Sleep architecture as a candidate for phenotyping sleep bruxism: A narrative physiological review.

BACKGROUND: Sleep bruxism (SB), an oral behaviour in otherwise healthy individuals, is characterised by frequent rhythmic masticatory muscle activity (RMMA) during sleep. RMMA/SB episodes occur over various sleep stages (N1-N3 and rapid eye movement (REM)), sleep cycles (non-REM to REM), and frequently with microarousals. It currently remains unclear whether these characteristics of sleep architecture are phenotype candidates for the genesis of RMMA/SB. OBJECTIVES: This narrative review investigated the relationship between sleep architecture and the occurrence of RMMA as a SB phenotype candidate. METHODS: PubMed research was performed using keywords related to RMMA/SB and sleep architecture. RESULTS: In non-SB and SB healthy individuals, RMMA episodes were most frequent in the light non-REM sleep stages N1 and N2, particularly during the ascending phase of sleep cycles. The onset of RMMA/SB episodes in healthy individuals was preceded by a physiological arousal sequence of autonomic cardiovascular to cortical activation. It was not possible to extract a consistent sleep architecture pattern in the presence of sleep comorbidities. The lack of standardisation and variability between subject complexified the search for specific sleep architecture phenotype(s). CONCLUSION: In otherwise healthy individuals, the genesis of RMMA/SB episodes is largely affected by oscillations in the sleep stage and cycle as well as the occurrence of microarousal. Furthermore, a specific sleep architecture pattern cannot be confirmed in the presence of sleep comorbidity. Further studies are needed to delineate sleep architecture phenotype candidate(s) that contribute to the more accurate diagnosis of SB and treatment approaches using standardised and innovative methodologies.

Longitudinal electromyographic analysis of jaw-closing muscle activities during ingestive behaviors from pre-weaning to juvenile periods in rats.

This longitudinal study investigated developmental changes in jaw-closing muscle activities during ingestive behaviors in rats. On postnatal day (P) 10, electromyography (EMG) electrodes were inserted into the masseter and temporalis muscles of rat pups. EMG activities were recorded for the following ingestive behaviors between P14 and P49: for suckling, including nipple attachment and rhythmic sucking on P14 and for pasta biting, pellet chewing, and milk licking between P21 and P49. Burst rhythms and muscle coordination (i.e., the correlation and time lag) between masseter and temporalis activities were assessed for each behavior. The burst rhythms of nipple attachment and rhythmic sucking on P14 were significantly slower than those of pasta biting, pellet chewing, and milk licking on P21. Muscle coordination differed between suckling on P14 and mastication and licking on P21. Between P21 and P49, increases were observed in burst rhythms for pasta biting and pellet chewing. The rate of increases in burst rhythms was higher for pasta biting than for pellet chewing. Muscle coordination between the two muscle activities for pasta biting did not significantly change between P21 and P49, whereas that for pellet chewing significantly changed between P21 and P24 and stabilized after P24. Burst rhythms for milk licking did not significantly change over time, while muscle coordination between the two muscle activities changed from agonist to antagonist muscle-like activity on approximately P35. The present results demonstrate that distinct patterns of rhythmic jaw-closing muscle activities emerge before weaning, they continue to change over time, and they exhibit unique developmental dynamics for each behavior after weaning.

Understanding the pathophysiology of sleep bruxism based on human and animal studies: A narrative review.

BACKGROUND: Sleep bruxism (SB) is a common sleep disorder that affects approximately 20% of children and 10% of adults. It may cause orodental problems, such as tooth wear, jaw pain, and temporal headaches. However, the pathophysiological mechanisms underlying SB remain largely unknown, and a definitive treatment has not yet been established. HIGHLIGHT: Human studies involving polysomnography have shown that rhythmic masticatory muscle activity (RMMA) is more frequent in otherwise healthy individuals with SB than in normal individuals. RMMA occurs during light non-rapid eye movement (non-REM) sleep in association with transient arousals and cyclic sleep processes. To further elucidate the neurophysiological mechanisms of SB, jaw motor activities have been investigated in naturally sleeping animals. These animals exhibit various contractions of masticatory muscles, including episodes of rhythmic and repetitive masticatory muscle bursts that occurred during non-REM sleep in association with cortical and cardiac activation, similar to those found in humans. Electrical microstimulation of corticobulbar tracts may also induce rhythmic masticatory muscle contractions during non-REM sleep, suggesting that the masticatory motor system is activated during non-REM sleep by excitatory inputs to the masticatory central pattern generator. CONCLUSION: This review article summarizes the pathophysiology of SB based on the findings from human and animal studies. Physiological factors contributing to RMMA in SB have been identified in human studies and may also be present in animal models. Further research is required to integrate the findings between human and animal studies to better understand the mechanisms underlying SB.

Anesthetic Management Using a Laryngeal Mask Airway for a Patient With Ankylosing Spondylitis: A Case Report.

Ankylosing spondylitis (AS), a type of chronic spondyloarthritis, significantly increases patients' risk of cervical spine fracture. We describe the anesthetic management of a 32-year-old male with AS who was scheduled to have bilateral mandibular third molar extractions under general anesthesia. To minimize the potential for cervical spine damage, a laryngeal mask airway was used for airway management while the patient's head was held firmly during surgery. Additionally, he developed a postoperative surgical infection that was attributed to his continued immunotherapy with infliximab. In patients with AS, postoperative infection control as well as cervical spine protection throughout the perioperative period is important.