Effect of respiratory therapy on patients with sleep bruxism and associated respiratory events: Study protocol for a randomized controlled clinical trial
Keywords:Sleep bruxism; Respiratory therapy; Sleep apnea.
Aim: The aim of this study will be to perform respiratory physiotherapy on patients with sleep bruxism and associated respiratory events (apnea and hypopnea). Methodology: The study will be a randomized, controlled, double-blind, clinical trial with a sample of individuals with sleep bruxism and associated respiratory events. Respiratory (inspiratory and/or expiratory) physiotherapy will be performed using the THRESHOLD IMT and PEP and the results will be compared to a placebo group. Discussion: Regarding respiratory events, there is a broad variety of possible treatments for sleep apnea depending on the physiopathology, severity and patient preference, with CPAP considered the gold standard. However, data on CPAP are inconsistent, with adherence to therapy reported to be between 45 and 89%. Thus, other forms of treatment are proposed, including respiratory training. Understanding obstructive sleep apnea syndrome as the loss of the dilation strength of the pharynx and the inability to maintain the path open for air, respiratory muscle training could assist in increasing dilation strength, enabling the passage of air during sleep. Taking into consideration that sleep bruxism may be associated with events of apnea and hypopnea, the intervention to treat obstructive respiratory events related to sleep may have a positive impact on events related to sleep bruxism (rhythmic activity of the masticatory muscles). To determine this, we will measure the apnea/hypopnea index (AHI) and number of contractions of the masseter muscle (characteristic of the activity of bruxism) before and after the intervention using polysomnography. Trial registration: The trial was registered with the REBEC platform: RBR-9F6JKM (ensaiosclinicos.gov.br).
Almeida, I. P., Bertucci, N. R., & de Lima, V. P. (2008). Variações da pressão inspiratória máxima e pressão expiratória máxima a partir da capacidade residual funcional ou da capacidade pulmonar total e volume residual em indivíduos normais (Variations in maximum inspiratory pressure and maximum expiratory pressure from functional residual capacity or total lung capacity and residual volume in normal individuals). O Mundo da Saúde, 32(2), 176-182. http://dx.doi.org/10.1590/S1413-35552007000500006
Boutron, I., Altman, D. G., Moher, D., Schulz, K. F., & Ravaud, P. (2017). CONSORT statement for randomized trials of nonpharmacologic treatments: a 2017 update and a CONSORT extension for nonpharmacologic trial abstracts. Annals of internal medicine, 167(1), 40-47. https://doi.org/10.7326/M17-0046
Carra, M. C., Huynh, N., & Lavigne, G. (2012). Sleep bruxism: a comprehensive overview for the dental clinician interested in sleep medicine. Dental Clinics, 56(2),387-413. https://doi.org/10.1016/j.cden.2012.01.003
Castroflorio, T., Bargellini, A., Rossini, G., Cugliari, G., Rainoldi, A., & Deregibus, A. (2015). Risk factors related to sleep bruxism in children: A systematic literature review. Archives of oral biology, 60(11), 1618-1624.https://doi.org/10.1016/j.archoralbio.2015.08.014
de Souza Kock, K., Calônico, J. C., Luiz, Â. R., Arent, Y. A., & Fernandes, I. (2019). Análise da pressão inspiratória com alto e baixo fluxos em resistor alinear (Analysis of inspiratory pressure with high and low flows in line resistor). ASSOBRAFIR Ciência, 6(1), 13-20.
Hasegawa, Y., Lavigne, G., Rompré, P., Kato, T., Urade, M., & Huynh, N. (2013). Is there a first night effect on sleep bruxism? A sleep laboratory study. Journal of Clinical Sleep Medicine, 9(11), 1139-1145.https://doi.org/10.5664/jcsm.3152
Herkenrath, S. D., Treml, M., Priegnitz, C., Galetke, W., & Randerath, W. J. (2018). Effects of respiratory muscle training (RMT) in patients with mild to moderate obstructive sleep apnea (OSA). Sleep and Breathing, 22(2), 323-328. https://doi.org/10.1007/s11325-017-1582-6
Hosoya, H., Kitaura, H., Hashimoto, T., Ito, M., Kinbara, M., Deguchi, T., ... & Takano-Yamamoto, T. (2014). Relationship between sleep bruxism and sleep respiratory events in patients with obstructive sleep apnea syndrome. Sleep and Breathing, 18(4), 837-844.https://doi.org/10.1007/s11325-014-0953-5
Inoko, Y., Shimizu, K., Morita, O., & Kohno, M. (2004). Relationship between masseter muscle activity and sleep‐disordered breathing. Sleep and Biological Rhythms, 2(1), 67-68. https://doi.org/10.1111/j.1479-8425.2003.00068.x
Jadidi, F., Nørregaard, O., Baad‐Hansen, L., Arendt‐Nielsen, L., & Svensson, P. (2011). Assessment of sleep parameters during contingent electrical stimulation in subjects with jaw muscle activity during sleep: a polysomnographic study. European journal of oral sciences, 119(3), 211-218. https://doi.org/10.1111/j.1600-0722.2011.00822.x
Kapur, V. K., Auckley, D. H., Chowdhuri, S., Kuhlmann, D. C., Mehra, R., Ramar, K., & Harrod, C. G. (2017). Clinical practice guideline for diagnostic testing for adult obstructive sleep apnea: an American Academy of Sleep Medicine clinical practice guideline. Journal of Clinical Sleep Medicine, 13(3), 479-504.https://doi.org/10.5664/jcsm.6506
Kato, T., Montplaisir, J. Y., Guitard, F., Sessle, B. J., Lund, J. P., & Lavigne, G. J. (2003). Evidence that experimentally induced sleep bruxism is a consequence of transient arousal. Journal of dental research, 82(4), 284-288. https://doi.org/10.1177%2F154405910308200408
Kuo, Y. C., Song, T. T., Bernard, J. R., & Liao, Y. H. (2017). Short-term expiratory muscle strength training attenuates sleep apnea and improves sleep quality in patients with obstructive sleep apnea. Respiratory physiology & neurobiology, 243, 86-91.https://doi.org/10.1016/j.resp.2017.05.007
Lavigne, G. J., Kato, T., Kolta, A., & Sessle, B. J. (2003). Neurobiological mechanisms involved in sleep bruxism. Critical Reviews in Oral Biology & Medicine, 14(1), 30-46. https://doi.org/10.1177%2F154411130301400104
Lavigne, G. J., Rompre, P. H., Poirier, G., Huard, H., Kato, T., & Montplaisir, J. Y. (2001). Rhythmic masticatory muscle activity during sleep in humans. Journal of dental research, 80(2), 443-448.https://doi.org/10.1177%2F00220345010800020801
Lavigne, G., Manzini, C., & Huynh, N. T. (2011). Sleep bruxism In: Kryger MH, Roth T, Dement WC, editors. Principles and practice of sleep medicine, 1128-39.
Lin, H. C., Chiang, L. L., Ong, J. H., Tsai, K. L., Hung, C. H., & Lin, C. Y. (2020). The effects of threshold inspiratory muscle training in patients with obstructive sleep apnea: a randomized experimental study. Sleep and Breathing, 24(1), 201-209. https://doi.org/10.1007/s11325-019-01862-y
Lobbezoo, F., Ahlberg, J., Raphael, K. G., Wetselaar, P., Glaros, A. G., Kato, T., ... & Manfredini, D. (2018). International consensus on the assessment of bruxism: Report of a work in progress. Journal of oral rehabilitation, 45(11), 837-844.https://doi.org/10.1111/joor.12663
Mayer, P., Heinzer, R., & Lavigne, G. (2016). Sleep bruxism in respiratory medicine practice. Chest, 149(1), 262-271. https://doi.org/10.1378/chest.15-0822
Ohayon, M. M., Li, K. K., & Guilleminault, C. (2001). Risk factors for sleep bruxism in the general population. Chest, 119(1), 53-61.. https://doi.org/10.1378/chest.119.1.53
Okeson, J. P., Phillips, B. A., Berry, D. T., Cook, Y. R., & Cabelka, J. F. (1991). Nocturnal bruxing events in subjects with sleep-disordered breathing and control subjects. Journal of Craniomandibular Disorders, 5(4).
Olsen, S., Smith, S., & Oei, T. P. (2008). Adherence to continuous positive airway pressure therapy in obstructive sleep apnoea sufferers: a theoretical approach to treatment adherence and intervention. Clinical psychology review, 28(8), 1355-1371.
Remmers, J. E., DeGroot, W. J., Sauerland, E. K., & Anch, A. M. (1978). Pathogenesis of upper airway occlusion during sleep. Journal of Applied Physiology, 44(6), 931-938. https://doi.org/10.1152/jappl.19220.127.116.111
Saito, M., Yamaguchi, T., Mikami, S., Watanabe, K., Gotouda, A., Okada, K., ... & Lavigne, G. (2016). Weak association between sleep bruxism and obstructive sleep apnea. A sleep laboratory study. Sleep and Breathing, 20(2), 703-709.http://doi.org/10.1007/s11325-015-1284-x
Silva, E. (2011). Análise eletromiográfica dos músculos respiratórios em indivíduos saudáveis submetidos a diferentes cargas de treinamento muscular inspiratório (Electromyographic analysis of respiratory muscles in healthy individuals submitted to different loads of inspiratory muscle training). São José dos Campos.
Sjöholm, T. T., Lowe, A. A., Miyamoto, K., Fleetham, J. A., & Ryan, C. F. (2000). Sleep bruxism in patients with sleep-disordered breathing. Archives of oral biology, 45(10), 889-896. https://doi.org/10.1016/S0003-9969(00)00044-3
Souza, A. K. F., de Andrade, A. D., de Medeiros, A. I. C., de Aguiar, M. I. R., de Souza Rocha, T. D., Pedrosa, R. P., & de Lima, A. M. J. (2018). Effectiveness of inspiratory muscle training on sleep and functional capacity to exercise in obstructive sleep apnea: a randomized controlled trial. Sleep and Breathing, 22(3), 631-639. https://doi.org/10.1007/s11325-017-1591-5
Strollo Jr, P. J., Soose, R. J., Maurer, J. T., De Vries, N., Cornelius, J., Froymovich, O., ... & Strohl, K. P. (2014). Upper-airway stimulation for obstructive sleep apnea. New England Journal of Medicine, 370(2), 139-149. https://www.nejm.org/doi/full/10.1056/NEJMoa1308659
Sullivan, C., Berthon-Jones, M., Issa, F., & Eves, L. (1981). Reversal of obstructive sleep apnoea by continuous positive airway pressure applied through the nares. The Lancet, 317(8225), 862-865.https://doi.org/10.1016/S0140-6736(81)92140-1
Van de Heyning, P. H., Badr, M. S., Baskin, J. Z., Cramer Bornemann, M. A., De Backer, W. A., Dotan, Y., ... & Woodson, B. T. (2012). Implanted upper airway stimulation device for obstructive sleep apnea. The Laryngoscope, 122(7), 1626-1633. https://doi.org/10.1002/lary.23301
Vranish, J. R., & Bailey, E. F. (2016). Inspiratory muscle training improves sleep and mitigates cardiovascular dysfunction in obstructive sleep apnea. Sleep, 39(6), 1179-1185. https://doi.org/10.5665/sleep.5826
Weaver, T. E., & Grunstein, R. R. (2008). Adherence to continuous positive airway pressure therapy: the challenge to effective treatment. Proceedings of the American Thoracic Society, 5(2), 173-178.
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Copyright (c) 2021 Bianca Lopes Cavalcante-Leão; José Stechman-Neto; Glória Cortz Ravazzi; Anne Elise Sarraff Fischer; Yasmin Abdula; Miguel Meira e Cruz; Rosane Sampaio Santos; Bianca Simone Zeigelboim
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