Wieczorek Tomasz, Jodkowska Anna, Orzeszek Sylwia, Wieckiewicz Mieszko, Michalek-Zrabkowska Monika, Mazur Grzegorz, Rymaszewska Joanna, Smardz Joanna, Wojakowska Anna, Martynowicz Helena
Department of Psychiatry, Wroclaw Medical University, Wroclaw, Poland.
Clinical Department of Internal and Occupational Diseases, Hypertension and Clinical Oncology, Wroclaw Medical University, Wroclaw, Poland.
Front Psychiatry. 2024 May 22;15:1362429. doi: 10.3389/fpsyt.2024.1362429. eCollection 2024.
Causal relationships between psychopathological symptoms, personality traits, coping mechanisms, and sleep bruxism (SB) were studied in the past, giving inconsistent results mostly based on self-assessment evaluations. This polysomnography-based cross-sectional study aimed to explore the relationships between severe SB, personality traits (according to the Big Five model), and coping strategies with objective polysomnographic verification.
The study included 66 participants divided into severe SB (SSB) (n=32) and no or mild SB (n=34) groups based on video-polysomnography performed in the sleep laboratory. Questionnaire assessment included the use of the Beck Depression Inventory, Beck Anxiety Inventory, Mini-COPE, International Personality Item Pool Big Five Markers 20-Item version, and Oral Behavior Checklist.
Participants with SSB presented with fewer self-reported anxiety (p=0.008) and depressive (p=0.01) symptoms than the non- or mild-SB groups. The SSB group scored significantly higher in Big Five personal traits such as extraversion (p=0.007), emotional stability (p=0.013), and intellect (p=0.004), while regarding coping strategies, the SSB group was less likely to use negative strategies: self-distraction (p=0.036), denial (p=0.006), venting (p=0.03), behavioral disengagement (p=0.046), and self-blame (p=0.003), and turning to religion (p=0.041). The intensity of oral parafunctional behaviors was comparable in both groups (p=0.054). Emotional stability was a moderate protective factor (p=0.004), and the self-blame strategy was a strong risk factor (p<0.001) for increased oral parafunctional behavior intensity. Phasic activity negatively correlated with anxiety symptom severity (p=0.005), whereas tonic (p=0.122) and mixed (p=0.053) phenotypes did not. SB intensity was a protective factor against anxiety symptoms (p=0.016).
In terms of psychopathology, severe sleep bruxers tend to present less severe anxiety and depressive symptoms, while some of their personality traits (extraversion, emotional stability, and intellect) were more strongly pronounced. SSB is possibly related to the lesser use of the "maladaptive" coping strategies and there were no specific coping strategies preferred by SSB participants, compared to the other group. These observations require further studies, as it should be determined whether SB (especially phasic activity) might be a form of a somatization/functional disorder. Further research should focus on the psychogenic background of oral parafunctional behaviors, which occur more often in less emotionally stable personalities and in people using self-blame coping strategies.
过去曾对精神病理症状、人格特质、应对机制与睡眠磨牙症（SB）之间的因果关系进行研究，结果大多基于自我评估且不一致。这项基于多导睡眠图的横断面研究旨在通过客观的多导睡眠图验证，探索重度SB、人格特质（根据大五人格模型）和应对策略之间的关系。
该研究纳入了66名参与者，根据在睡眠实验室进行的视频多导睡眠图，将其分为重度SB（SSB）组（n = 32）和无或轻度SB组（n = 34）。问卷调查评估包括使用贝克抑郁量表、贝克焦虑量表、简易应对方式问卷、国际人格项目池大五人格标记20项版本和口腔行为检查表。
与无或轻度SB组相比，SSB参与者自我报告的焦虑（p = 0.008）和抑郁（p = 0.01）症状较少。SSB组在外向性（p = 0.007）、情绪稳定性（p = 0.013）和智力（p = 0.004）等大五人格特质方面得分显著更高，而在应对策略方面，SSB组较少使用消极策略：自我分心（p = 0.036）、否认（p = 0.006）、发泄（p = 0.03）、行为脱离（p = 0.046）、自责（p = 0.003）和求助宗教（p = 0.041）。两组口腔副功能行为的强度相当（p = 0.054）。情绪稳定性是口腔副功能行为强度增加的中度保护因素（p = 0.004），自责策略是强烈的危险因素（p < 0.001）。阶段性活动与焦虑症状严重程度呈负相关（p = 0.005），而紧张性（p = 0.122）和混合性（p = 0.053）表型则不然。SB强度是焦虑症状的保护因素（p = 0.016）。
在精神病理学方面，重度睡眠磨牙者往往表现出不太严重的焦虑和抑郁症状，而他们的一些人格特质（外向性、情绪稳定性和智力）更为明显。SSB可能与较少使用“适应不良”的应对策略有关，与另一组相比，SSB参与者没有特别偏好的应对策略。这些观察结果需要进一步研究，因为应确定SB（尤其是阶段性活动）是否可能是一种躯体化/功能性障碍的形式。进一步的研究应关注口腔副功能行为的心理成因背景，这种行为在情绪不太稳定的人格以及使用自责应对策略的人群中更常出现。
