Cid-Verdejo Rosana, Domínguez Gordillo Adelaida A, Sánchez-Romero Eleuterio A, Ardizone García Ignacio, Martínez Orozco Francisco J
Faculty of Dentistry, Universidad Complutense de Madrid, 28040 Madrid, Spain.
Department of Clinical Dentistry, Faculty of Biomedical Sciences, Universidad Europea de Madrid, 28670 Madrid, Spain.
Clocks Sleep. 2023 Nov 20;5(4):717-733. doi: 10.3390/clockssleep5040047.
The gold standard for diagnosing sleep bruxism (SB) and obstructive sleep apnea (OSA) is polysomnography (PSG). However, a final hypermotor muscle activity often occurs after apnea episodes, which can confuse the diagnosis of SB when using portable electromyography (EMG) devices. This study aimed to compare the number of SB episodes obtained from PSG with manual analysis by a sleep expert, and from a manual and automatic analysis of an EMG and electrocardiography (EKG) device, in a population with suspected OSA.
Twenty-two subjects underwent a polysomnographic study with simultaneous recording with the EMG-EKG device. SB episodes and SB index measured with both tools and analyzed manually and automatically were compared. Masticatory muscle activity was scored according to published criteria. Patients were segmented by severity of OSA (mild, moderate, severe) following the American Academy of Sleep Medicine (AASM) criteria. ANOVA and the Bland-Altman plot were used to quantify the agreement between both methods. The concordance was calculated through the intraclass correlation coefficient (ICC).
On average, the total events of SB per night in the PSG study were (8.41 ± 0.85), lower than the one obtained with EMG-EKG manual (14.64 ± 0.76) and automatic (22.68 ± 16.02) analysis. The mean number of SB episodes decreases from the non-OSA group to the OSA group with both PSG (5.93 ± 8.64) and EMG-EKG analyses (automatic = 22.47 ± 18.07, manual = 13.93 ± 11.08). However, this decrease was minor in proportion compared to the automatic EMG-EKG analysis mode (from 23.14 to 22.47). The ICC based on the number of SB episodes in the segmented sample by severity degree of OSA along the three tools shows a moderate correlation in the non-OSA (0.61) and mild OSA (0.53) groups. However, it is poorly correlated in the moderate (0.24) and severe (0.23) OSA groups: the EMG-EKG automatic analysis measures 14.27 units more than PSG. The results of the manual EMG-EKG analysis improved this correlation but are not good enough.
The results obtained in the PSG manual analysis and those obtained by the EMG-EKG device with automatic and manual analysis for the diagnosis of SB are acceptable but only in patients without OSA or with mild OSA. In patients with moderate or severe OSA, SB diagnosis with portable electromyography devices can be confused due to apneas, and further study is needed to investigate this.
诊断睡眠磨牙症（SB）和阻塞性睡眠呼吸暂停（OSA）的金标准是多导睡眠图（PSG）。然而，呼吸暂停发作后常出现最终的运动亢进肌肉活动，这在使用便携式肌电图（EMG）设备时可能会混淆SB的诊断。本研究旨在比较在疑似OSA人群中，通过PSG由睡眠专家进行手动分析以及通过EMG和心电图（EKG）设备进行手动和自动分析所获得的SB发作次数。
22名受试者接受了多导睡眠图研究，并同时使用EMG - EKG设备进行记录。比较了使用两种工具测量并手动和自动分析的SB发作次数和SB指数。咀嚼肌活动根据已发表的标准进行评分。根据美国睡眠医学学会（AASM）标准，将患者按OSA严重程度（轻度、中度、重度）进行分类。使用方差分析和布兰德 - 奥特曼图来量化两种方法之间的一致性。通过组内相关系数（ICC）计算一致性。
平均而言，PSG研究中每晚SB的总事件数为（8.41±0.85），低于EMG - EKG手动分析（14.64±0.76）和自动分析（22.68±16.02）所获得的结果。无论是PSG（5.93±8.64）还是EMG - EKG分析（自动 = 22.47±18.07，手动 = 13.93±11.08），SB发作的平均次数从非OSA组到OSA组均减少。然而，与自动EMG - EKG分析模式相比，这种减少的比例较小（从23.14降至22.47）。基于OSA严重程度对样本进行分段后，沿三种工具的SB发作次数计算的ICC在非OSA组（0.61）和轻度OSA组（0.53）中显示出中等相关性。然而，在中度（0.24）和重度（0.23）OSA组中相关性较差：EMG - EKG自动分析比PSG多测量14.27个单位。手动EMG - EKG分析的结果改善了这种相关性，但仍不够好。
PSG手动分析以及EMG - EKG设备进行自动和手动分析用于诊断SB所获得的结果是可以接受的，但仅适用于无OSA或轻度OSA的患者。在中度或重度OSA患者中，由于呼吸暂停，使用便携式肌电图设备进行SB诊断可能会产生混淆，需要进一步研究对此进行调查。
