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Oral appliances reduce masticatory muscle activity-sleep bruxism metrics independently of changes in heart rate variability

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Abstract

Objectives

Sleep bruxism (SB) is associated with physiological activities including sympathetic autonomic system dominance and sleep micro-arousal. While oral appliances (OA) are used to prevent SB harmful effects, the influence of OAs physiological mechanisms during sleep is unknown. The aim of this study is to assess whether heart rate variability (HRV) changes, as a marker of autonomic nervous system activity, would be associated with the OA mechanism of action on SB using occlusal splint (OS) and mandibular advancement splint (MAS).

Materials and methods

A retrospective analysis, from data previously collected in 21 participants with SB (25.6 ± 4.5 years) with polysomnographic recordings, was done. HRV data were compared between a reference night (no-device) and ones during which OS or MAS was used in a crossover study design. Rhythmic masticatory muscle activity (RMMA) index was compared between nights. HRV was evaluated using autoregressive model analysis for three sections: baseline (distance from RMMA), immediately before, and after RMMA period.

Results

A significant reduction in RMMA index, when wearing OA during sleep, was observed (P < 0.01), but was not associated with HRV parameters change. HRV significantly changed after RMMA onset for nights with OA during non-REM sleep in comparison with baseline (P < 0.02).

Conclusions

The usage of OAs for SB participants reduced RMMA, but most likely independently of changes in HRV linked to the mechanism associated with SB genesis.

Clinical relevance

Wearing OA seems to reduce grinding noise and protect from dental injuries but does not seem to influence SB genesis.

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References

  1. Lobbezoo F, Ahlberg J, Glaros AG, Kato T, Koyano K, Lavigne GJ, de Leeuw R, Manfredini D, Svensson P, Winocur E (2013) Bruxism defined and graded: an international consensus. J Oral Rehabil 40:2–4. https://doi.org/10.1111/joor.12011

    Article  PubMed  Google Scholar 

  2. Lobbezoo F, Ahlberg J, Raphael KG, Wetselaar P, Glaros AG, Kato T, Santiago V, Winocur E, De Laat A, De Leeuw R, Koyano K, Lavigne GJ, Svensson P, Manfredini D (2018) International consensus on the assessment of bruxism: report of a work in progress. J Oral Rehabil. https://doi.org/10.1111/joor.12663

    Article  PubMed  PubMed Central  Google Scholar 

  3. Medicine AAoS (2014) International classification of sleep disorders–third edition (ICSD-3). American Academy of Sleep Medicine, Westchester, NY

  4. Raphael KG, Santiago V, Lobbezoo F (2016) Is bruxism a disorder or a behaviour? Rethinking the international consensus on defining and grading of bruxism. J Oral Rehabil 43:791–798. https://doi.org/10.1111/joor.12413

    Article  PubMed  PubMed Central  Google Scholar 

  5. Mayer P, Heinzer R, Lavigne G (2016) Sleep bruxism in respiratory medicine practice. Chest 149:262–271. https://doi.org/10.1378/chest.15-0822

    Article  PubMed  Google Scholar 

  6. van Selms MK, Visscher CM, Knibbe W, Thymi M, Lobbezoo F (2020) The association between self-reported awake oral behaviors and orofacial pain depends on the belief of patients that these behaviors are harmful to the jaw. J Oral Facial Pain Headache 34:273–280. https://doi.org/10.11607/ofph.2629

    Article  PubMed  Google Scholar 

  7. Lavigne G, Kato T, Herrero Babiloni A, Huynh N, Dal Fabbro C, Svensson P, Aarab G, Ahlberg J, Baba K, Carra MC, Cunha TCA, Gonçalves DAG, Manfredini D, Stuginski-Barbosa J, Wieckiewicz M and Lobbezoo F (2021) Research routes on improved sleep bruxism metrics: toward a standardised approach. J Sleep Res:e13320. https://doi.org/10.1111/jsr.13320

  8. Harada T, Ichiki R, Tsukiyama Y, Koyano K (2006) The effect of oral splint devices on sleep bruxism: a 6-week observation with an ambulatory electromyographic recording device. J Oral Rehabil 33:482–488. https://doi.org/10.1111/j.1365-2842.2005.01576.x

    Article  PubMed  Google Scholar 

  9. Nikolopoulou M, Ahlberg J, Visscher CM, Hamburger HL, Naeije M, Lobbezoo F (2013) Effects of occlusal stabilization splints on obstructive sleep apnea: a randomized controlled trial. J Orofac Pain 27:199–205. https://doi.org/10.11607/jop.967

    Article  PubMed  Google Scholar 

  10. Carra MC, Huynh NT, El-Khatib H, Remise C, Lavigne GJ (2013) Sleep bruxism, snoring, and headaches in adolescents: short-term effects of a mandibular advancement appliance. Sleep Med 14:656–661. https://doi.org/10.1016/j.sleep.2013.03.009

    Article  PubMed  Google Scholar 

  11. Franco L, Rompré PH, de Grandmont P, Abe S, Lavigne GJ (2011) A mandibular advancement appliance reduces pain and rhythmic masticatory muscle activity in patients with morning headache. J Orofac Pain 25:240–249

    PubMed  Google Scholar 

  12. Landry ML, Rompré PH, Manzini C, Guitard F, de Grandmont P, Lavigne GJ (2006) Reduction of sleep bruxism using a mandibular advancement device: an experimental controlled study. Int J Prosthodont 19:549–556

    PubMed  Google Scholar 

  13. Landry-Schonbeck A, de Grandmont P, Rompré PH, Lavigne GJ (2009) Effect of an adjustable mandibular advancement appliance on sleep bruxism: a crossover sleep laboratory study. Int J Prosthodont 22:251–259

    PubMed  Google Scholar 

  14. Mainieri VC, Saueressig AC, Fagondes SC, Teixeira ER, Rehm DD, Grossi ML (2014) Analysis of the effects of a mandibular advancement device on sleep bruxism using polysomnography, the BiteStrip, the sleep assessment questionnaire, and occlusal force. Int J Prosthodont 27:119–126. https://doi.org/10.11607/ijp.3675

    Article  PubMed  Google Scholar 

  15. Solanki N, Singh BP, Chand P, Siddharth R, Arya D, Kumar L, Tripathi S, Jivanani H, Dubey A (2017) Effect of mandibular advancement device on sleep bruxism score and sleep quality. J Prosthet Dent 117:67–72. https://doi.org/10.1016/j.prosdent.2016.04.009

    Article  PubMed  Google Scholar 

  16. Kato T, Montplaisir JY, Guitard F, Sessle BJ, Lund JP, Lavigne GJ (2003) Evidence that experimentally induced sleep bruxism is a consequence of transient arousal. J Dent Res 82:284–288. https://doi.org/10.1177/154405910308200408

    Article  PubMed  Google Scholar 

  17. Lavigne GJ, Huynh N, Kato T, Okura K, Adachi K, Yao D, Sessle B (2007) Genesis of sleep bruxism: motor and autonomic-cardiac interactions. Arch Oral Biol 52:381–384. https://doi.org/10.1016/j.archoralbio.2006.11.017

    Article  PubMed  Google Scholar 

  18. Carra MC, Huynh N, Morton P, Rompré PH, Papadakis A, Remise C, Lavigne GJ (2011) Prevalence and risk factors of sleep bruxism and wake-time tooth clenching in a 7- to 17-yr-old population. Eur J Oral Sci 119:386–394. https://doi.org/10.1111/j.1600-0722.2011.00846.x

    Article  PubMed  Google Scholar 

  19. Kato T, Rompré P, Montplaisir JY, Sessle BJ, Lavigne GJ (2001) Sleep bruxism: an oromotor activity secondary to micro-arousal. J Dent Res 80:1940–1944. https://doi.org/10.1177/00220345010800101501

    Article  PubMed  Google Scholar 

  20. Huynh N, Kato T, Rompré PH, Okura K, Saber M, Lanfranchi PA, Montplaisir JY, Lavigne GJ (2006) Sleep bruxism is associated to micro-arousals and an increase in cardiac sympathetic activity. J Sleep Res 15:339–346. https://doi.org/10.1111/j.1365-2869.2006.00536.x

    Article  PubMed  Google Scholar 

  21. Inano S, Mizumori T, Kobayashi Y, Sumiya M, Yatani H (2013) Identification of sleep bruxism with an ambulatory wireless recording system. Int J Prosthodont 26:527–535. https://doi.org/10.11607/ijp.3331

    Article  PubMed  Google Scholar 

  22. Kostka PS, Tkacz EJ (2015) Multi-sources data analysis with sympatho-vagal balance estimation toward early bruxism episodes detection. Conference proceedings : Annual International Conference of the IEEE Engineering in Medicine and Biology Society IEEE Engineering in Medicine and Biology Society Annual Conference 2015:6010–6013. https://doi.org/10.1109/embc.2015.7319761

    Article  Google Scholar 

  23. Huynh N, Lavigne GJ, Lanfranchi PA, Montplaisir JY, de Champlain J (2006) The effect of 2 sympatholytic medications–propranolol and clonidine–on sleep bruxism: experimental randomized controlled studies. Sleep 29:307–316. https://doi.org/10.1093/sleep/29.3.307

    Article  PubMed  Google Scholar 

  24. Sakai T, Kato T, Yoshizawa S, Suganuma T, Takaba M, Ono Y, Yoshizawa A, Yoshida Y, Kurihara T, Ishii M, Kawana F, Kiuchi Y, Baba K (2017) Effect of clonazepam and clonidine on primary sleep bruxism: a double-blind, crossover, placebo-controlled trial. J Sleep Res 26:73–83. https://doi.org/10.1111/jsr.12442

    Article  PubMed  Google Scholar 

  25. Vanderveken OM, Devolder A, Marklund M, Boudewyns AN, Braem MJ, Okkerse W, Verbraecken JA, Franklin KA, De Backer WA, Van de Heyning PH (2008) Comparison of a custom-made and a thermoplastic oral appliance for the treatment of mild sleep apnea. Am J Respir Crit Care Med 178:197–202. https://doi.org/10.1164/rccm.200701-114OC

    Article  PubMed  Google Scholar 

  26. Rechtschaffen A and Kales A (1968) A manual of standardized terminology, techniques and scoring techniques for sleep stages of human subjects. Brain Research Institute, Los Angeles

  27. Bonnet M, Carley D, Carskadon M, Easton P, Guilleminault C, Harper RM, Hayes B, Hirshkowitz M, Ktonas P, Keenan S (1992) EEG arousals: scoring rules and examples: a preliminary report from the Sleep Disorders Atlas Task Force of the American Sleep Disorders Association. Sleep 15:173–184

    Article  Google Scholar 

  28. TRoaAAoSMT Force (1999) Sleep-related breathing disorders in adults: recommendations for syndrome definition and measurement techniques in clinical research. Sleep 22:667–689

    Article  Google Scholar 

  29. Lavigne GJ, Guitard F, Rompré PH, Montplaisir JY (2001) Variability in sleep bruxism activity over time. J Sleep Res 10:237–244. https://doi.org/10.1046/j.1365-2869.2001.00261.x

    Article  PubMed  Google Scholar 

  30. Lavigne GJ, Rompré PH, Montplaisir JY (1996) Sleep bruxism: validity of clinical research diagnostic criteria in a controlled polysomnographic study. J Dent Res 75:546–552. https://doi.org/10.1177/00220345960750010601

    Article  PubMed  Google Scholar 

  31. Lavigne GJ, Rompré PH, Poirier G, Huard H, Kato T, Montplaisir JY (2001) Rhythmic masticatory muscle activity during sleep in humans. J Dent Res 80:443–448. https://doi.org/10.1177/00220345010800020801

    Article  PubMed  Google Scholar 

  32. Rompré PH, Daigle-Landry D, Guitard F, Montplaisir JY, Lavigne GJ (2007) Identification of a sleep bruxism subgroup with a higher risk of pain. J Dent Res 86:837–842. https://doi.org/10.1177/154405910708600906

    Article  PubMed  Google Scholar 

  33. Electrophysiology TFotESoCatNASoPa (1996) Heart rate variability. Standards of measurement, physiological interpretation, and clinical use. Eur Heart J 17:354–81

  34. Lanfranchi PA, Fradette L, Gagnon JF, Colombo R, Montplaisir J (2007) Cardiac autonomic regulation during sleep in idiopathic REM sleep behavior disorder. Sleep 30:1019–1025. https://doi.org/10.1093/sleep/30.8.1019

    Article  PubMed  PubMed Central  Google Scholar 

  35. Lavigne GJ, Okura K, Abe S, Colombo R, Huynh N, Montplaisir JY, Marchand S, Lanfranchi PA (2011) Gender specificity of the slow wave sleep lost in chronic widespread musculoskeletal pain. Sleep Med 12:179–185. https://doi.org/10.1016/j.sleep.2010.07.015

    Article  PubMed  Google Scholar 

  36. Burr RL (2007) Interpretation of normalized spectral heart rate variability indices in sleep research: a critical review. Sleep 30:913–919. https://doi.org/10.1093/sleep/30.7.913

    Article  PubMed  PubMed Central  Google Scholar 

  37. Lavigne GJ, Khoury S, Abe S, Yamaguchi T, Raphael K (2008) Bruxism physiology and pathology: an overview for clinicians. J Oral Rehabil 35:476–494. https://doi.org/10.1111/j.1365-2842.2008.01881.x

    Article  PubMed  Google Scholar 

  38. Dube C, Rompré PH, Manzini C, Guitard F, de Grandmont P, Lavigne GJ (2004) Quantitative polygraphic controlled study on efficacy and safety of oral splint devices in tooth-grinding subjects. J Dent Res 83:398–403. https://doi.org/10.1177/154405910408300509

    Article  PubMed  Google Scholar 

  39. Huynh NT, Rompré PH, Montplaisir JY, Manzini C, Okura K, Lavigne GJ (2006) Comparison of various treatments for sleep bruxism using determinants of number needed to treat and effect size. Int J Prosthodont 19:435–441

    PubMed  Google Scholar 

  40. Saueressig AC, Mainieri VC, Grossi PK, Fagondes SC, Shinkai RS, Lima EM, Teixeira ER, Grossi ML (2010) Analysis of the influence of a mandibular advancement device on sleep and sleep bruxism scores by means of the BiteStrip and the Sleep Assessment Questionnaire. Int J Prosthodont 23:204–213

    PubMed  Google Scholar 

  41. Singh PK, Alvi HA, Singh BP, Singh RD, Kant S, Jurel S, Singh K, Arya D, Dubey A (2015) Evaluation of various treatment modalities in sleep bruxism. J Prosthet Dent 114:426–431. https://doi.org/10.1016/j.prosdent.2015.02.025

    Article  PubMed  Google Scholar 

  42. Abekura H, Yokomura M, Sadamori S, Hamada T (2008) The initial effects of occlusal splint vertical thickness on the nocturnal EMG activities of masticatory muscles in subjects with a bruxism habit. Int J Prosthodont 21:116–120

    PubMed  Google Scholar 

  43. Arima T, Tomonaga A, Toyota M, Inoue SI, Ohata N, Svensson P (2012) Does restriction of mandibular movements during sleep influence jaw-muscle activity? J Oral Rehabil 39:545–551. https://doi.org/10.1111/j.1365-2842.2012.02310.x

    Article  PubMed  Google Scholar 

  44. Avivi-Arber L, Martin R, Lee JC, Sessle BJ (2011) Face sensorimotor cortex and its neuroplasticity related to orofacial sensorimotor functions. Arch Oral Biol 56:1440–1465. https://doi.org/10.1016/j.archoralbio.2011.04.005

    Article  PubMed  Google Scholar 

  45. Dao TT, Lavigne GJ (1998) Oral splints: the crutches for temporomandibular disorders and bruxism? Crit Rev Oral Biol Med 9:345–361. https://doi.org/10.1177/10454411980090030701

    Article  PubMed  Google Scholar 

  46. Ikuta M, Iida T, Kothari M, Shimada A, Komiyama O, Svensson P (2019) Impact of sleep bruxism on training-induced cortical plasticity. J Prosthodont Res 63:277–282. https://doi.org/10.1016/j.jpor.2018.12.008

    Article  PubMed  Google Scholar 

  47. Matsumoto H, Tsukiyama Y, Kuwatsuru R, Koyano K (2015) The effect of intermittent use of occlusal splint devices on sleep bruxism: a 4-week observation with a portable electromyographic recording device. J Oral Rehabil 42:251–258. https://doi.org/10.1111/joor.12251

    Article  PubMed  Google Scholar 

  48. Clark GT, Beemsterboer PL, Solberg WK, Rugh JD (1979) Nocturnal electromyographic evaluation of myofascial pain dysfunction in patients undergoing occlusal splint therapy. J Am Dent Assoc 99:607–611. https://doi.org/10.14219/jada.archive.1979.0348

    Article  PubMed  Google Scholar 

  49. Van der Zaag J, Lobbezoo F, Wicks DJ, Visscher CM, Hamburger HL, Naeije M (2005) Controlled assessment of the efficacy of occlusal stabilization splints on sleep bruxism. J Orofac Pain 19:151–158

    PubMed  Google Scholar 

  50. Macaluso GM, Guerra P, Di Giovanni G, Boselli M, Parrino L, Terzano MG (1998) Sleep bruxism is a disorder related to periodic arousals during sleep. J Dent Res 77:565–573. https://doi.org/10.1177/00220345980770040901

    Article  PubMed  Google Scholar 

  51. Badilini F, Maison-Blanche P, Coumel P (1998) Heart rate variability in passive tilt test: comparative evaluation of autoregressive and FFT spectral analyses. Pacing Clin Electrophysiol 21:1122–1132. https://doi.org/10.1111/j.1540-8159.1998.tb00159.x

  52. Fagard RH, Pardaens K, Staessen JA, Thijs L (1998) Power spectral analysis of heart rate variability by autoregressive modelling and fast Fourier transform: a comparative study. Acta Cardiol 53:211–218

    PubMed  Google Scholar 

  53. Li K, Rudiger H, Ziemssen T (2019) Spectral analysis of heart rate variability: time window matters. Front Neurol 10:545. https://doi.org/10.3389/fneur.2019.00545

    Article  PubMed  PubMed Central  Google Scholar 

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Acknowledgements

The authors would like to thank Keigo Miyata and Yusuke Kameoka in Chest Co. for their support of RemLogic software in the study. This paper was based on data from sleep studies supported by the Canadian Institutes of Health Research (CIHR) and the Fonds de la Recherche en Santé du Québec (FRSQ) grants to G. Lavigne who holds a Canada Research Chair in Pain, Sleep and Trauma. Susumu Abe was a visiting scholar from Tokushima University Graduate School, Tokushima, Japan, during his stay in Montreal, Canada. Recognition to Margaret Mckyes and Joshua Wolfe for English editing.

Funding

This paper was based on data from sleep studies supported by the Canadian Institutes of Health Research (CIHR) and the Fonds de la Recherche en Santé du Québec (FRSQ) grants to G. Lavigne who holds a Canada Research Chair in Pain, Sleep and Trauma.

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Authors and Affiliations

  1. Center for Advanced Research in Sleep Medicine, Research Centre, Hôpital du Sacré-Coeur de Montréal, 5400 boul, Gouin Ouest, Québec, H4J 1C5, Montréal, Canada

    Susumu Abe & Gilles J. Lavigne

  2. Faculté de Médecine Dentaire, Université de Montréal, CP 6128, Succursale Centre- ville, Montréal, Québec, H3C 3J7, Canada

    Susumu Abe, Nelly T. Huynh, Pierre H. Rompré, Anaïs Landry-Schönbeck, Marie-Lou Landry, Pierre de Grandmont & Gilles J. Lavigne

  3. Department of Comprehensive Dentistry, Tokushima University Graduate School of Biomedical Sciences, 3-18-15 Kuramoto-cho, Tokushima, 770-8504, Japan

    Susumu Abe & Fumiaki Kawano

  4. Department of Oral Physiology, Osaka University Graduate School of Dentistry, 1-8 Yamadaoka, Suita, Osaka, 565-0871, Japan

    Takafumi Kato

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  1. Susumu Abe
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  2. Nelly T. Huynh
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  9. Gilles J. Lavigne
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Correspondence to Susumu Abe.

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Pierre de Grandmont is deceased.

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Abe, S., Huynh, N.T., Kato, T. et al. Oral appliances reduce masticatory muscle activity-sleep bruxism metrics independently of changes in heart rate variability. Clin Oral Invest 26, 5653–5662 (2022). https://doi.org/10.1007/s00784-022-04520-y

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