Prevalence of sleep apnea–hypopnea syndrome (SAHS) among a bruxism population. Preliminary data

Abstract

Sleep bruxism is a very common oral pathology which has been associated with different clinical manifestations (sleeping disorders, orofacial pain, broken teeth, headaches, muscle spasms, etc.). The apnea–hypopnea syndrome (OSA) is also a highly prevalent disease and could be associated to bruxism during sleep. Both of them are underdiagnosed and could share some pathophysiological mechanisms. To investigate if these disease are associated could improve their appropriate diagnosis and would facilitate an early treatment. Aim: To determine the prevalence of OSA in patients with protrusive bruxism diagnosed at a dental clinic and establish its potential association with OSA. Between June and March of 2011, 30 consecutive patients older than 18 years were identified in a dental clinic. Bruxism was diagnosed according to the International Classification of Sleep Disorders criteria (ICSD-2) and they had a protrusive profile. A sleep study was performed with a validated device (Embleta Gold. ResMed, USA) to assess the presence of OSA. Anthropometric parameters (weight, height, body mass index, BMI, blood pressure, pharmacological and toxic habits, and presence of comorbidity) and Epworth Sleepiness Scale to assess daytime sleepiness were collected. The analysis of the sleep study was done manually according to the Spanish Society of Pneumology and Thoracic Surgery (SEPAR) criteria. We studied 30 patients (70% male): age 59.5 + 10.8 years old, body mass index (BMI) 27.9 + 3.4 kg/m2; Prevalence of hypertension was 44%; Epworth Sleepiness Scale was 9.5 + 32.4 and an apnea–hypopnea index (AHI) 32.4 + 24.9. The prevalence of OSA defined by an AHI > 5 was 93.3%, and 86% for moderate-severe OSA (AHI > 15) and 36.7 for severe OSA (AHI > 30). Also observed was a positive correlation between the severity of bruxism and OSA severity (Spearman correlation coefficient of 0.52; p = 0.004). Comments: Our data suggest that the prevalence of OSA in patients with protrusive bruxism is fourfold when compared to the general population and there is a dose- response relationship between the severity of tooth wear caused by bruxism and the severity of OSA. If these data are confirmed in a larger study it would imply that all patients with protrusive bruxism should be examined for the presence of OSA. To the workers of the dental clinic.