Obstructive sleep apnea affects around 20 million Americans and can lead to hypertension, heart attack, stroke, depression, muscle pain, fibromyalgia, morning headaches, and excessive daytime sleepiness.

Friday, May 20, 2011

Grinding (Bruxism )appliances and Sleep Apnea: Can a grinding appliance make Sleep Apnea Worse? The answer is a definite maybe.

A recent article inthe Journal of Oral Rehabilitation examined the question as to whether a grinding appliance could make sleep apnea aworse. ( of 18 patients showed increases in AHI when their bites were opened without mandibular advancement but only 2 were significantly changed. The article considers whether the vertical opening is responsible for increasing AHI but it is also possible that grinding and/or clenching habits may be protective of the airway and the utilization of these appliances may reduce that activity that is protective against sleep apnea.

It has been previously reported that bruxism appliances can increase sleep apnea in some patients.

J Oral Rehabil. 2011 Apr 5. doi: 10.1111/j.1365-2842.2011.02221.x. [Epub ahead of print]
The effect of raising the bite without mandibular protrusion on obstructive sleep apnoea.
Nikolopoulou M, Naeije M, Aarab G, Hamburger HL, Visscher CM, Lobbezoo F.

Department of Oral Kinesiology, Academic Centre for Dentistry Amsterdam (ACTA), Research Institute MOVE, University of Amsterdam and VU University Amsterdam, Amsterdam Department of Clinical Neurophysiology and Center for Sleep-Wake Disorders, Slotervaart Medical Center, Amsterdam, The Netherlands.

Summary  It has recently been suggested that wearing a maxillary occlusal splint (i.e. a hard acrylic resin dental appliance that covers the occlusal surfaces of the maxillary dentition and that is being indicated for the treatment of, e.g. temporomandibular pain) may be associated with a risk of aggravating obstructive sleep apnoea (OSA). The present study tested the hypothesis that raising the bite without mandibular protrusion in OSA patients is associated with an increase in the apnoea-hypopnoea index (AHI). Eighteen OSA patients (13 men; 49·5 ± 8·1 years old) received a mandibular advancement device in 0% protrusion of the mandible (0%MAD). The MAD caused a bite rise of 6 mm as measured interincisally. Polysomnographic recordings were obtained at baseline and with the 0%MAD in situ. No statistically significant difference in AHI was noted between the baseline night and the 0%MAD night. However, nine patients had an aggravation in AHI during the night they used the 0%MAD. Taking into account the previously established smallest detectable difference of 12·8 in AHI, the AHI increased in only two of the patients. The outcomes of this study suggest that an increased jaw gape without mandibular protrusion might be associated with a risk of aggravation of OSA for some, but not for all OSA patients. Dental practitioners should be aware of this possible association when treating patients with oral devices that raise the bite.

© 2011 Blackwell Publishing Ltd.

[PubMed - as supplied by publisher]

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posted by Dr Shapira at 1:44 PM