dysfunction, Academic Centre for Dentistry Amsterdam, University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Nico de Vries
- Department of Orofacial Pain and Dysfunction, Academic Centre for Dentistry Amsterdam, University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Department of Otorhinolaryngology, OLVG West, Amsterdam, The Netherlands
- Faculty of Medicine and Health Sciences, Department of Otorhinolaryngology, Head and Neck Surgery, Antwerp University Hospital, Edegem, Belgium
| | - Antonius Hilgevoord
- Department of Clinical Neurophysiology, OLVG West, Amsterdam, The Netherlands
| | - Ghizlane Aarab
- Department of Orofacial Pain and Dysfunction, Academic Centre for Dentistry Amsterdam, University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
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9
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Huang Z, Zhou N, Lobbezoo F, Almeida FR, Cistulli PA, Dieltjens M, Huynh NT, Kato T, Lavigne GJ, Masse JF, Pliska BT, van de Rijt L, Sutherland K, Thymi M, Vanderveken OM, de Vries R, Aarab G. Dental sleep-related conditions and the role of oral healthcare providers: A scoping review. Sleep Med Rev 2023; 67:101721. [PMID: 36446166 DOI: 10.1016/j.smrv.2022.101721] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Revised: 11/12/2022] [Accepted: 11/15/2022] [Indexed: 11/21/2022]
Abstract
Dental sleep medicine as a discipline was first described about a quarter of a century ago. Snoring, obstructive sleep apnea, sleep bruxism, xerostomia, hypersalivation, gastroesophageal reflux disease, and orofacial pain were identified as dental sleep-related conditions. This scoping review aimed to: i) identify previously unidentified dental sleep-related conditions; and ii) identify the role of oral healthcare providers in the prevention, assessment, and management of dental sleep-related conditions in adults. A systematic literature search was conducted in PubMed, Embase.com, Web of Science, and Cochrane. Studies that reported an actual or likely role of oral healthcare providers in the prevention, assessment, and/or management of sleep-related conditions were included. Of the 273 included studies, 260 were on previously listed dental sleep-related conditions; the other 13 were on burning mouth syndrome. Burning mouth syndrome was therefore added to the list of dental sleep-related conditions for the first aim and categorized into sleep-related orofacial pain. For the second aim, the role of oral healthcare providers was found to be significant in the prevention, assessment, and management of obstructive sleep apnea and sleep bruxism; in the assessment and management of snoring, sleep-related orofacial pain, and oral dryness; and in the assessment of sleep-related gastroesophageal reflux condition.
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Affiliation(s)
- Zhengfei Huang
- Department of Orofacial Pain and Dysfunction, Academic Center for Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam, the Netherlands; Department of Clinical Neurophysiology, OLVG, Amsterdam, the Netherlands.
| | - Ning Zhou
- Department of Orofacial Pain and Dysfunction, Academic Center for Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam, the Netherlands; Department of Oral and Maxillofacial Surgery, Amsterdam UMC Location AMC and Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam, Amsterdam, the Netherlands
| | - Frank Lobbezoo
- Department of Orofacial Pain and Dysfunction, Academic Center for Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Fernanda R Almeida
- Division of Orthodontics, Department of Oral Health Sciences, Faculty of Dentistry, University of British Columbia, Vancouver, Canada
| | - Peter A Cistulli
- Sleep Research Group, Charles Perkins Centre & Northern Clinical School, Faculty of Medicine and Health, University of Sydney, Camperdown, Australia
| | - Marijke Dieltjens
- Faculty of Medicine and Health Sciences, Translational Neurosciences, University of Antwerp, Antwerp, Belgium; Department of Otorhinolaryngology, Head and Neck Surgery, Antwerp University Hospital, Antwerp, Belgium
| | - Nelly T Huynh
- Faculté de Médecine Dentaire, Université de Montréal, Montréal, Canada
| | - Takafumi Kato
- Department of Oral Physiology, Osaka University Graduate School of Dentistry, Suita, Japan
| | - Gilles J Lavigne
- Faculté de Médecine Dentaire, Université de Montréal, Montréal, Canada
| | | | - Benjamin T Pliska
- Division of Orthodontics, Department of Oral Health Sciences, Faculty of Dentistry, University of British Columbia, Vancouver, Canada
| | - Liza van de Rijt
- Department of Orofacial Pain and Dysfunction, Academic Center for Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Kate Sutherland
- Sleep Research Group, Charles Perkins Centre & Northern Clinical School, Faculty of Medicine and Health, University of Sydney, Camperdown, Australia
| | - Magdalini Thymi
- Department of Orofacial Pain and Dysfunction, Academic Center for Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Olivier M Vanderveken
- Faculty of Medicine and Health Sciences, Translational Neurosciences, University of Antwerp, Antwerp, Belgium; Department of Otorhinolaryngology, Head and Neck Surgery, Antwerp University Hospital, Antwerp, Belgium; Multidisciplinary Sleep Disorders Centre, Antwerp University Hospital, Edegem, Belgium
| | - Ralph de Vries
- Medical Library, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Ghizlane Aarab
- Department of Orofacial Pain and Dysfunction, Academic Center for Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
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10
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Okura M, Kato T, Mashita M, Muraki H, Sugita H, Ohi M, Taniguchi M. Relationships between respiratory and oromotor events differ between motor phenotypes in patients with obstructive sleep apnea. Front Neurol 2023; 14:1150477. [PMID: 37025207 PMCID: PMC10071011 DOI: 10.3389/fneur.2023.1150477] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Accepted: 03/02/2023] [Indexed: 04/08/2023] Open
Abstract
Purpose The present study investigated the relationship between sleep bruxism (SB) and obstructive sleep apnea (OSA) in relation to the sleep architecture. Methods We 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. Results The 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. Conclusion In 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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Affiliation(s)
- Mutsumi Okura
- Department of Oral Physiology, Osaka University Graduate School of Dentistry, Suita, Osaka, Japan
- Sleep Medical Center, Osaka Kaisei Hospital, Osaka, Japan
- Center for Sleep Medicine, Asahi University Hospital, Gifu, Japan
| | - Takafumi Kato
- Department of Oral Physiology, Osaka University Graduate School of Dentistry, Suita, Osaka, Japan
- *Correspondence: Takafumi Kato,
| | - Midori Mashita
- Department of Psychiatry, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
| | - Hisae Muraki
- Sleep Medical Center, Osaka Kaisei Hospital, Osaka, Japan
- Center for Sleep Medicine, Asahi University Hospital, Gifu, Japan
| | - Hideko Sugita
- Sleep Medical Center, Osaka Kaisei Hospital, Osaka, Japan
| | - Motoharu Ohi
- Sleep Medical Center, Osaka Kaisei Hospital, Osaka, Japan
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11
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Wieczorek T, Michałek-Zrąbkowska M, Więckiewicz M, Mazur G, Rymaszewska J, Smardz J, Wojakowska A, Martynowicz H. Sleep Bruxism Contributes to Motor Activity Increase during Sleep in Apneic and Nonapneic Patients-A Polysomnographic Study. Biomedicines 2022; 10:biomedicines10102666. [PMID: 36289928 PMCID: PMC9599859 DOI: 10.3390/biomedicines10102666] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Revised: 10/15/2022] [Accepted: 10/17/2022] [Indexed: 11/20/2022] Open
Abstract
Background: Jaw motor activity (MA) in sleep bruxism (SB) has been demonstrated to accompany lower limb movements. However, it remains unknown whether SB activity coexists with other types of movements and what the possible underlying mechanisms of such temporal coexistence are. In obstructive sleep apnea (OSA), increased movement activity is also reported, including SB activity; however, no studies have compared MA in apneic and nonapneic SB patients. Aim: This cross-sectional study focused on the phenomenon of “big body movements” in patients with either SB or OSA (or both) and intended to identify the primary factors contributing to their appearance, using polysomnography (PSG) recording. Methods: A whole-night videoPSG was carried out in 287 participants, and 124 apneic and 146 nonapneic participants were selected for the study. In both groups, participants were further divided into no SB, moderate SB, and severe SB (SSB) subgroups based on their bruxism episode index (BEI). MA was recorded using a built-in sensor of the central PSG unit located on the participant’s chest during the examination. Results: The presence of SB was related to the higher intensity of MA in both apneic and nonapneic participants, though in general the MA level was higher in apneic participants, with the highest level observed in SSB apneic participants. Conclusions: SB might contribute to MA. The prevalence of SB might be higher in nonapneic patients due to phasic and mixed SB activity, whereas the SB phenotype seems to be less relevant in apneic patients. SB activity is likely to increase MA in non-REM 1 sleep.
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Affiliation(s)
- Tomasz Wieczorek
- Department and Clinic of Psychiatry, Wroclaw Medical University, 50-367 Wroclaw, Poland
- Correspondence:
| | - Monika Michałek-Zrąbkowska
- Department and Clinic of Internal Medicine, Occupational Diseases, Hypertension and Clinical Oncology, Wroclaw Medical University, 50-367 Wroclaw, Poland
| | - Mieszko Więckiewicz
- Department of Experimental Dentistry, Wroclaw Medical University, 50-367 Wroclaw, Poland
| | - Grzegorz Mazur
- Department and Clinic of Internal Medicine, Occupational Diseases, Hypertension and Clinical Oncology, Wroclaw Medical University, 50-367 Wroclaw, Poland
| | - Joanna Rymaszewska
- Department and Clinic of Psychiatry, Wroclaw Medical University, 50-367 Wroclaw, Poland
| | - Joanna Smardz
- Department of Experimental Dentistry, Wroclaw Medical University, 50-367 Wroclaw, Poland
| | - Anna Wojakowska
- Department and Clinic of Internal Medicine, Occupational Diseases, Hypertension and Clinical Oncology, Wroclaw Medical University, 50-367 Wroclaw, Poland
| | - Helena Martynowicz
- Department and Clinic of Internal Medicine, Occupational Diseases, Hypertension and Clinical Oncology, Wroclaw Medical University, 50-367 Wroclaw, Poland
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12
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Smardz J, Wieckiewicz M, Wojakowska A, Michalek-Zrabkowska M, Poreba R, Gac P, Mazur G, Martynowicz H. Incidence of Sleep Bruxism in Different Phenotypes of Obstructive Sleep Apnea. J Clin Med 2022; 11:jcm11144091. [PMID: 35887854 PMCID: PMC9323077 DOI: 10.3390/jcm11144091] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Revised: 07/07/2022] [Accepted: 07/10/2022] [Indexed: 02/06/2023] Open
Abstract
(1) Background: Sleep bruxism (SB) is a common sleep behavior. Obstructive sleep apnea (OSA) is a prevalent sleep-related breathing disorder with potential long-term major neurocognitive and cardiovascular sequelae. Although the co-occurrence of SB and OSA has been described previously, the exact relationship remains unclear. The present study aimed to evaluate the incidence of SB in different phenotypes of OSA. (2) Methods: The participants of this study were adult patients referred to the Department and Clinic of Internal Medicine, Occupational Diseases, Hypertension and Clinical Oncology at the Wroclaw Medical University. They underwent a single-night video polysomnography in a sleep laboratory. The data related to common OSA phenotypes were analyzed in two separate groups of patients: body position related (n = 94) and rapid eye movement (REM) related (n = 85). (3) Results: The obtained results showed that the incidence of SB and severe SB was higher for body position-related OSA phenotype (p < 0.05 for all comparisons). No statistically significant differences were observed for REM-related OSA phenotype (p > 0.05 for all comparisons). (4) Conclusions: Body position-related OSA phenotype seems to be associated with higher SB and severe SB incidence, but the relationship is not independent. However, in the light of the unclear relationship between SB and sleep-disordered breathing, the topic needs further study.
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Affiliation(s)
- Joanna Smardz
- Department of Experimental Dentistry, Wroclaw Medical University, 50-425 Wroclaw, Poland;
| | - Mieszko Wieckiewicz
- Department of Experimental Dentistry, Wroclaw Medical University, 50-425 Wroclaw, Poland;
- Correspondence:
| | - Anna Wojakowska
- Department and Clinic of Internal Medicine, Occupational Diseases, Hypertension and Clinical Oncology, Wroclaw Medical University, 50-556 Wroclaw, Poland; (A.W.); (M.M.-Z.); (R.P.); (G.M.); (H.M.)
| | - Monika Michalek-Zrabkowska
- Department and Clinic of Internal Medicine, Occupational Diseases, Hypertension and Clinical Oncology, Wroclaw Medical University, 50-556 Wroclaw, Poland; (A.W.); (M.M.-Z.); (R.P.); (G.M.); (H.M.)
| | - Rafal Poreba
- Department and Clinic of Internal Medicine, Occupational Diseases, Hypertension and Clinical Oncology, Wroclaw Medical University, 50-556 Wroclaw, Poland; (A.W.); (M.M.-Z.); (R.P.); (G.M.); (H.M.)
| | - Pawel Gac
- Department of Population Health, Division of Environmental Health and Occupational Medicine, Wroclaw Medical University, 50-345 Wroclaw, Poland;
| | - Grzegorz Mazur
- Department and Clinic of Internal Medicine, Occupational Diseases, Hypertension and Clinical Oncology, Wroclaw Medical University, 50-556 Wroclaw, Poland; (A.W.); (M.M.-Z.); (R.P.); (G.M.); (H.M.)
| | - Helena Martynowicz
- Department and Clinic of Internal Medicine, Occupational Diseases, Hypertension and Clinical Oncology, Wroclaw Medical University, 50-556 Wroclaw, Poland; (A.W.); (M.M.-Z.); (R.P.); (G.M.); (H.M.)
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13
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The effects of mandibular advancement appliance therapy on the sequence of jaw-closing muscle activity and respiratory events in individuals with obstructive sleep apnea. Sleep Breath 2022; 27:757-764. [DOI: 10.1007/s11325-022-02624-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Revised: 03/16/2022] [Accepted: 04/19/2022] [Indexed: 10/18/2022]
Abstract
Abstract
Purpose
To determine the effects of a mandibular advancement appliance (MAA) on sequences of jaw-closing muscle activity (JCMA) and apneic or hypopneic event (AHE) in individuals with obstructive sleep apnea (OSA).
Methods
Individuals with OSA were included in a secondary analysis of a randomized controlled crossover trial, in which two ambulatory polysomnographic recordings were performed: one with MAA in situ and the other without MAA. A time span of 16 s between JCMA and AHE was applied to classify JCMAs into four sequences: (1) JCMA occurs before AHE (B-type); (2) both events occur simultaneously (S-type); (3) JCMA occurs after AHE (A-type); and (4) JCMA is time-unrelated to AHE (U-type). The effects of MAA on the distribution of these sequences were analyzed by Wilcoxon signed-rank test.
Results
Among 16 individuals (10 men, mean age 51.3 ± 8.5 years) baseline apnea–hypopnea index and JCMA index were 23.8 ± 16.0 events/h and 10.8 ± 10.3 events/h, respectively. In both conditions, i.e., without and with MAA, most JCMAs were U-type (48% and 65%, respectively), followed by A-type (41% and 22%), B-type (25% and 21%), and S-type (2% and 1%). With MAA in situ, only the A-type JCMA index decreased significantly (P = 0.005), while B-type, S-type, and U-type JCMA indices did not change significantly (all P > 0.05).
Conclusion
MAA therapy only significantly reduces the jaw-closing muscle activities that occur after apneic or hypopneic events in individuals with OSA.
Trial registration
www.clinicaltrials.gov (NCT02011425); December 13, 2013.
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14
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Emodi-Perlman A, Soliman J, Frideman-Rubin P, Eli I. Symptoms of Nocturnal Masticatory Muscle Activity among Women of Different Age Groups and Their Association to Obstructive Sleep Apnea-A Cross Sectional Study. J Clin Med 2022; 11:jcm11051199. [PMID: 35268290 PMCID: PMC8911247 DOI: 10.3390/jcm11051199] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Revised: 02/11/2022] [Accepted: 02/20/2022] [Indexed: 11/16/2022] Open
Abstract
Sleep bruxism (SB), snoring, and excessive daytime sleepiness are often associated with obstructive sleep apnea (OSA). OSA, which is characterized by a repetitive collapse of the upper airway during sleep, can cause oxygen desaturation and lead to adverse medical conditions, such as cardiovascular events, hypertension, heart attack, and stroke. In the present study, 112 Arab women aged 20−40 years (Early Adulthood/Adulthood−EarlyA) and 116 Arab women aged 50 and above (Middle Age−MiddleA), were requested to complete questionnaires regarding demographic variables, symptoms of nocturnal masticatory muscle activity (possible SB, headache, and stiffness of the oral and/or neck musculature upon awakening), risk of OSA (STOP-BANG questionnaire), and daytime sleepiness (Epworth sleepiness scale—ESS). Women, who reported snoring, experienced more SB (35.8% vs. 20.6%, chi-square, p < 0.05), more headaches (33.3% vs. 19.3%, p < 0.05), and more muscle stiffness upon awakening (34.3% vs. 16.3%, p < 0.005), than their non-snoring counterparts. Out of the women who snore, 11% showed high risk for OSA, as compared to only 1% among the non-snoring participants (p < 0.000). Symptoms of nocturnal masticatory muscle activity and/or snoring can serve as initial indicators of OSA. Higher awareness of dentists to such symptoms, particularly among their middle-aged female patients, can prevent a development of harmful conditions associated with OSA.
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15
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Pitkanen H, Duce B, Leppanen T, Kainulainen S, Kulkas A, Myllymaa S, Toyras J, Korkalainen H. Gamma Power of Electroencephalogram Arousal is Modulated by Respiratory Event Type and Severity in Obstructive Sleep Apnea. IEEE Trans Biomed Eng 2021; 69:1417-1423. [PMID: 34613906 DOI: 10.1109/tbme.2021.3118229] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
OBJECTIVE We aimed to investigate the differences in electroencephalogram (EEG) gamma power (30-40 Hz) of respiratory arousals between varying types and severities of respiratory events, and in different sleep stages. METHODS Power spectral densities of EEG signals from diagnostic Type I polysomnograms of 869 patients with clinically suspected obstructive sleep apnea were investigated. Arousals were compared between sleep stages, as well as between the type (obstructive apnea and hypopnea), and duration (10-20 s, 20-30 s, and >30 s) of the related respiratory event. Moreover, we investigated whether the presence of a ≥3% blood oxygen desaturation influenced the arousal gamma power. RESULTS Gamma power of respiratory arousals was the lowest in Stage R sleep and increased from Stage N1 towards Stage N3. Gamma power was higher when the arousals were caused by obstructive apneas compared to hypopneas. Moreover, arousal gamma power increased when the duration of the related apnea increased, whereas an increase in the hypopnea duration did not have a similar effect. Furthermore, respiratory events associated with desaturations increased the arousal gamma power more compared to respiratory events not associated with desaturations. CONCLUSION Gamma power of respiratory arousals increased in deeper sleep and as the severity of the related respiratory event increased in terms of degree of obstruction and presence of desaturation. SIGNIFICANCE As increased gamma power might indicate a greater shift towards wakefulness, the present findings demonstrate that the arousal intensity and the magnitude of sleep disruption may vary depending on the event type and severity.
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16
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Imai H, Haraki S, Tsujisaka A, Okura M, Adachi H, Ohno Y, Yatani H, Kato T. A lack of specific motor patterns between rhythmic/non-rhythmic masticatory muscle activity and bodily movements in sleep bruxism. J Prosthodont Res 2021; 65:415-420. [PMID: 33281172 DOI: 10.2186/jpr.jpr_d_20_00012] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Purpose The aims of the present study were to investigate the temporal relationships between jaw and bodily movements and clarify motor processes in the genesis of rhythmic masticatory muscle activity (RMMA) in sleep bruxism (SB).Methods Video-polysomnography recordings were obtained from ten subjects with SB (mean age: 23.4 ± 1.6 years) and ten matched normal controls (CTL) (mean age: 24.4 ± 3.2 years). RMMA and nonspecific masseter activity (NSMA) were scored in association with bodily movements in the leg, arm, head, and trunk using electromyography and video recordings. The relationship between oromotor episodes and bodily movements was assessed in terms of sleep stage distributions and temporal relationships. Cardiac changes preceding oromotor episodes in stage N2 were assessed.Results Approximately 80% of RMMA and NSMA were associated with movements in one or more body sites. RMMA and NSMA were more frequently associated with movements of the leg (70-75%) and arm (40-55%) than movements of the head (17-22%) and trunk (5-25%). The relationship between oromotor episodes and bodily movements did not significantly differ among sleep stages. Oromotor episodes and bodily movements did not show a consistent temporal pattern in the SB and CTL groups. Regardless of the temporal relationship between oromotor episodes and bodily movements, the mean heart rate significantly increased by 5 beats before the onset of oromotor episodes.Conclusions No specific temporal motor patterns were found between RMMA and bodily movements. RMMA and NSMA represent a repertoire of arousal-related autonomic motor responses during sleep.
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Affiliation(s)
- Hideto Imai
- Faculty of Nursing, Setsunan University, Osaka, Japan
| | - Shingo Haraki
- Department of Fixed Prosthodontics, Osaka University Graduate School of Dentistry, Osaka, Japan
| | - Akiko Tsujisaka
- Department of Fixed Prosthodontics, Osaka University Graduate School of Dentistry, Osaka, Japan
| | - Mutsumi Okura
- Center for Sleep Medicine, Department of Neurology Asahi University Hospital, Gifu, Japan.,Department of Oral Physiology, Osaka University Graduate School of Dentistry, Osaka, Japan
| | - Hiroyoshi Adachi
- Health and Counseling Center, Osaka University, Osaka, Japan.,Sleep Medicine Center, Osaka University Hospital, Osaka, Japan
| | - Yuko Ohno
- Department of Health Sciences, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Hirofumi Yatani
- Department of Fixed Prosthodontics, Osaka University Graduate School of Dentistry, Osaka, Japan
| | - Takafumi Kato
- Department of Oral Physiology, Osaka University Graduate School of Dentistry, Osaka, Japan.,Sleep Medicine Center, Osaka University Hospital, Osaka, Japan
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17
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Toyota R, Fukui KI, Kamimura M, Katagiri A, Sato H, Toyoda H, Rompré P, Ikebe K, Kato T. Sleep stage-dependent changes in tonic masseter and cortical activities in young subjects with primary sleep bruxism. Sleep 2021; 45:6349091. [PMID: 34383078 DOI: 10.1093/sleep/zsab207] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Revised: 07/02/2021] [Indexed: 11/14/2022] Open
Abstract
STUDY OBJECTIVES The present study investigated the hypothesis that subjects with primary sleep bruxism (SB) exhibit masseter and cortical hyperactivities during quiet sleep periods that are associated with a high frequency of rhythmic masticatory muscle activity (RMMA). METHODS Fifteen SB and ten control participants underwent polysomnographic recordings. The frequencies of oromotor events and arousals and the percentage of arousals with oromotor events were assessed. Masseter muscle tone during sleep was quantified using a cluster analysis. Electroencephalography power and heart rate variability were quantified and then compared between the two groups and among sleep stages. RESULTS The frequency of RMMA and percentage of arousals with RMMA were significantly higher in SB subjects than in controls in all stages, while these variables for non-rhythmic oromotor events did not significantly differ between the groups. In SB subjects, the frequency of RMMA was the highest in stage N1 and the lowest in stages N3 and R, while the percentage of arousals with RMMA was higher in stage N3 than stages N1 and R. The cluster analysis classified masseter activity during sleep into two clusters for masseter tone and contractions. Masseter muscle tone showed typical stage-dependent changes in both groups, but did not significantly differ between the groups. Furthermore, no significant differences were observed in electroencephalography power or heart rate variability between the groups. CONCLUSION Young SB subjects exhibited sleep stage-dependent increases in the responsiveness of RMMA to transient arousals, but did not show masseter or cortical hyperactivity during sleep.
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Affiliation(s)
- Risa Toyota
- Department of Oral Physiology, Osaka University Graduate School of Dentistry, Osaka, Japan.,Department of Prosthodontics, Gerodontology and Oral Rehabilitation, Osaka University Graduate School of Dentistry, Osaka, Japan
| | - Ken-Ichi Fukui
- SANKEN (The Institute of Scientific and Industrial Research), Osaka University, Osaka, Japan
| | - Mayo Kamimura
- Department of Oral Physiology, Osaka University Graduate School of Dentistry, Osaka, Japan
| | - Ayano Katagiri
- Department of Oral Physiology, Osaka University Graduate School of Dentistry, Osaka, Japan
| | - Hajime Sato
- Department of Oral Physiology, Osaka University Graduate School of Dentistry, Osaka, Japan.,Division of Pharmacology, Meikai University School of Dentistry
| | - Hiroki Toyoda
- Department of Oral Physiology, Osaka University Graduate School of Dentistry, Osaka, Japan
| | - Pierre Rompré
- Faculty of Dentistry, Université de Montréal, Montreal
| | - Kazunori Ikebe
- Department of Prosthodontics, Gerodontology and Oral Rehabilitation, Osaka University Graduate School of Dentistry, Osaka, Japan
| | - Takafumi Kato
- Department of Oral Physiology, Osaka University Graduate School of Dentistry, Osaka, Japan.,Sleep Medicine Center, Osaka University Hospital, Osaka, Japan
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18
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Shiraishi Y, Tachibana M, Shirota A, Mohri I, Taniike M, Yamashiro T, Kato T. Relationships between cortical, cardiac, and arousal-motor activities in the genesis of rhythmic masticatory muscle activity across sleep cycles in primary sleep bruxism children. Sleep 2021; 44:6310842. [PMID: 34181734 DOI: 10.1093/sleep/zsab156] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Revised: 06/03/2021] [Indexed: 11/13/2022] Open
Abstract
STUDY OBJECTIVES The present study aimed to clarify the physiological relationships between rhythmic masticatory muscle activity (RMMA) and cyclic changes in cortical, autonomic, and arousal-motor activities during sleep in sleep bruxism (SB) children. METHODS Polysomnographic recordings were performed on fifteen SB children (9 boys, 6 girls, 10.3 ± 2.5 years) and eighteen control children (5 boys, 13 girls, 10.7 ± 3.1 years) free from sleep and developmental disorders. Sleep and RMMA were scored by the standard rules. Sleep cycle was divided into NREM and REM sleep segments and the frequency of RMMA, transient arousal and movement, and cortical and cardiac activities were then quantitatively analyzed in relation to sleep cycles. RESULTS Neither sleep architecture nor sleep stage distribution of RMMA significantly differed between two groups. In sleep cycles, SB children showed more frequent RMMA in all segments than controls, while cyclic changes in cortical and autonomic activities did not significantly differ between two groups. In SB children, RMMA was the most frequent in the last NREM segment before REM sleep and was associated with increases in cortical beta activity and arousal; more than 70% of RMMA time-dependently occurred with cortical and motor arousals. CONCLUSIONS This is the first study to suggest that the potentiation of RMMA occurrence was associated with transient arousal under cyclic sleep processes in primary SB children.
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Affiliation(s)
- Yuki Shiraishi
- Department of Orthodontics and Dentofacial Orthopedics, Osaka University Graduate School of Dentistry, Suita, Osaka, Japan.,Department of Oral Physiology, Osaka University Graduate School of Dentistry, Suita, Osaka, Japan
| | - Masaya Tachibana
- United Graduate School of Child Development, Osaka University, Suita, Osaka, Japan.,Department of Pediatrics, Osaka University Graduate School of Medicine, Suita, Osaka, Japan.,Osaka University Hospital, Sleep Medicine Center, Suita, Osaka, Japan
| | - Ai Shirota
- Department of Oral Physiology, Osaka University Graduate School of Dentistry, Suita, Osaka, Japan
| | - Ikuko Mohri
- United Graduate School of Child Development, Osaka University, Suita, Osaka, Japan.,Department of Pediatrics, Osaka University Graduate School of Medicine, Suita, Osaka, Japan.,Osaka University Hospital, Sleep Medicine Center, Suita, Osaka, Japan
| | - Masako Taniike
- United Graduate School of Child Development, Osaka University, Suita, Osaka, Japan.,Department of Pediatrics, Osaka University Graduate School of Medicine, Suita, Osaka, Japan.,Osaka University Hospital, Sleep Medicine Center, Suita, Osaka, Japan
| | - Takashi Yamashiro
- Department of Orthodontics and Dentofacial Orthopedics, Osaka University Graduate School of Dentistry, Suita, Osaka, Japan
| | - Takafumi Kato
- Department of Oral Physiology, Osaka University Graduate School of Dentistry, Suita, Osaka, Japan.,United Graduate School of Child Development, Osaka University, Suita, Osaka, Japan.,Osaka University Hospital, Sleep Medicine Center, Suita, Osaka, Japan
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19
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Lavigne G, Kato T, Herrero Babiloni A, Huynh N, Dal Fabbro C, Svensson P, Aarab G, Ahlberg J, Baba K, Carra MC, Cunha TCA, Gonçalves DAG, Manfredini D, Stuginski-Barbosa J, Wieckiewicz M, Lobbezoo F. Research routes on improved sleep bruxism metrics: Toward a standardised approach. J Sleep Res 2021; 30:e13320. [PMID: 33675267 DOI: 10.1111/jsr.13320] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Revised: 02/05/2021] [Accepted: 02/05/2021] [Indexed: 12/17/2022]
Abstract
A recent report from the European Sleep Research Society's task force "Beyond AHI" discussed an issue that has been a long-term subject of debate - what are the best metrics for obstructive sleep apnoea (OSA) diagnosis and treatment outcome assessments? In a similar way, sleep bruxism (SB) metrics have also been a recurrent issue for >30 years and there is still uncertainty in dentistry regarding their optimisation and clinical relevance. SB can occur alone or with comorbidities such as OSA, gastroesophageal reflux disorder, insomnia, headache, orofacial pain, periodic limb movement, rapid eye movement behaviour disorder, and sleep epilepsy. Classically, the diagnosis of SB is based on the patient's dental and medical history and clinical manifestations; electromyography is used in research and for complex cases. The emergence of new technologies, such as sensors and artificial intelligence, has opened new opportunities. The main objective of the present review is to stimulate the creation of a collaborative taskforce on SB metrics. Several examples are available in sleep medicine. The development of more homogenised metrics could improve the accuracy and refinement of SB assessment, while moving forward toward a personalised approach. It is time to develop SB metrics that are relevant to clinical outcomes and benefit patients who suffer from one or more possible negative consequences of SB.
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Affiliation(s)
- Gilles Lavigne
- Faculty of Dental Medicine, Universite de Montreal & CIUSSS Nord Ile de Montreal, Center for Advance Research in Sleep Medicine & Stomatology, CHUM, Montreal, QC, Canada
| | - Takafumi Kato
- Department of Oral Physiology Graduate School of Dentistry, Sleep Medicine Center, Osaka University Hospital, Osaka University, Suita, Japan
| | - Alberto Herrero Babiloni
- Division of Experimental Medicine, McGill University, Montreal, QC, Canada.,CIUSSS Nord Ile de Montreal, Center for Advance Research in Sleep Medicine, Montreal, QC, Canada
| | - Nelly Huynh
- Faculty of Dental Medicine, Universite de Montreal and CHU Saint-Justine Research Center, Montreal, QC, Canada
| | - Cibele Dal Fabbro
- Faculty of Dental Medicine, Universite de Montreal & CIUSSS Nord Ile de Montreal, Center for Advance Research in Sleep Medicine & Stomatology, CHUM, Montreal, QC, Canada
| | - Peter Svensson
- Section of Orofacial Pain and Jaw Function, Department of Dentistry and Oral Health, Aarhus University, Aarhus, Denmark.,Faculty of Odontology, Malmø University, Malmø, Sweden
| | - Ghizlane Aarab
- Department of Orofacial Pain and Dysfunction, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Jari Ahlberg
- Department of Oral and Maxillofacial Diseases, University of Helsinki, Helsinki, Finland
| | - Kazuyoshi Baba
- Department of Prosthodontics, School of Dentistry, Showa University, Tokyo, Japan
| | - Maria Clotilde Carra
- UFR of Odontology Garanciere, Université de Paris and Service of Odontology, Rothschild Hospital (AP-HP), Paris, France
| | - Thays Crosara A Cunha
- Department of Genetics and Biochemistry, Federal University of Uberlandia, Uberlandia, Brazil
| | - Daniela A G Gonçalves
- Department of Dental Materials and Prosthodontics, School of Dentistry, São Paulo State University (Unesp), Araraquara, Brazil
| | - Daniele Manfredini
- Department of Biomedical Technologies, School of Dentistry, University of Siena, Siena, Italy
| | | | - Mieszko Wieckiewicz
- Department of Experimental Dentistry, Wroclaw Medical University, Wroclaw, Poland
| | - Frank Lobbezoo
- Department of Orofacial Pain and Dysfunction, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
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Aarab G, Arcache P, Lavigne GJ, Lobbezoo F, Huynh N. The effects of mandibular advancement appliance therapy on jaw-closing muscle activity during sleep in patients with obstructive sleep apnea: a 3-6 months follow-up. J Clin Sleep Med 2020; 16:1545-1553. [PMID: 32501212 DOI: 10.5664/jcsm.8612] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
STUDY OBJECTIVES The main aim of this study was to investigate the effects of mandibular advancement appliance (MAA) therapy on jaw-closing muscle activity (JCMA) time-related to respiratory arousals, and on JCMA time-related to nonrespiratory arousals in patients with obstructive sleep apnea. METHODS Eighteen patients with OSA (mean ± standard deviation = 49.4 ± 9.8 years) with a mean ± standard deviation apnea-hypopnea index of 22.0 ± 16.0 events/h of sleep participated in a randomized controlled crossover trial in which two ambulatory polysomnographic recordings, 1 with an MAA in situ and another without the MAA in situ, were performed. JCMA was quantified as the sum of rhythmic masticatory muscle activities and other orofacial activities. RESULTS Significant reductions in the apnea-hypopnea index (Z = -2.984; P = .003), in the respiratory arousal index (Z = -2.896; P = .004), and in the JCMA time-related to respiratory arousal index (Z = -3.434; P = .001) were found with MAA in situ. On the nonrespiratory arousal index, and on the JCMA time-related to nonrespiratory arousal index, MAA had no significant effect (T = 2.23; P = .82; and Z = -0.66; P = .51, respectively). CONCLUSIONS This study shows that effective mandibular advancement appliance therapy significantly reduces jaw-closing muscle activities time-related to respiratory arousals in OSA patients. Future studies are needed to confirm these findings in obstructive sleep apnea patients with comorbid sleep bruxism. CLINICAL TRIAL REGISTRATION Registry: ClinicalTrials.gov; Name: The Effects of Oral Appliance Therapy on Masseter Muscle Activity in Obstructive Sleep Apnea; Identifier: NCT02011425.
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Affiliation(s)
- Ghizlane Aarab
- Department of Orofacial Pain and Dysfunction, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.,Faculté de Médecine Dentaire, Université de Montréal, Montréal, Canada
| | - Patrick Arcache
- Faculté de Médecine Dentaire, Université de Montréal, Montréal, Canada
| | - Gilles J Lavigne
- Faculté de Médecine Dentaire, Université de Montréal, Montréal, Canada
| | - Frank Lobbezoo
- Department of Orofacial Pain and Dysfunction, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Nelly Huynh
- Faculté de Médecine Dentaire, Université de Montréal, Montréal, Canada
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21
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The key role of the mandible in modulating airflow amplitude during sleep. Respir Physiol Neurobiol 2020; 279:103447. [DOI: 10.1016/j.resp.2020.103447] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Revised: 05/01/2020] [Accepted: 05/01/2020] [Indexed: 11/20/2022]
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22
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Nikolopoulou M, Aarab G, Ahlberg J, Hamburger HL, de Lange J, Lobbezoo F. Oral appliance therapy versus nasal continuous positive airway pressure in obstructive sleep apnea: A randomized, placebo-controlled trial on temporomandibular side-effects. Clin Exp Dent Res 2020; 6:400-406. [PMID: 32246748 PMCID: PMC7453778 DOI: 10.1002/cre2.288] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2020] [Revised: 03/05/2020] [Accepted: 03/06/2020] [Indexed: 11/21/2022] Open
Abstract
Purpose To assess the differences in the frequency of clinical signs of temporomandibular disorder (TMD) pain and mandibular function impairment between mandibular advancement device (MAD) and nasal continuous positive airway pressure (nCPAP) therapies in obstructive sleep apnea (OSA) patients at baseline and after 6 month of treatment. Methods This study concerns a secondary analysis of a randomized placebo‐controlled trial in which different treatment effects of an objectively titrated MAD were compared with those of nCPAP and an intra‐oral placebo appliance in a parallel design. Sixty‐four mild to severe OSA patients (52.0 ± 9.6 years) were randomly assigned to these three groups. All patients underwent a shortened functional examination of their masticatory system at baseline and after 6 months to establish the presence of clinical signs of TMD pain. Mandibular function impairment was assessed with a questionnaire. Results Clinical signs of TMD pain were only rarely present at baseline and therapy evaluation. No significant differences were found between the three groups in the (low) frequency of clinical signs of TMD pain at both time points (p = .401–.176). In addition, the (low) scores of mandibular function impairment did not differ between the three groups either, neither at baseline (p = .744) nor after 6 months (p = .359). Conclusions A low frequency of clinical signs of TMD pain in mild to severe OSA patients was found after 6 months, regardless of treatment with MAD or nCPAP. In addition, no difference in mandibular function impairment was observed between the different treatment modalities.
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Affiliation(s)
- Maria Nikolopoulou
- Department of Orofacial Pain and Dysfunction, Academic Centre of Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Ghizlane Aarab
- Department of Orofacial Pain and Dysfunction, Academic Centre of Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Jari Ahlberg
- Department of Oral and Maxillofacial Diseases, University of Helsinki, Helsinki, Finland
| | - Hans L Hamburger
- Amsterdam Sleep Centre, Boerhaave Medical Centre, Amsterdam, The Netherlands
| | - Jan de Lange
- Department of Oral and Maxillofacial Surgery, Amsterdam University Medical Centre and Academic Centre for Dentistry Amsterdam (ACTA), Amsterdam, The Netherlands
| | - Frank Lobbezoo
- Department of Orofacial Pain and Dysfunction, Academic Centre of Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
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Martinot JB, Borel JC, Le-Dong NN, Silkoff PE, Denison S, Gozal D, Pépin JL. Bruxism Relieved Under CPAP Treatment in a Patient With OSA Syndrome. Chest 2020; 157:e59-e62. [DOI: 10.1016/j.chest.2019.07.032] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2019] [Revised: 07/10/2019] [Accepted: 07/27/2019] [Indexed: 11/26/2022] Open
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Miki H, Minakuchi H, Miyagi M, Hara ES, Shigemoto S, Suzuki Y, Maekawa K, Matsuka Y, Clark GT, Kuboki T. Association of masticatory muscle activity with sleep arousal and other concomitant movements during sleep. J Oral Rehabil 2019; 47:281-288. [DOI: 10.1111/joor.12913] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2019] [Revised: 10/23/2019] [Accepted: 11/14/2019] [Indexed: 11/29/2022]
Affiliation(s)
- Haruna Miki
- Department of Oral Rehabilitation and Regenerative Medicine Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Okayama Japan
| | - Hajime Minakuchi
- Department of Oral Rehabilitation and Regenerative Medicine Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Okayama Japan
| | - Mayu Miyagi
- Department of Stomatgnathic Function and Occlusal Reconstruction Institute of Biomedical Sciences Clinical Dentistry Tokushima University Graduate School Tokushima Japan
| | - Emilio Satoshi Hara
- Department of Biomaterials Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Okayama Japan
| | - Shuji Shigemoto
- Department of Fixed Prosthodontics School of Dental Medicine Tsurumi University Yokohama Japan
| | - Yoshitaka Suzuki
- Department of Stomatgnathic Function and Occlusal Reconstruction Institute of Biomedical Sciences Clinical Dentistry Tokushima University Graduate School Tokushima Japan
| | - Kenji Maekawa
- Department of Oral Rehabilitation and Regenerative Medicine Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Okayama Japan
| | - Yoshizo Matsuka
- Department of Stomatgnathic Function and Occlusal Reconstruction Institute of Biomedical Sciences Clinical Dentistry Tokushima University Graduate School Tokushima Japan
| | - Glenn T. Clark
- Advanced Program in Orofacial Pain and Oral Medicine Ostrow School of DentistryUniversity of Southern California Los Angeles CA USA
| | - Takuo Kuboki
- Department of Oral Rehabilitation and Regenerative Medicine Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Okayama Japan
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25
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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.
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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
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26
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Eye movements in relation to rhythmic masticatory muscle activities in patients with sleep bruxism. Sleep Med 2019; 65:36-44. [PMID: 31707287 DOI: 10.1016/j.sleep.2019.07.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2019] [Revised: 05/23/2019] [Accepted: 07/08/2019] [Indexed: 11/21/2022]
Abstract
OBJECTIVES To characterize eye movements during rhythmic masticatory muscle activities (RMMAs) in patients with sleep bruxism (SB). METHODS Polysomnographic (PSG) recordings were performed on SB patients and normal controls during sleep (n = 8 for each group) and wakefulness (n = 9 for each group). The eye movements associated with episodes of RMMAs/SB during sleep and jaw movements during wakefulness were analyzed. RESULTS During sleep, all episodes of RMMAs/SB in the SB patients and controls were associated with eye movements and most of the RMMAs/SB related slow eye movements (SB patients: 96.29%, 1583/1644; Controls: 97.49%, 543/557) were horizontal in the SB patients and controls. During wakefulness, all of the series of jaw movements were associated with eye movements. Most of cycles of jaw movements (SB patients: 88.89%, 200/225; Controls: 95.11%, 214/225) were associated with slow eye movements and most of the eye movements (SB patients: 52.50%, 105/200; Controls: 61.21%, 131/214) were vertical. There were significant correlations between the durations of episodes of eye movements and RMMAs/SB during sleep and between the duration of episodes of eye movements and duration of series of jaw movements during wakefulness in the SB patients and controls. CONCLUSIONS Most of RMMAs/SB episodes during sleep and jaw movements during wakefulness are associated with eye movements in SB patients and normal controls.
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27
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Matsuda M, Ogawa T, Sitalaksmi RM, Miyashita M, Ito T, Sasaki K. Effect of mandibular position achieved using an oral appliance on genioglossus activity in healthy adults during sleep. Head Face Med 2019; 15:26. [PMID: 31684973 PMCID: PMC6827235 DOI: 10.1186/s13005-019-0210-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2018] [Accepted: 10/21/2019] [Indexed: 11/24/2022] Open
Abstract
Background Oral appliances (OAs) are generally designed to displace the mandible anteriorly and downward, to increase the airway patency. The present study aimed to examine the relationship between genioglossus (GG) muscle activity and mandibular position, considering both anterior and vertical displacements during sleep. Methods Seven healthy male adults aged 29.4 ± 1.99 years were evaluated. Maxillary and mandibular OAs were fabricated from 2-mm-thick resin plates with pressure-welding. The activity of the left GG was recorded using two silver ball electrodes attached to the lingual edge of the mandibular OA. Respiratory status and right masseter muscle activity were measured by an airflow sensor and surface electrodes, respectively. Electroencephalography was used to determine the sleep status. Stage 2 (the second stage of sleep) was defined as the state of sleeping. Four test conditions with different mandibular positions (0 and 50% anterior protrusion) and bite openings (4 mm and 12 mm) were examined. Results GG activity in SL4A (4 mm bite opening, 50% protrusion during sleep) and SL12 (12 mm bite opening, 0% protrusion during sleep) were significantly higher than that in SL4 (4 mm bite opening, 0% protrusion during sleep). Respiratory volume did not significantly differ between all test conditions. Conclusion GG activity is influenced not only by anterior protrusion of the mandible but also by vertical displacement during sleep. Thus, when determining the effectiveness of intraoral appliances in the treatment of obstructive sleep apnea, both protrusion and the size of the mandibular opening should be evaluated and taken into account.
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Affiliation(s)
- Michikazu Matsuda
- Division of Advanced Prosthetic Dentistry, Tohoku University Graduate School of Dentistry, 4-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi, 980-8575, Japan
| | - Toru Ogawa
- Division of Advanced Prosthetic Dentistry, Tohoku University Graduate School of Dentistry, 4-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi, 980-8575, Japan.
| | - Ratri M Sitalaksmi
- Division of Advanced Prosthetic Dentistry, Tohoku University Graduate School of Dentistry, 4-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi, 980-8575, Japan.,Department of Prosthodontics, Faculty of Dental Medicine, Universitas Airlangga, Surabaya, Indonesia
| | - Makiko Miyashita
- Division of Advanced Prosthetic Dentistry, Tohoku University Graduate School of Dentistry, 4-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi, 980-8575, Japan
| | - Toshimi Ito
- Division of Advanced Prosthetic Dentistry, Tohoku University Graduate School of Dentistry, 4-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi, 980-8575, Japan
| | - Keiichi Sasaki
- Division of Advanced Prosthetic Dentistry, Tohoku University Graduate School of Dentistry, 4-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi, 980-8575, Japan
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da Costa Lopes AJ, Cunha TCA, Monteiro MCM, Serra-Negra JM, Cabral LC, Júnior PCS. Is there an association between sleep bruxism and obstructive sleep apnea syndrome? A systematic review. Sleep Breath 2019; 24:913-921. [DOI: 10.1007/s11325-019-01919-y] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2019] [Revised: 07/21/2019] [Accepted: 08/02/2019] [Indexed: 10/25/2022]
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Lu J, Zhang Y, Han K, Wang C, Zhong Z, Xu M, Zou X, Yu B, Yao D. Heart rate changes associated with rhythmic masticatory muscle activities and limb movements in sleep bruxers: Preliminary findings. Cranio 2019; 39:47-57. [PMID: 30774008 DOI: 10.1080/08869634.2019.1578032] [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] [Indexed: 01/14/2023]
Abstract
Objective: To investigate the relationship of rhythmic masticatory muscle activities (RMMAs) and limb movements (LMs) with heart rate (HR) acceleration. Methods: The amplitude and duration of HR increases, the time to reach peak HR associated with RMMAs/LMs during sleep, duration of movement events, and their relationships with cortical arousal levels were determined in 9 sleep bruxers and 10 normal controls. Results: A total of 48.15% and 49.44% HR increased before the onset of RMMAs/LMs in the sleep bruxers and controls, respectively. All of the parameters of HR increases were significantly different between the sleep bruxers and the controls (p < 0.05-0.001) and between different cortical arousal levels (p < 0.01), and the duration of RMMAs/LMs was positively correlated with the parameters (Sleep bruxers: r2 = 0.18-0.88, p < 0.0001; Controls: r2 = 0.16-0.78, p < 0.0001). Discussion: These data suggest the HR increases are associated with the movement events and changes in cortical arousal levels in the sleep bruxers and controls. Abbreviations: LMs: Limb movements; HR: Heart rate; RMMAs: Rhythmic masticatory muscle activities; SB: Sleep bruxism; PSG: Polysomnographic; EEG: Electroencephalographic; PLMS: Periodic leg movements; SSRIs: Selective serotonin reuptake inhibitors; ECG: Electrocardiographic; EOG: Electrooculographic; EMG: Electromyographic; SD: Standard deviation; Fig: Figure; SEM: Standard error of mean; N1: Non-rapid eye movement sleep stage 1; N2: Non-rapid eye movement sleep stage 2; N3: Non-rapid eye movement sleep stage 3; REM: Rapid eye movement ; NA: No arousal; mAR: Microarousal; AW: Awakening.
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Affiliation(s)
- Junlan Lu
- Neurological Institute of Jiangxi Province and Department of Neurology, Jiangxi Provincial People's Hospital , Nanchang, PR China.,School of Pharmaceutical Sciences, Nanchang University , Nanchang, PR China
| | - Yangping Zhang
- Neurological Institute of Jiangxi Province and Department of Neurology, Jiangxi Provincial People's Hospital , Nanchang, PR China.,School of Pharmaceutical Sciences, Nanchang University , Nanchang, PR China
| | - Kangning Han
- Queen Mary College, Nanchang University , Nanchang, PR China
| | - Chuanying Wang
- Queen Mary College, Nanchang University , Nanchang, PR China
| | - Zhijun Zhong
- School of Pharmaceutical Sciences, Nanchang University , Nanchang, PR China
| | - Miao Xu
- School of Pharmaceutical Sciences, Nanchang University , Nanchang, PR China
| | - Xueliang Zou
- Jiangxi Mental Hospital, Nanchang University , Nanchang, PR China
| | - Bin Yu
- Jiangxi Mental Hospital, Nanchang University , Nanchang, PR China
| | - Dongyuan Yao
- Neurological Institute of Jiangxi Province and Department of Neurology, Jiangxi Provincial People's Hospital , Nanchang, PR China.,School of Pharmaceutical Sciences, Nanchang University , Nanchang, PR China
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Tsujisaka A, Haraki S, Nonoue S, Mikami A, Adachi H, Mizumori T, Yatani H, Yoshida A, Kato T. The occurrence of respiratory events in young subjects with a frequent rhythmic masticatory muscle activity: a pilot study. J Prosthodont Res 2018; 62:317-323. [DOI: 10.1016/j.jpor.2017.12.004] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2017] [Revised: 12/13/2017] [Accepted: 12/15/2017] [Indexed: 11/30/2022]
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Martinot JB, Borel JC, Le-Dong NN, Guénard HJP, Cuthbert V, Silkoff PE, Gozal D, Pepin JL. Monitoring mandibular movements to detect Cheyne-Stokes Breathing. Respir Res 2017; 18:66. [PMID: 28427400 PMCID: PMC5399309 DOI: 10.1186/s12931-017-0551-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2016] [Accepted: 04/12/2017] [Indexed: 12/01/2022] Open
Abstract
Background The patterns of mandibular movements (MM) during sleep can be used to identify increased respiratory effort periodic large-amplitude MM (LPM), and cortical arousals associated with “sharp” large-amplitude MM (SPM). We hypothesized that Cheyne Stokes breathing (CSB) may be identified by periodic abnormal MM patterns. The present study aims to evaluate prospectively the concordance between CSB detected by periodic MM and polysomnography (PSG) as gold-standard. The present study aims to evaluate prospectively the concordance between CSB detected by periodic MM and polysomnography (PSG) as gold-standard. Methods In 573 consecutive patients attending an in-laboratory PSG for suspected sleep disordered breathing (SDB), MM signals were acquired using magnetometry and scored manually while blinded from the PSG signal. Data analysis aimed to verify the concordance between the CSB identified by PSG and the presence of LPM or SPM. The data were randomly divided into training and validation sets (985 5-min segments/set) and concordance was evaluated using 2 classification models. Results In PSG, 22 patients (mean age ± SD: 65.9 ± 15.0 with a sex ratio M/F of 17/5) had CSB (mean central apnea hourly indice ± SD: 17.5 ± 6.2) from a total of 573 patients with suspected SDB. When tested on independent subset, the classification of CSB based on LPM and SPM is highly accurate (Balanced-accuracy = 0.922, sensitivity = 0.922, specificity = 0.921 and error-rate = 0.078). Logistic models based odds-ratios for CSB in presence of SPM or LPM were 172.43 (95% CI: 88.23–365.04; p < 0.001) and 186.79 (95% CI: 100.48–379.93; p < 0.001), respectively. Conclusion CSB in patients with sleep disordered breathing could be accurately identified by a simple magnetometer device recording mandibular movements.
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Affiliation(s)
- Jean-Benoît Martinot
- Centre du Sommeil et de la Vigilance, CHU UCL Namur Site Ste Elisabeth, 15, Place Louise Godin, 5000, Namur, Belgium.
| | - Jean-Christian Borel
- AGIR à dom. Association, 38240, Meylan, France.,University Grenoble Alpes, HP2 INSERM U1042, 38000, Grenoble, France
| | | | | | - Valerie Cuthbert
- Centre du Sommeil et de la Vigilance, CHU UCL Namur Site Ste Elisabeth, 15, Place Louise Godin, 5000, Namur, Belgium
| | | | | | - Jean-Louis Pepin
- University Grenoble Alpes, HP2 INSERM U1042, 38000, Grenoble, France.,CHU de Grenoble, Laboratoire EFCR, Pôle THORAX et VAISSEAUX, Grenoble, France
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33
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Jokubauskas L, Baltrušaitytė A. Relationship between obstructive sleep apnoea syndrome and sleep bruxism: a systematic review. J Oral Rehabil 2017; 44:144-153. [DOI: 10.1111/joor.12468] [Citation(s) in RCA: 45] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/06/2016] [Indexed: 12/26/2022]
Affiliation(s)
- L. Jokubauskas
- Faculty of Odontology; Lithuanian University of Health Sciences; Kaunas Lithuania
| | - A. Baltrušaitytė
- Department of Prosthodontics; Faculty of Odontology; Lithuanian University of Health Sciences; Kaunas Lithuania
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34
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Anitua E, Saracho J, Almeida GZ, Duran-Cantolla J, Alkhraisat MH. Frequency of Prosthetic Complications Related to Implant-Borne Prosthesis in a Sleep Disorder Unit. J ORAL IMPLANTOL 2016; 43:19-23. [PMID: 27700231 DOI: 10.1563/aaid-joi-d-16-00100] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Sleep bruxism and higher clench index have been associated with obstructive sleep apnea (OSA). However, there is no study that reports on the prosthetic complications in patients with OSA. Records of patients who had performed a sleep study to diagnose OSA were examined for the occurrence of prosthetic complications in implant-borne reconstructions. The primary outcome was the frequency of prosthetic complications. The secondary outcomes were anthropometric data, type of complication, type of prosthesis, type of retention, number of supporting implants, number of prosthetic units, and the presence of obstructive sleep apnea. Of the 172 patients, 67 had an implant-supported prosthesis, and all were included in the study. The mean age was 61 ± 10 years, and 36 were female. Thirty complications in 22 prostheses were identified in 16 patients. The complications were porcelain fracture (14 events), screw/implant fracture (8 events), screw loosening (3 events), and decementation (5 events). The follow-up time was 117 ± 90 months after placement of the prosthesis. The average time for complications to occur was 73 ± 65 months after the placement of the prosthesis. According to the apnea-hypopnea index (AHI), 49 patients had OSA. Thirteen of the 16 patients having a prosthetic complication also had OSA. The highest AHI and thus the severity of OSA was identified in patients with a fracture complication related to an implant, a screw, or a porcelain. The frequency of prosthetic complications has been higher in patients with obstructive sleep apnea.
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Affiliation(s)
- Eduardo Anitua
- 1 Private practice in oral implantology, Vitoria, Spain.,2 Eduardo Anitua Foundation, Vitoria, Spain.,3 BTI Biotechnology Institute, Vitoria, Spain
| | - Juan Saracho
- 1 Private practice in oral implantology, Vitoria, Spain
| | - Gabriela Zamora Almeida
- 4 Bioaraba Research Institute, OSI Araba University Hospital, Vitoria, Spain.,5 Interdisciplinary Sleep Unit, OSI Araba University Hospital, Vitoria, Spain
| | - Joaquin Duran-Cantolla
- 4 Bioaraba Research Institute, OSI Araba University Hospital, Vitoria, Spain.,5 Interdisciplinary Sleep Unit, OSI Araba University Hospital, Vitoria, Spain
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35
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Hoque R, DelRosso LM. Nocturnal Hypermotor Activity during Apnea-Related Arousals. J Clin Sleep Med 2016; 12:1305-7. [PMID: 27092691 DOI: 10.5664/jcsm.6140] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2016] [Accepted: 03/21/2016] [Indexed: 11/13/2022]
Abstract
ABSTRACT We present a case of a 50-year-old patient who exhibits nocturnal hypermotor activity occurring exclusively during apnea-related arousals consisting of repetitive lower extremity hip-flapping. This movement is unusual and reflects a new form of lower extremity movement associated with apnea-related arousals.
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Affiliation(s)
- Romy Hoque
- Emory Sleep Center, Department of Neurology, Atlanta, GA
| | - Lourdes M DelRosso
- University of San Francisco Benioff Children's Hospital Sleep Center, San Francisco, CA
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36
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Affiliation(s)
- Steven D Bender
- Clinical Assistant Professor and Director of the Center for Facial Pain and Sleep Medicine; Texas A&M University Baylor College of Dentistry; Dallas TX USA
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37
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Weak association between sleep bruxism and obstructive sleep apnea. A sleep laboratory study. Sleep Breath 2015; 20:703-9. [PMID: 26564168 DOI: 10.1007/s11325-015-1284-x] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2015] [Revised: 10/01/2015] [Accepted: 10/21/2015] [Indexed: 10/22/2022]
Abstract
PURPOSE No definitive associations or causal relationships have been determined between obstructive sleep apnea-hypopnea (OSAH) and sleep bruxism (SB). The purpose of this study was to investigate, in a population reporting awareness of both OSAH and SB, the associations between each specific breathing and jaw muscle event. METHODS Polysomnography and audio-video data of 59 patients reporting concomitant OSAH and SB history were analyzed. Masseteric bursts after sleep onset were scored and classified into three categories: (1) sleep rhythmic masticatory muscle activity with SB (RMMA/SB), (2) sleep oromotor activity other than RMMA/SB (Sleep-OMA), and (3) wake oromotor activity after sleep onset (Wake-OMA). Spearman's rank correlation coefficient analyses were performed. Dependent variables were the number of RMMA/SB episodes, RMMA/SB bursts, Sleep-OMA, and Wake-OMA; independent variables were apnea-hypopnea index (AHI), arousal index(AI), body mass index(BMI), gender, and age. RESULTS Although all subjects had a history of both SB and OSAH, sleep laboratory results confirmed that these conditions were concomitant in only 50.8 % of subjects. Moderate correlations were found in the following combinations (p < 0.05); RMMA/SB episode with AI, RMMA/SB burst with AI and age, Sleep-OMA burst with AHI, and Wake-OMA burst with BMI. CONCLUSIONS The results suggest that (1) sleep arousals in patients with concomitant SB and OSAH are not strongly associated with onset of RMMA/SB and (2) apnea-hypopnea events appear to be related to higher occurrence of other types of sleep oromotor activity, and not SB activity. SB genesis and OSAH activity during sleep are probably influenced by different mechanisms.
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38
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Dumais IE, Lavigne GJ, Carra MC, Rompré PH, Huynh NT. Could transient hypoxia be associated with rhythmic masticatory muscle activity in sleep bruxism in the absence of sleep-disordered breathing? A preliminary report. J Oral Rehabil 2015; 42:810-8. [PMID: 26139077 DOI: 10.1111/joor.12323] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/24/2015] [Indexed: 12/20/2022]
Abstract
Sleep bruxism (SB) is a repetitive jaw-muscle activity characterised by clenching or grinding of the teeth during sleep. Sleep bruxism activity is characterised by rhythmic masticatory muscle activity (RMMA). Many but not all RMMA episodes are associated with sleep arousal. The aim of this study was to evaluate whether transient oxygen saturation level change can be temporally associated with genesis of RMMA/SB. Sleep laboratory or home recordings data from 22 SB (tooth grinding history in the absence of reported sleep-disordered breathing) and healthy subjects were analysed. A total of 143 RMMA/SB episodes were classified in four categories: (i) no arousal + no body movement; (ii) arousal + no body movement; (iii) no arousal + body movement; (iv) arousal + body movement. Blood oxygen levels (SaO2 ) were assessed from finger oximetry signal at the baseline (before RMMA), and during RMMA. Significant variation in SaO2 over time (P = 0·001) was found after RMMA onset (+7 to +9 s). No difference between categories (P = 0·91) and no interaction between categories and SaO2 variation over time (P = 0·10) were observed. SaO2 of six of 22 subjects (27%) remained equal or slight increase after the RMMA/SB onset (+8 s) compared to baseline; 10 subjects (45%) slightly decreased (drop 0·01-1%) and the remaining (27%) decreased between 1% and 2%. These preliminary findings suggest that a subgroup of SB subjects had (i) a minor transient hypoxia potentially associated with the onset of RMMA episodes, and this (ii) independently of concomitant sleep arousal or body movements.
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Affiliation(s)
- I E Dumais
- Faculté de médecine dentaire, Université de Montréal, Montréal, QC, Canada
| | - G J Lavigne
- Faculté de médecine dentaire, Université de Montréal, Montréal, QC, Canada.,Centre de recherche, Hôpital du Sacré-Cœur de Montréal, Montréal, QC, Canada
| | - M C Carra
- Faculté de médecine dentaire, Université de Montréal, Montréal, QC, Canada
| | - P H Rompré
- Faculté de médecine dentaire, Université de Montréal, Montréal, QC, Canada
| | - N T Huynh
- Faculté de médecine dentaire, Université de Montréal, Montréal, QC, Canada
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Martinot JB, Senny F, Denison S, Cuthbert V, Gueulette E, Guénard H, Pépin JL. Mandibular movements identify respiratory effort in pediatric obstructive sleep apnea. J Clin Sleep Med 2015; 11:567-74. [PMID: 25766710 DOI: 10.5664/jcsm.4706] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2014] [Accepted: 01/19/2015] [Indexed: 11/13/2022]
Abstract
STUDY OBJECTIVES Obstructive sleep apnea-hypopnea (OAH) diagnosis in children is based on the quantification of flow and respiratory effort (RE). Pulse transit time (PTT) is one validated tool to recognize RE. Pattern analysis of mandibular movements (MM) might be an alternative method to detect RE. We compared several patterns of MM to concomittant changes in PTT during OAH in children with adenotonsillar hypertrophy. METHODS PARTICIPANTS 33 consecutive children with snoring and symptoms/signs of OAH. MEASUREMENTS MMs were measured during polysomnography with a magnetometer device (Brizzy Nomics, Liege, Belgium) placed on the chin and forehead. Patterns of MM were evaluated representing peak to peak fluctuations > 0.3 mm in mandibular excursion (MML), mandibular opening (MMO), and sharp MM (MMS), which closed the mouth on cortical arousal (CAr). RESULTS The median (95% CI) hourly rate of at least 1 MM (MML, or MMO, or MMS) was 18.1 (13.2-36.3) and strongly correlated with OAHI (p = 0.003) but not with central apnea-hypopnea index (CAHI; p = 0.292). The durations when the MM amplitude was > 0.4 mm and PTT > 15 ms were strongly correlated (p < 0.001). The mean (SD) of MM peak to peak amplitude was larger during OAH than CAH (0.9 ± 0.7 mm and 0.2 ± 0.3 mm; p < 0.001, respectively). MMS at the termination of OAH had larger amplitude compared to MMS with CAH (1.5 ± 0.9 mm and 0.5 ± 0.7 mm, respectively, p < 0.001). CONCLUSIONS MM > 0.4 mm occurred frequently during periods of OAH and were frequently terminated by MMS corresponding to mouth closure on CAr. The MM findings strongly correlated with changes in PTT. MM analysis could be a simple and accurate promising tool for RE characterization and optimization of OAH diagnosis in children.
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Affiliation(s)
- Jean-Benoît Martinot
- Départements de Pneumologie et de Pédiatrie, Clinique et Maternité St Elisabeth, Namur, Belgium
| | | | - Stéphane Denison
- Départements de Pneumologie et de Pédiatrie, Clinique et Maternité St Elisabeth, Namur, Belgium
| | - Valérie Cuthbert
- Départements de Pneumologie et de Pédiatrie, Clinique et Maternité St Elisabeth, Namur, Belgium
| | - Emmanuelle Gueulette
- Départements de Pneumologie et de Pédiatrie, Clinique et Maternité St Elisabeth, Namur, Belgium
| | - Hervé Guénard
- Laboratoire de Physiologie et CHU de Bordeaux, France
| | - Jean-Louis Pépin
- Université Grenoble Alpes, HP2; Inserm U1042, Grenoble, France. CHU de Grenoble, Laboratoire EFCR, Secteur Physiologie Sommeil et Exercice, Pole THORAX et VAISSEAUX Grenoble, France
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40
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Durán-Cantolla J, Alkhraisat MH, Martínez-Null C, Aguirre JJ, Guinea ER, Anitua E. Frequency of obstructive sleep apnea syndrome in dental patients with tooth wear. J Clin Sleep Med 2015; 11:445-50. [PMID: 25665693 DOI: 10.5664/jcsm.4602] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2014] [Accepted: 11/12/2014] [Indexed: 11/13/2022]
Abstract
STUDY OBJECTIVES To estimate the frequency of obstructive sleep apnea syndrome (OSAS) in dental patients with tooth wear, and to assess the role of dentists in the identification of patients at risk of OSAS. METHODS Dental patients with tooth wear and treated with occlusal splint were prospectively recruited to perform sleep study. The severity of tooth wear was established by the treating dentist before patient referral to sleep disorders unit. Sleep questionnaires, anthropometric measurements, and validated respiratory polygraphy were performed. RESULTS All patients with dental wear were offered a sleepiness analysis. Of 31 recruited patients, 30 (77% males) participated in this study. Patients' mean age was 58.5 ± 10.7 years (range: 35-90 years) and the body mass index was 27.9 ± 3.4 kg/m(2). Tooth wear was mild in 13 patients, moderate in 8 and severe in 9. The mean apnea-hypopnea index (AHI) was 32.4 ± 24.9. AHI < 5 was reported in 2 patients, AHI of 5-29 in 17, and AHI ≥ 30 in 11. A statistically significant association was found between AHI severity and tooth wear severity (Spearman R = 0.505; p = 0.004). CONCLUSIONS Tooth wear could be a tool to identify those patients at risk of having OSAS. This highlights the importance of dental professionals to identify and refer patients with OSAS.
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Affiliation(s)
- Joaquín Durán-Cantolla
- Sleep Disorders Unit, Clínica Eduardo Anitua, Vitoria, Spain.,Sleep Disorders Unit, Hospital Universitario Araba, Vitoria, Spain.,Research Service, BioAraba Project, Hospital Universitario Araba, Vitoria, Spain.,Centro de Investigación Biomédica en Red Enfermedades Respiratorias, (CIBERES), ISCIII, Madrid, Spain.,Faculty of Medicine, University of País Vasco UPV/EHU, Biscay, Spain
| | | | - Cristina Martínez-Null
- Sleep Disorders Unit, Clínica Eduardo Anitua, Vitoria, Spain.,Sleep Disorders Unit, Hospital Universitario Araba, Vitoria, Spain.,Research Service, BioAraba Project, Hospital Universitario Araba, Vitoria, Spain.,Centro de Investigación Biomédica en Red Enfermedades Respiratorias, (CIBERES), ISCIII, Madrid, Spain
| | | | | | - Eduardo Anitua
- Sleep Disorders Unit, Clínica Eduardo Anitua, Vitoria, Spain.,Eduardo Anitua Foundation, Vitoria, Spain
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41
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Manfredini D, Guarda-Nardini L, Marchese-Ragona R, Lobbezoo F. Theories on possible temporal relationships between sleep bruxism and obstructive sleep apnea events. An expert opinion. Sleep Breath 2015; 19:1459-65. [DOI: 10.1007/s11325-015-1163-5] [Citation(s) in RCA: 63] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2014] [Revised: 02/18/2015] [Accepted: 03/10/2015] [Indexed: 12/17/2022]
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42
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Kostrzewa-Janicka J, Jurkowski P, Zycinska K, Przybyłowska D, Mierzwińska-Nastalska E. Sleep-Related Breathing Disorders and Bruxism. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2015; 873:9-14. [PMID: 26022906 DOI: 10.1007/5584_2015_151] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Obstructive sleep apnea (OSA) syndrome is a sleep-related breathing disorder, due mainly to peripheral causes, characterized by repeated episodes of obstruction of the upper airways, associated with snoring and arousals. The sleep process fragmentation and oxygen desaturation events lead to the major health problems with numerous pathophysiological consequences. Micro-arousals occurring during sleep are considered to be the main causal factor for night jaw-closing muscles activation called bruxism. Bruxism is characterized by clenching and grinding of the teeth or by bracing or thrusting of the mandible. The causes of bruxism are multifactorial and are mostly of central origin. Among central factors there are secretion disorders of central nervous system neurotransmitters and basal ganglia disorders. Recently, sleep bruxism has started to be regarded as a physiological phenomenon occurring in some parts of the population. In this article we present an evaluation of the relationship between OSA and sleep bruxism. It has been reported that the frequency of apneic episodes and that of teeth clenching positively correlates in OSA. However, clinical findings suggest that further studies are needed to clarify sleep bruxism pathophysiology and to develop new approaches to tailor therapy for individual patients with concomitant sleep bruxism and OSA.
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Affiliation(s)
- J Kostrzewa-Janicka
- Department of Prosthodontics, Medical University of Warsaw, Pavillon XIa, 59 Nowogrodzka St., 02-006, Warsaw, Poland.
| | - P Jurkowski
- Department of Prosthodontics, Medical University of Warsaw, Pavillon XIa, 59 Nowogrodzka St., 02-006, Warsaw, Poland
| | - K Zycinska
- Department of Family Medicine Internal and Metabolic Diseases, Medical University of Warsaw and Systemic Vasculitis is outpatient Clinic, Czerniakowski Hospital, Warsaw, Poland
| | - D Przybyłowska
- Department of Prosthodontics, Medical University of Warsaw, Pavillon XIa, 59 Nowogrodzka St., 02-006, Warsaw, Poland
| | - E Mierzwińska-Nastalska
- Department of Prosthodontics, Medical University of Warsaw, Pavillon XIa, 59 Nowogrodzka St., 02-006, Warsaw, Poland
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43
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Saito M, Yamaguchi T, Mikami S, Watanabe K, Gotouda A, Okada K, Hishikawa R, Shibuya E, Lavigne G. Temporal association between sleep apnea-hypopnea and sleep bruxism events. J Sleep Res 2013; 23:196-203. [PMID: 24635459 DOI: 10.1111/jsr.12099] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2013] [Accepted: 09/05/2013] [Indexed: 12/01/2022]
Abstract
There is some evidence suggesting that obstructive sleep apnea-hypopnea syndrome is concomitant with sleep bruxism. The aim of this study was to investigate the temporal association between sleep apnea-hypopnea events and sleep bruxism events. In an open observational study, data were gathered from 10 male subjects with confirmed obstructive sleep apnea-hypopnea syndrome and concomitant sleep bruxism. Polysomnography and audio-video recordings were performed for 1 night in a sleep laboratory. Breathing, brain, heart and masticatory muscle activity signals were analysed to quantify sleep and sleep stage duration, and number and temporal distribution of apnea-hypopnea events and sleep bruxism events. Apnea-hypopnea events were collected within a 5-min time window before and after sleep bruxism events, with the sleep bruxism events as the pivotal reference point. Two temporal patterns were analysed: (i) the interval between apnea-hypopnea events termination and sleep bruxism events onset, called T1; and (ii) the interval between sleep bruxism events termination and apnea-hypopnea events onset, called T2. Of the intervals between sleep bruxism events and the nearest apnea-hypopnea event, 80.5% were scored within 5 min. Most intervals were distributed within a period of <30 s, with peak at 0-10 s. The T1 interval had a mean length of 33.4 s and was significantly shorter than the T2 interval (64.0 s; P < 0.05). Significantly more sleep bruxism events were scored in association with the T1 than the T2 pattern (P < 0.05). Thus, in patients with concomitant obstructive sleep apnea-hypopnea syndrome and sleep bruxism, most sleep bruxism events occurred after sleep apnea-hypopnea events, suggesting that sleep bruxism events occurring close to sleep apnea-hypopnea events is a secondary form of sleep bruxism.
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Affiliation(s)
- Miku Saito
- Department of Gnatho-occlusal Function, Graduate School of Dental Medicine, Hokkaido University, Sapporo, Japan
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44
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Sleep less and bite more: Sleep disorders associated with occlusal loads during sleep. J Prosthodont Res 2013; 57:69-81. [DOI: 10.1016/j.jpor.2013.03.001] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2013] [Revised: 03/05/2013] [Accepted: 03/05/2013] [Indexed: 11/18/2022]
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