Sleep Bruxism amplitude and temporal occurrence in relation to OSA.
The purpose of this post is to open a conversation regarding the implicacations on 2 aspects of sleep bruxism as measured using the Nox T3 by Carefusion, a home sleep testing device with the ability to measure cheek EMG. Cheek EMG is measured by placing an EMG lead on the masseter muscle and the zygomatic arch. ICD-2 defines sleep bruxism as “an oral parafunction characterized by grinding or clenching of the teeth during sleep that is associated with an excessive (intense) sleep arousal activity.”
- The amplitude as measured in microvolts (uV)
- The occurance of the bruxism in relation to a respiratory disturbance
In viewing this sample epoch collected by the NOX-T3, there are notable observations which I would like to open for discussion:
The first bruxism is well over 100uV in amplitude which is in stark contrast to the other bruxisms seen. One possible explanation for the increased amplitude compared to the other bruxism noted is that tooth contact is made which would have the effect of creating a much stronger EMG signal. Another distinction noted on the first bruxism is that it proceeds the obstructive event. With these observations one MIGHT conclude the first sleep bruxism is independent to this patient obvious OSA. There are other conclusions that may be drawn as well for which I would like the group to comment on.
The second sleep bruxism noted in this epoch is approximately 25uV and is much more common in this patients sleep study. It also occurs within the OSA event and appears to be part the OSA arousal response. One more comment on the second and smaller sleep bruxism is that it occurs early in the arousal response and likely proceeds the EEG arousal but during the obstruction hinting that the massetter is being used to some how “stimulate” the musculature of the airway.
If it is true this patient has 2 distinct and seperate types of bruxism, my questions as a non-dentist are: How important is it to know the difference between apnea realted bruxism and “idiopathic” bruxism?
What, if any treatment changes would be recommended with this patient knowing there are 2 types of bruxing?
For more detailed information on the Nox T3 by Carefusion click: http://bit.ly/1hZcwry