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Sleep and awake bruxism in adult with Down syndrome


To our knowledge, no studies have accessed awake bruxism (AB) and stage by stage sleep bruxism (SB) in adults with Down syndrome (DS). The gold standard for SB diagnosis is polysomnography type I, but recent works have shown that the accuracy of portable PSG systems for SB is considered good even in absence of audio-video recording.


To evaluate the prevalence of awake and stage-by-stage sleep bruxism in adult with Down syndrome through questionnaire answered by caregivers and PSG type II.


Twenty-three adults with DS were enrolled in this study. Clinic examination, dental anamnesis and RDC-TMD were performed in order to address anthropometric data, dental status, parafunctional habits and temporomandibular symptoms. The history of SB/AB was answered by caregivers. A portable PSG type II system (Embla Embletta MPR+PG ST+Proxy, Natus, California-USA) was used to perform a full-sleep study at patients’ home. Sleep data were visually scored according to the AAMS criteria and SB was scored according to the published rules. RMMA activity was defined as low (>1 and <2 episodes/h of sleep), moderate (>2 and <4 episodes/h of sleep), or high (>4 episodes/h of sleep). Subjects received the PSG diagnosis of SB if RMMA index was >2 episodes/h of sleep.


The sample was composed by 23 adults with DS (mean age 21.74.3; 9 females, 14 males). All patients presented moderate to severe tooth wear and identations on tongue. Muscular and temporomandibular joint(TMJ) palpation presented 8.7% and 0% for local myalgia and TMJ pain, respectively. According to caregivers reporting, all patients presented AB and only 13.1% SB. PSG data showed a SB prevalence of 91.3%, with a mean RMMA index 40.030.0/h. When the RMMA index was separated by frequency, it was found 17.4% low RMMA, 21.7% moderate RMMA and 43.5% high RMMA. Only 2 showed RMMA index of 0.0/h. SB episodes/h were 30.4%, 8.7%, 21.7% and 26.1% in N1, N2, N3 and REM sleep stage, respectively. Clinical data showed probable AB. In addition, all patients presented obstructive sleep apnea 32.828.6 and snoring per hour was 26.215.0. Despite the raised RMMA index, the majority of patients did not present TMD symptoms. Comparing caregivers reports with PSG data, they seem not be aware of the presence of SB.


The high prevalence of definitive SB and probable AB, added to the high prevalence of obstructive sleep apnea and snoring, point to the recommendation for the PSG in adult with Down syndrome, routinely. Parents seem not to be aware about the presence of SB.


Down syndrome; sleep bruxism; awake bruxism


Área Clínica


Centro Universitário de Anápolis Uni-Evangélica - Ceara - Brasil, Hospital do Servidor Público Estadual de São Paulo-IAMSPE-HSPE - Para - Brasil, ICT-UNESP/SJC - Sao Paulo - Brasil


Lilian Chrystiane Giannasi, Marignes S T Dutra, Tatiana G G P Rezende, Sergio Roberto Nacif, Ezequiel Fernandes Oliveira, Luis Vicente Franco Oliveira, Wagner Oliveira, Bruna D Pereira, Monica Fernandes Gomes