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Título

PREDICTION OF SLEEP BRUXISM DIAGNOSIS WITH CONCOMITANT INSOMNIA COMPLAINTS: A MID-AGE SUB-GROUP IN GENERAL POPULATION

Introdução

Sleep bruxism (SB) is characterized by rhythmic masticatory muscle activity (RMMA) during sleep with occasional tooth grinding. It is reported by 8-12% of the population. Screening of SB in clinic include reports of tooth grinding sounds, tooth wear, jaw muscle fatigue or pain. SB risk factors and concomitant sleep complaints or disorders include age, gender, body mass index (BMI), sleep quality, insomnia and obstructive sleep apnea (OSA).

Objetivo

The aims of the present study are to: i) assess if among the above variables which are the predominant ones in a general population for SB, ii) if these variables can help to better predict presence of SB/RMMA on PSG.

Métodos

Individuals from a general population participated 2 times in the EPISONO Sao Paulo, Brazil, sleep study (20 to 80 y.o; time 1, 2007: n= 1042 and time 2, 2015: n=712. SB and insomnia symptoms were self-reported and insomnia was further scored with DSM-IV criteria, for both time 1 and 2. From a one night of PSG scoring used 2 RMMA/hr and over and AHI of 5/hr criteria. Tests used were: logistic regression, identification of predictor variable with CHAID decision tree mathematical analysis. The validation of predictor assessment was done with time 2 follow up data. Cluster were identified by correspondence analysis.

Resultados

With questionnaires data there is an higher risk of being a SB subject (n=127) if a subject is a male (Prevalence ratio 1.5), overweight & obese (PR 3.3 & 2.7, respectively), reporting insomnia corresponding to DSM IV (PR 2.7) and presenting AHI over 30 (PR 2.8). With PSG data (n=56) overweight and DSM IV had a PR of 3 regardless age or gender. Using the CHAID tree analysis decision, SB complaints correctly classifies non-SB subjects/+SB in 87.7% of cases with questionnaires data (p= 0.001). SB subjects present higher frequency of DSM-IV insomnia (21.3%/10.7% for good sleepers). Using PSG data RMMA/h of 2 and over correctly classifies non-SB subjects/+SB at 91% (p= 0.008). SB subjects again present higher frequency of DSM-IV insomnia (17.7%/7.8% for good sleepers). The follow-up revealed that the prediction values is still acceptable since it correctly discriminate non SB, based on 2 RMMA/hr, at 70.1 % with a male gender dominance for SB subjects. The correspondence analysis revealed 3 age sub-groups of SB subjects.

Conclusões

Concomitant insomnia is a predictive variable for SB diagnosis. In mid-age female subjects' insomnia is comorbid to SB as is OSA in older obese man.

Palavras-chave

Sleep Bruxism, Insomnia, Polysomnography

Área

Área Clínica

Autores

Milton Maluly, Cibele Dal-Fabbro, Gilles Lavigne, Monica Andersen, Sergio Tufik