Sleep Apnoea and Sleep Bruxism

The connection between sleep apnea and teeth grinding, also known as sleep bruxism (SB), is important for both sleep medicine and dental practitioners. Despite being separate conditions, there is evidence indicating overlap or association between the two conditions 1-2. A recent large study of 914 adults showed that nearly half of adults with OSA have comorbid SB 3. The Bruxism Episode Index (BEI) measures the number of bruxism episodes per hour of sleep (<2: irrelevant SB; 2–4: mild/moderate SB; >4: severe SB). The BEI can be calculated using lab polysomnography 4. A recent study has shown that the Sunrise device can also measure the BEI using its AI-driven automated analysis to assess the co-occurrence of OSA/SB without the need for an In lab full polysomnography study which is more convenient for the patient in the comfort of their own home 5.

SDX indicates SB on Sunrise OSA screening test report Right side of picture indicates SB

1. Prevalence of OSA/SB:

Some studies report a higher prevalence of SB in people with sleep apnea and vice versa 2. This relationship is complex and not fully understood, but there may be common underlying factors contributing to both conditions.

2. Mechanisms of Association:

a. Hypoxia and Arousal: One proposed mechanism where OSA/SB co-occur is intermittent hypoxia experienced by individuals with sleep apnea. Repeated episodes of hypoxia during sleep can cause arousal from sleep, and this arousal response may trigger teeth grinding in some people.

b. Central Nervous System Dysfunction: Both OSA/SB impact on dysregulation of the central nervous system during sleep. which can affect neurotransmitter pathways that may contribute to the co-occurrence of these conditions.

3. Shared Risk Factors:

Shared risk factors, including obesity and stress, are linked to both OSA/SB. Addressing these common risk factors is important in managing both conditions.

4. Clinical Implications:

Dental practitioners and sleep medicine clinicians should work collaboratively in screening, diagnosis and management of people with both OSA/SB. Continuous Positive Airway Pressure (CPAP) therapy may have an impact on SB in some cases. Dental interventions, such as the use of custom-made mandibular advancement devices ( MAD's) to treat OSA may also improve SB

5. Treatment Options:

Management of the co-occurrence of OSA/SB should involve a multidisciplinary approach to achieve the best personalised care treatment outcomes 6. Therapies like CPAP to treat OSA may be considered or MAD's may be an option in milder cases of OSA 7.

Further research is needed to understand the connection between OSA/SB and clinicians should customise their approach based on phenotypic patient characteristics. It is important for people exhibiting symptoms associated with OSA/SB to be referred to sleep medicine services for diagnosis and personalised treatment plans to ensure that OSA/SB is managed in a person-centred way.

References:

1. Martynowicz H, Gac P, Brzecka A, Poreba R, Wojakowska A, Mazur G, Smardz J, Wieckiewicz M. The Relationship between Sleep Bruxism and Obstructive Sleep Apnea Based on Polysomnographic Findings. J Clin Med. 2019 Oct 11;8(10):1653. doi: 10.3390/jcm8101653. PMID: 31614526; PMCID: PMC6832407.

2. Tan MWY, Yap AU, Chua AP, Wong JCM, Parot MVJ, Tan KBC. Prevalence of Sleep Bruxism and Its Association with Obstructive Sleep Apnea in Adult Patients: A Retrospective Polysomnographic Investigation. J Oral Facial Pain Headache. 2019 Summer;33(3):269–277. doi: 10.11607/ofph.2068. Epub 2018 Oct 26. PMID: 30371687.

3. 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. Journal of Clinical Sleep Medicine. 2023 Mar 1;19(3):443-51.

4. Martynowicz H, Smardz J, Michalek-Zrabkowska M, Gac P, Poreba R, Wojakowska A, Mazur G, Wieckiewicz M. Evaluation of Relationship Between Sleep Bruxism and Headache Impact Test-6 (HIT-6) Scores: A Polysomnographic Study. Front Neurol. 2019 May 14;10:487. doi: 10.3389/fneur.2019.00487. PMID: 31139138; PMCID: PMC6527752.

5. Martinot JB, Le-Dong NN, Cuthbert V, Denison S, Gozal D, Lavigne G, Pépin JL. Artificial Intelligence Analysis of Mandibular Movements Enables Accurate Detection of Phasic Sleep Bruxism in OSA Patients: A Pilot Study. Nat Sci Sleep. 2021 Aug 23;13:1449-1459. doi: 10.2147/NSS.S320664. PMID: 34466045; PMCID: PMC8397703.

6. Herrero Babiloni A, Lavigne GJ. Sleep bruxism: A “bridge” between dental and sleep medicine. Journal of Clinical Sleep Medicine. 2018 Aug 15;14(8):1281-3.

7. 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 Mar;157(3):e59-e62. doi: 10.1016/j.chest.2019.07.032. PMID: 32145817.