Manfredini Daniele, Guarda-Nardini Luca, Marchese-Ragona Rosario, Lobbezoo Frank
Temporomandibular Disorders Clinic, Department of Maxillofacial Surgery, University of Padova, Padova, Italy.
Institute of Otolaryngology, Department of Neurosciences, University of Padova, Padova, Italy.
Sleep Breath. 2015 Dec;19(4):1459-65. doi: 10.1007/s11325-015-1163-5. Epub 2015 Mar 22.
Sleep bruxism (SB) is a term covering different motor phenomena with various risk and etiological factors and potentially different clinical relevance, especially as far as its possible protective role against obstructive sleep apnea (OSA) is concerned. The present expert opinion discusses the possible temporal relationships between the two phenomena.
Four hypothetical scenarios for a temporal relationship may be identified: (1) the two phenomena are unrelated; (2) the onset of the OSA event precedes the onset of the SB event within a limited time span, with SB having a potential OSA-protective role; (3) the onset of the SB event precedes the onset of the OSA event within a limited time span, with SB having an OSA-inducing effect; and (4) the onset of the OSA and SB event occurs at the same moment.
Literature findings on the SB-OSA temporal relationship are inconclusive. The most plausible hypothesis is that the above scenarios are all actually possible and that the relative predominance of one specific sequence of events varies at the individual level. SB activity may be protective against OSA by protruding the mandible and restoring airway patency in those subjects who benefit from mandibular advancement strategies or may even be related to OSA induction, as a consequence of airways' mucosae swelling resulting from a SB-induced trigeminal cardiac reflex.
Clinicians should keep in mind that the SB-OSA relationship is complex and that interindividual differences may explain the possible different SB-OSA relationships, with particular regard to the anatomical site of obstruction.
睡眠磨牙（SB）是一个涵盖不同运动现象的术语，这些现象具有各种风险和病因，并且可能具有不同的临床意义，尤其是就其对阻塞性睡眠呼吸暂停（OSA）可能的保护作用而言。本专家意见讨论了这两种现象之间可能的时间关系。
可以确定四种时间关系的假设情况：（1）这两种现象无关；（2）OSA事件的发作在有限的时间范围内先于SB事件的发作，SB具有潜在的OSA保护作用；（3）SB事件的发作在有限的时间范围内先于OSA事件的发作，SB具有诱发OSA的作用；（4）OSA和SB事件同时发作。
关于SB与OSA时间关系的文献研究结果尚无定论。最合理的假设是，上述所有情况实际上都是可能的，并且在个体层面上，一种特定事件序列的相对优势有所不同。对于那些从下颌前移策略中受益的受试者，SB活动可能通过使下颌前突和恢复气道通畅来对OSA起到保护作用，或者甚至可能由于SB诱发的三叉神经心脏反射导致气道黏膜肿胀而与OSA的诱发有关。
临床医生应牢记，SB与OSA的关系很复杂，个体差异可能解释了SB与OSA之间可能存在的不同关系，特别是在阻塞的解剖部位方面。
