A Significant Increase in Breathing Amplitude Precedes Sleep Bruxism

A Significant Increase in Breathing Amplitude Precedes Sleep Bruxism an article by: Samar Khoury, MSc; Guy A. Rouleau, MD, PhD; Pierre H. Rompre´, MSc;Pierre Mayer, MD; Jacques Y. Montplaisir, MD, PhD; andGilles J. Lavigne, DMD, PhD

Background: Sleep bruxism (SB) is a stereotyped movement disorder that is characterized byrhythmic masticatory muscle activity (RMMA) and tooth grinding. Evidence has suggested that SB is associated with sleep arousals and that most RMMA episodes are preceded by physiologic changes occurring in sequence, namely, a rise in autonomic sympathetic-cardiac activity followedby a rise in the frequency of EEG and suprahyoid muscle activity. In the present study, we hypothesize that an increase in respiration also characterizes the onset of SB within the arousal sequence.

Methods: Polygraphic sleep recordings of 20 SB subjects without any sleep-related breathing disorders were analyzed for changes in respiration (ie, root mean square, area under the curve,peak, peak-to-peak, and length) extracted from a nasal cannula signal. Variables were analyzed and compared using analysis of variance and correlation tests.

Results: Measurements of respiration showed significant changes over time. Four seconds beforeRMMA muscle activity, the amplitude of respiration is already increased (8 to 23%); the rise is higher at the onset of the suprahyoid activity (60 to 82% 1 s before RMMA); the rise is maximal during RMMA (108 to 206%) followed by a rapid return to levels preceding RMMA. A positive and significant correlation was found between the frequencies of RMMA episodes and the amplitude of breath (R2 0.26; p  0.02). The amplitude of respiratory changes was 11 timeshigher when arousal was associated with RMMA in comparison to arousal alone.Conclusions: To our knowledge, this is the first report showing that RMMA-SB muscle activity is associated with a rise in respiration within arousal.

CHEST 2008; 134:332–337

Bradley Eli DMD, MS

Bradley Eli DMD, MS

Dr. Brad Eli is a nationally recognized leader in pain management and sleep disorders treatment. He has developed a multi-disciplinary approach to treat acute and chronic orofacial pain including migraines, stress and tension headaches, myofascial pain, neuralgia, temporomandibular disorders (TMD), Sleep Bruxism, and head and neck injuries. Refined techniques include behavior modification, psychology, physical medicine, and anesthesiology. His expertise in sleep led him to develop a patient centered method that offers a variety of sleep treatment options and matches each patient with the best treatment for their symptoms and life style. Dr. Eli understands how much chronic/acute pain can limit and negatively impact a person’s life, so he is tenacious about finding whatever is the right method is to help a patient so they can not only live a better life, but they can wake up knowing their day isn’t going to be defined by their pain. Dr Eli earned a post-doctoral master’s Degree at UCLA where he received advanced training in the field of orofacial pain and the treatment of sleep disordered breathing. He remains the only specialist with this unique skill set in the San Diego region. He is a member of and teaches for numerous professional associations including the American Headache Society, American Academy of Sleep Medicine and the American Academy of Dental Sleep Medicine. He maintains offices in San Diego county, where he is on the staff at both Scripps Memorial Hospital, La Jolla and Encinitas, Tri-City Medical Center, and Palomar Medical Center. Dr. Eli is the first specialist of this type in San Diego and works with multiple insurance plans, including Medicare and Tricare. www.sleeptreatmentspecialists.com

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