EC Dental Science

Introduction and Purpose: Obstructive sleep apnoea (OSA) is a common sleep disorder characterised by repeated episodes of shallow (hypopnoeic) or absent (apnoeic) breathing during sleep. Bruxism is another condition commonly observed in patients with OSA, however, the evidence of its association to OSA is still inconclusive. The objective of this study was to determine if there is an association between OSA and bruxism.

Methods: Participants were recruited from 1^st December 2017 to 30^th November 2018. Eligible participants were assessed for bruxism. All participants underwent a structured questionnaire and oral examination by an experienced dentist (SM). Tooth wear was assessed by using the Basic Erosive Wear Examination (BEWE). Collected data was analysed using SPSS version 26 and Statistical significance was set at p value < 0.05.

Results: A total of 29 participants included in the study, with a mean age of 55 ± 18 years and 72% being males. While only about 14% of participants reported having been heard grinding their teeth at night, almost all participants (96.5%) showed signs of bruxism. Majority of participants had some degree of tooth wear with a BEWE score of 2 (79.3%). The median apnoea-hypo-apnoea index (AHI) was 9.9 (IQR: 6 - 22). Twenty-four percent (24%) of participants had no OSA, 38% had mild OSA, 24% had moderate OSA and 14% had severe OSA. There was no statistically significant association between the presence of and the severity of OSA and the sex, age, marital status, and occlusion/malocclusion, tooth wear-BEWE scores of the participants. Likewise, there was no correlation between age, the BEWE score and the AHI index.

Conclusion: While only about 14% of participants reported symptoms of teeth grinding at night, all twenty-nine except one participant were found to have objective sign of bruxism. However, no significant association was found between bruxism and the presence or severity of OSA. More studies with larger sample sizes are required to further consolidate this observation.

Keywords: Bruxism; Obstructive Sleep Apnoea; Association; Tooth-Wear

1. Lyons-Coleman M., et al. “Obstructive sleep apnoea and the role of the dental team”. British Dental Journal9 (2020): 681-685.
2. Steier J., et al. “Predicted relative prevalence estimates for obstructive sleep apnoea and the associated healthcare provision across the UK”. Thorax4 (2014): 390-392.
3. Peppard PE., et al. “Increased prevalence of sleep-disordered breathing in adults”. American Journal of Epidemiology9 (2013): 1006-1014.
4. Senaratna CV., et al. “Prevalence of obstructive sleep apnea in the general population: A systematic review”. Sleep Medicine Reviews 34 (2017): 70-81.
5. Shahar E., et al. “Sleep-disordered breathing and cardiovascular disease: cross-sectional results of the Sleep Heart Health Study”. American Journal of Respiratory and Critical Care Medicine1 (2001): 19-25.
6. Johns MW. “Daytime sleepiness, snoring, and obstructive sleep apnea. The Epworth Sleepiness Scale”. Chest1 (1993): 30-36.
7. Medical Advisory Secretariat. “Polysomnography in patients with obstructive sleep apnea: an evidence-based analysis”. Journal: Ontario Health Technology Assessment Series13 (2006): 1-38.
8. Kılınç DD and Didinen S. “An algorithm of dental/dentofacial-based options for managing patients with obstructive sleep apnoea referred to a dentist/dental specialist by a physician”. British Dental Journal1 (2016): 37-40.
9. Behrents RG., et al. “Obstructive sleep apnea and orthodontics: An American Association of Orthodontists White Paper”. The American Journal of Orthodontics and Dentofacial Orthopedics1 (2019): 13-28.
10. Lobbezoo F., et al. “International consensus on the assessment of bruxism: Report of a work in progress”. Journal of Oral Rehabilitation11 (2018): 837-844.
11. Maluly M., et al. “Polysomnographic study of the prevalence of sleep bruxism in a population sample”. Journal of Dental Research7 (2013): 97S-103S.
12. Lavigne GJ., et al. “Sleep bruxism: validity of clinical research diagnostic criteria in a controlled polysomnographic study”. Journal of Dental Research1 (1996): 546-552.
13. Martynowicz H., et al. “The Relationship between Sleep Bruxism and Obstructive Sleep Apnea Based on Polysomnographic Findings”. Journal of Clinical Medicine10 (2019): 1653.
14. Da Costa Lopes AJ., et al. “Is there an association between sleep bruxism and obstructive sleep apnea syndrome? A systematic review”. Sleep Breath Schlaf Atm3 (2020): 913-921.
15. Jokubauskas L and Baltrušaitytė A. “Relationship between obstructive sleep apnoea syndrome and sleep bruxism: a systematic review”. Journal of Oral Rehabilitation2 (2017): 144-153.
16. De Luca Canto G., et al. “Sleep bruxism and sleep-disordered breathing: a systematic review”. The Journal of Oral and Facial Pain and Headache4 (2014): 299-305.
17. Pintado MR., et al. “Variation in tooth wear in young adults over a two-year period”. The Journal of Prosthetic Dentistry3 (1997): 313-320.
18. Bartlett D., et al. “Basic Erosive Wear Examination (BEWE): a new scoring system for scientific and clinical needs”. Clinical Oral Investigations1 (2008): 65-68.
19. Budhiraja R., et al. “The association between obstructive sleep apnea characterized by a minimum 3 percent oxygen desaturation or arousal hypopnea definition and hypertension”. Journal of Clinical Sleep Medicine9 (2019): 1261-1270.
20. Jauhar S., et al. “The role of the dentist in sleep disorders”. Dent Update10 (2010): 674-676.
21. Ferguson KA., et al. “The relationship between obesity and craniofacial structure in obstructive sleep apnea”. Chest2 (1995): 375-381.
22. Izu SC., et al. “Obstructive sleep apnea syndrome (OSAS) in mouth breathing children”. Brazilian Journal of Otorhinolaryngology5 (2010): 552-556.
23. Staevska MT., et al. “Rhinitis and sleep apnea”. Current Allergy and Asthma Reports3 (2004): 193-199.
24. Okubo M., et al. “Morphologic analyses of mandible and upper airway soft tissue by MRI of patients with obstructive sleep apnea hypopnea syndrome”. Sleep7 (2006): 909-915.
25. Lobbezoo F., et al. “Bruxism defined and graded: an international consensus”. Journal of Oral Rehabilitation1 (2013): 2-4.
26. Wetselaar P., et al. “Associations between tooth wear and dental sleep disorders: A narrative overview”. Journal of Oral Rehabilitation8 (2019): 765-775.
27. Durán-Cantolla J., et al. “Frequency of Obstructive Sleep Apnea Syndrome in Dental Patients with Tooth Wear”. Journal of Clinical Sleep Medicine: JCSM: Official Publication of the American Academy of Sleep Medicine4 (2015): 445-450.
28. Schlueter N and Luka B. “Erosive tooth wear - a review on global prevalence and on its prevalence in risk groups”. British Dental Journal5 (2018): 364-370.
29. Hosoya H., et al. “Relationship between sleep bruxism and sleep respiratory events in patients with obstructive sleep apnea syndrome”. Sleep Breath Schlaf Atm4 (2014): 837-844.
30. Hasegawa Y., et al. “Is there a First Night Effect on Sleep Bruxism? A Sleep Laboratory Study”. Journal of Clinical Sleep Medicine11 (2013): 1139-1145.
31. Shetty S., et al. “Bruxism: A Literature Review”. The Journal of Indian Prosthodontic Society3 (2010): 141-148.