Sleep Apnoea and Sleep Bruxism

The Connection

The link between sleep apnoea and sleep bruxism (SB)—also known as teeth grinding—is an important consideration for both sleep medicine and dental professionals. While they are distinct conditions, research shows that they often occur together. A large study of 914 adults found that nearly 50% of those with obstructive sleep apnoea (OSA) also experience sleep bruxism.

The Bruxism Episode Index (BEI) measures bruxism severity by calculating the number of grinding episodes per hour of sleep:

  • <2 = Irrelevant

  • 2–4 = Mild to Moderate

  • >4 = Severe

Traditionally, BEI is measured via in-lab polysomnography. However, recent developments—such as the Sunrise device—allow AI-driven detection of bruxism through mandibular movement, enabling at-home screening for both OSA and SB.

SDX indicates SB on Sunrise OSA screening test report   

Right side of picture indicates SB

Prevalence of OSA/SB

Several studies report higher levels of bruxism in people with OSA, and vice versa. While the precise nature of the relationship is still being understood, a growing body of evidence suggests an important clinical association.

Mechanisms of Association

  • Hypoxia and Arousal: The intermittent hypoxia caused by sleep apnoea can lead to brief arousals from sleep, which may trigger bruxism episodes.

  • Central Nervous System Dysregulation: Both OSA and SB involve alterations in sleep-related brain activity, possibly due to shared dysfunction in neurotransmitter pathways.

Shared Risk Factors

Obesity and stress are both known to contribute to the development of sleep apnoea and sleep bruxism. Addressing these shared risks is a key part of comprehensive treatment.

Clinical Implications

Because both conditions often overlap, dental and sleep medicine professionals should collaborate on diagnosis and management.

  • CPAP therapy may help reduce both apnoeas and bruxism in some cases.

  • Mandibular advancement devices (MADs), often used to treat mild to moderate OSA, may also help manage bruxism.

Treatment Options

Managing co-existing sleep apnoea and sleep bruxism requires a multidisciplinary approach tailored to the individual:

 

  • CPAP is the gold standard for treating moderate to severe OSA and may reduce bruxism frequency in some cases

  • MADs are useful for milder forms of OSA and may benefit patients with coexisting bruxism

  • Further research is ongoing, and treatment should be personalised based on patient characteristics and symptom presentation.

If symptoms of either condition are present, referral to a sleep medicine service is essential for accurate diagnosis and the development of a patient-centred treatment plan.

References

    1. Martynowicz H et al. J Clin Med. 2019;8(10):1653.

    2. Tan MWY et al. J Oral Facial Pain Headache. 2019;33(3):269–277.

    3. Li D et al. J Clin Sleep Med. 2023;19(3):443-51.

    4. Martynowicz H et al. Front Neurol. 2019;10:487.

    5. Martinot JB et al. Nat Sci Sleep. 2021;13:1449-1459.

    6. Herrero Babiloni A, Lavigne GJ. J Clin Sleep Med. 2018;14(8):1281-3.

    7. Martinot JB et al. Chest. 2020;157(3):e59-e62.

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