Dal Fabbro Cibele, Bornhardt-Suazo Thomas, Landry Schönbeck Anaïs, de Meyer Micheline, Lavigne Gilles J
Faculty of Dental Medicine, Université de Montreal, Montreal, Canada.
Center for Advanced Research in Sleep Medicine, CIUSS Nord lle de Montreal, Montreal, Canada.
J Prosthodont. 2025 Apr;34(S1):46-61. doi: 10.1111/jopr.13966. Epub 2024 Oct 30.
Sleep-related bruxism (SRB) is a motor oral behavior characterized by tooth grinding and jaw clenching activity, reported by 8%-12% of the adult general population and 3% of older individuals. The frequency of one of its biomarkers, rhythmic masticatory muscle activity (RMMA), remains elevated across ages. Obstructive sleep apnea (OSA) is associated with the brief and repetitive pause of breathing (apnea) and with transient reduction in oxygen (hypoxia). OSA is observed at all ages and in about 50% of older individuals with a male preponderance. SRB clinical assessment is based on self-reporting of tooth grinding sound, awareness of clenching, jaw pain or headache, and clinical observation of tooth damage. OSA clinical assessment is based on sleepiness and fatigue, snoring, sleep quality, and awareness of breathing cessation, plus clinical examination of anatomical factors (e.g., obesity, retrognathia, large tonsil, macroglossia), age, gender, and body mass. Although the literature does not support association or causality between these two conditions, the co-occurrence is reported in about 30%-50% of adults. To confirm a diagnosis of co-occurring SRB and OSA, home sleep testing (HST) may be indicated. A sleep test is performed using electromyography (EMG) of jaw muscle (masseter or temporalis) and cardio-respiratory variables (e.g., air flow, respiratory effort, oxygen level, heart rate). The management of co-occurring SRB and OSA for individuals with prosthodontic needs is challenging to prevent compromising the oro-pharyngeal space and breathing efficiency. OSA treatment in the presence of SRB includes continuous positive airway pressure (CPAP) use alone or with an occlusal splint or mandibular advancement device (MAD). In addition, the following may be considered: supine sleep correction device, myofuncional therapy, medications, and surgeries. All have limitations and risks. Individual variability suggests that phenotyping is mandatory to select the most efficient and personalized treatment.
睡眠相关磨牙症（SRB）是一种口腔运动行为，其特征为磨牙和紧咬牙活动，在8%-12%的成年普通人群以及3%的老年人中存在。其生物标志物之一，节律性咀嚼肌活动（RMMA）的频率在各年龄段均持续升高。阻塞性睡眠呼吸暂停（OSA）与呼吸的短暂反复暂停（呼吸暂停）以及氧气的短暂减少（低氧）相关。OSA在各年龄段均有观察到，在约50%的老年人中更为常见，且男性居多。SRB的临床评估基于对磨牙声音的自我报告、紧咬牙的意识、颌部疼痛或头痛，以及牙齿损伤的临床观察。OSA的临床评估基于嗜睡和疲劳、打鼾、睡眠质量以及呼吸暂停的意识，再加上对解剖学因素（如肥胖、下颌后缩、扁桃体肿大、巨舌症）、年龄、性别和体重的临床检查。尽管文献并不支持这两种情况之间存在关联或因果关系，但约30%-50%的成年人报告称两者同时出现。为确诊SRB和OSA同时存在，可能需要进行家庭睡眠测试（HST）。使用颌肌（咬肌或颞肌）的肌电图（EMG）和心肺变量（如气流、呼吸努力、氧气水平、心率）进行睡眠测试。对于有口腔修复需求的个体，同时治疗SRB和OSA具有挑战性，因为要防止影响口咽空间和呼吸效率。在存在SRB的情况下，OSA的治疗包括单独使用持续气道正压通气（CPAP）或与咬合板或下颌前移装置（MAD）联合使用。此外，还可考虑以下方法：仰卧位睡眠矫正装置、肌功能治疗、药物治疗和手术治疗。所有这些方法都有局限性和风险。个体差异表明，必须进行表型分析以选择最有效和个性化的治疗方法。
