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<p>Sleep bruxism (SB), which is frequently observed in patients with obstructive sleep apnea (OSA), has received increasing attention in recent years. Oral appliance (OA) therapy may indirectly influence SB by reducing respiratory events and respiratory-related arousals. This exploratory within-subject study aimed to investigate how OA therapy influences SB activity and arousal characteristics by examining changes in SB, respiratory events, and arousal indices before and after OA therapy in patients with OSA. Patients diagnosed with OSA based on polysomnography (PSG) were referred for OA therapy using a custom-made mandibular advancement OA (monoblock or twin-block design). Twenty-three participants (10 males, 13 females; mean age 58.5 ± 15.8 years) were enrolled. Masseter muscle activity was simultaneously recorded using an identical single-channel wearable electromyography device during PSG. Participants underwent a second PSG and electromyography (EMG) evaluation after OA therapy. Treatment effectiveness was defined as a ≥ 50% reduction in the apnea–hypopnea index (AHI) or a post-treatment AHI &lt; 5. At baseline, the mean AHI was 17.4 [12.4–18.4] events/h, with a mean SB frequency of 13.25 [11.26–23.81] episodes/h. Baseline and post-treatment PSG and EMG evaluations demonstrated a significant reduction in the AHI (<i>p</i> = 0.002) and total SB episodes (<i>p</i> &lt; 0.001), along with a significant increase in spontaneous arousal index (SAI) during the rapid eye movement (REM) stage (<i>p</i> = 0.02). Reductions in total SB episodes were observed in both treatment-response groups; however, SB changes were not consistently aligned with improvements in respiratory indices. The effective group exhibited a significant increase in arousal index (ArI) during REM sleep (<i>p</i> = 0.018) and a significant decrease in respiratory arousal index (RAI) during REM sleep (<i>p</i> = 0.045). These findings suggest that changes in SB under OA therapy are not solely dependent on respiratory improvement and may reflect multifactorial mechanisms. OA therapy may therefore influence SB through both indirect respiratory effects and direct mechanical or neurophysiological pathways.</p>

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The relationship between sleep bruxism and sleep-related respiratory events under oral appliance therapy in patients with obstructive sleep apnea

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年5月14日

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  • Yuriko Dotsu,
  • George Umemoto,
  • Chikara Yoshimura,
  • Ritsuko Miyachi,
  • Mitsuko Kuchiishi,
  • Hideo Toyoshima

摘要

Sleep bruxism (SB), which is frequently observed in patients with obstructive sleep apnea (OSA), has received increasing attention in recent years. Oral appliance (OA) therapy may indirectly influence SB by reducing respiratory events and respiratory-related arousals. This exploratory within-subject study aimed to investigate how OA therapy influences SB activity and arousal characteristics by examining changes in SB, respiratory events, and arousal indices before and after OA therapy in patients with OSA. Patients diagnosed with OSA based on polysomnography (PSG) were referred for OA therapy using a custom-made mandibular advancement OA (monoblock or twin-block design). Twenty-three participants (10 males, 13 females; mean age 58.5 ± 15.8 years) were enrolled. Masseter muscle activity was simultaneously recorded using an identical single-channel wearable electromyography device during PSG. Participants underwent a second PSG and electromyography (EMG) evaluation after OA therapy. Treatment effectiveness was defined as a ≥ 50% reduction in the apnea–hypopnea index (AHI) or a post-treatment AHI < 5. At baseline, the mean AHI was 17.4 [12.4–18.4] events/h, with a mean SB frequency of 13.25 [11.26–23.81] episodes/h. Baseline and post-treatment PSG and EMG evaluations demonstrated a significant reduction in the AHI (p = 0.002) and total SB episodes (p < 0.001), along with a significant increase in spontaneous arousal index (SAI) during the rapid eye movement (REM) stage (p = 0.02). Reductions in total SB episodes were observed in both treatment-response groups; however, SB changes were not consistently aligned with improvements in respiratory indices. The effective group exhibited a significant increase in arousal index (ArI) during REM sleep (p = 0.018) and a significant decrease in respiratory arousal index (RAI) during REM sleep (p = 0.045). These findings suggest that changes in SB under OA therapy are not solely dependent on respiratory improvement and may reflect multifactorial mechanisms. OA therapy may therefore influence SB through both indirect respiratory effects and direct mechanical or neurophysiological pathways.