Mikami Saki, Yamaguchi Taihiko, Saito Miku, Nakajima Toshinori, Maeda Masana, Gotouda Akihito
Department of Temporomandibular Disorder, Center for Advanced Oral Medicine, Hokkaido University Hospital, Kita 14, Nishi 5, Kita-ku, Sapporo, 060-8648 Japan.
Department of Crown and Bridge Prosthodontics, Faculty of Dental Medicine, Hokkaido University, Kita 13 Nishi 7, Kita-ku, Sapporo, 060-8586 Japan.
Sleep Biol Rhythms. 2022 Jan 29;20(2):297-308. doi: 10.1007/s41105-021-00370-5. eCollection 2022 Apr.
Evaluation of sleep bruxism (SB) in clinical practice is currently conducted based on clinical findings, i.e., clinical diagnostic criteria consisting of medical interview, findings of tooth wear, and symptoms of temporomandibular joint (TMJ) and muscles. However, there are many unclear points about validity of the criteria. In this study, validity tests were conducted to clarify the accuracy of the clinical diagnostic criteria for SB by comparison with a reference standard using a single-channel masseteric electromyogram (EMG) obtained with ultraminiature electromyographic devices. The subjects included 30 'probable' bruxers (P-bruxers) who were clinically diagnosed as having SB and 30 non-bruxers. EMG was recorded during sleep under unrestrained and accustomed condition at each subject's home using ultraminiature cordless EMG devices. Bursts with amplitudes of more than 5%, 10%, 20% of the maximum voluntary contraction (MVC) value (EMG-burst-5%, EMG-burst-10%, and EMG-burst-20%) and episodes of sleep bruxism (EMG-episode) were selected for analyses. In all conditions for burst selection, the P-bruxer group showed a significantly larger number of bursts and episodes than those in the non-bruxer group. Accuracy of the clinical diagnosis criteria was 66.7% with the reference standard using EMG-burst-5%/h and 58.3% with that using EMG-episodes/h. By applying single-channel EMG as the reference standard, we were able to conduct validity tests of clinical diagnostic criteria with a larger sample. It was clarified that the level of accuracy of clinical diagnostic criteria for SB were not high despite using the combination of an interview and clinical findings.
目前在临床实践中，睡眠磨牙症（SB）的评估是基于临床发现进行的，即由医学访谈、牙齿磨损情况以及颞下颌关节（TMJ）和肌肉症状组成的临床诊断标准。然而，这些标准的有效性存在许多不明确之处。在本研究中，通过使用超微型肌电图设备获得的单通道咬肌肌电图（EMG）与参考标准进行比较，对SB临床诊断标准的准确性进行了有效性测试。研究对象包括30名临床诊断为患有SB的“疑似”磨牙症患者（P-磨牙症患者）和30名非磨牙症患者。使用超微型无线EMG设备，在每个受试者家中无约束且习惯的睡眠状态下记录EMG。选择幅度超过最大自主收缩（MVC）值5%、10%、20%的爆发（EMG-爆发-5%、EMG-爆发-10%和EMG-爆发-20%）以及睡眠磨牙症发作（EMG-发作）进行分析。在所有爆发选择条件下，P-磨牙症患者组的爆发和发作次数均显著多于非磨牙症患者组。以EMG-爆发-5%/小时为参考标准时，临床诊断标准的准确率为66.7%，以EMG-发作/小时为参考标准时为58.3%。通过将单通道EMG作为参考标准，我们能够对更大样本的临床诊断标准进行有效性测试。结果表明，尽管结合了访谈和临床发现，但SB临床诊断标准的准确性水平并不高。
