Understanding the Link Between Sleep Apnea and Sleep Bruxism

Sleep Bruxism (SB), commonly known as teeth grinding, and Obstructive Sleep Apnoea Hypopnoea Syndrome (OSAHS) often occur concurrently, with research studies reporting a 20-40% comorbidity rate. These conditions share risk factors such as age, obesity, and alcohol use. SB is a masticatory muscle activity during sleep that is characterized as rhythmic (phasic) or nonrhythmic (tonic) and is not a movement disorder or a sleep disorder in otherwise healthy individuals 1-2.

The Connection Between Sleep Apnea and Sleep Bruxism:

One hypothesised mechanism linking Sleep Apnea and Sleep Bruxism is that the breathing interruptions and drops in oxygen levels that occur with SAHS lead to brief arousals from sleep. Sleep bruxism may be triggered as a protective physiological response to open the airway and restore normal breathing following these events.

Common Signs and Symptoms:

Individuals suffering from both conditions often report poor sleep quality, snoring, and morning headaches. It is estimated that up to 50% of OSAHS patients may exhibit some form of SB.

The Role of Dental Practitioners in Screening:

Dental practitioners play a crucial role in screening for both Sleep Apnea and Sleep Bruxism. Additional training in sleep medicine may equip them to spot potential sleep apnea cases and refer patients for diagnosis and treatment.

Innovative Tools for Diagnosis:

The Sunrise device, for example, measures mandibular movements and can screen for the presence of SB. The automated report generated by this device includes the Bruxism Episode Index (BEI), a crucial tool for assessing the severity of SB.

Index (BEI) The BEI is a tool that clinicians can use to measure the severity of SB:

• Score <2: irrelevant SB

• Score 2–4: mild/moderate SB

• Score >4: severe SB.

Understanding and Managing Sleep Apnea and Sleep Bruxism:

Although SB and OSAHS seem tightly interconnected, the precise mechanisms linking them need to be better elucidated. Given their prevalence as sleep issues, enhanced screening and effective management warrant an interprofessional approach with dental practitioners as key team members.

References:

1.Li D, Kuang B, Lobbezoo F, de Vries N, Hilgevoord A, Aarab G. Sleep bruxism is highly prevalent in adults with obstructive sleep apnea: a large-scale polysomnographic study. J Clin Sleep Med. 2023;19(3):443–451.

2.González González A, Montero J, Gómez Polo C. Sleep Apnea–Hypopnea Syndrome and Sleep Bruxism: A Systematic Review. Journal of Clinical Medicine. 2023 Jan 23;12(3):910.