Does treating sleep apnea (Obstructive Sleep Apnea) improve bruxism symptoms?

Treatment of Sleep Apnea Improves Bruxism Symptoms

Both CPAP and mandibular advancement device (MAD) treatments for obstructive sleep apnea (OSA) are effective in reducing sleep bruxism intensity in patients with coexisting OSA. 1

Relationship Between Sleep Apnea and Bruxism

• Sleep bruxism has a 37.1% prevalence among OSA patients, suggesting a significant association between these two conditions 2
• OSA has been identified as one of the highest risk factors for tooth grinding during sleep 3
• Sleep bruxism episodes often appear as arousal responses at the end of apnea/hypopnea events 3
• Patients with sleep bruxism and OSA show significantly higher electromyographic (EMG) muscle tone and number of hypopneas compared to OSA patients without bruxism 2

Effectiveness of OSA Treatments on Bruxism

CPAP Therapy

• CPAP treatment has been shown to significantly decrease bruxism parameters in OSA patients 1
• In severe cases, CPAP can completely eliminate tooth grinding events when they are related to apnea/hypopnea episodes 3
• Case reports demonstrate that successful treatment of sleep-related respiratory effort with CPAP may lead to improvement or resolution of bruxism 4

Mandibular Advancement Devices

• MADs significantly reduce bruxism episode index (BEI) in patients with OSA 1
• MADs are recommended as an effective treatment for mild to moderate OSA by multiple guidelines 5, 6
• While CPAP is more effective in reducing the apnea-hypopnea index (AHI), there is no significant difference between CPAP and MAD in their effectiveness for BEI reduction 1

Treatment Selection Considerations

• CPAP is considered the gold standard treatment for moderate to severe symptomatic OSA 6
• MADs are appropriate for:
  • Patients with mild to moderate OSA with no comorbidities 6
  • Patients with severe OSA who are intolerant to CPAP therapy 6
  • Patients who request an alternative to CPAP 6
• Patient adherence with MADs is generally better than with CPAP 6

Potential Side Effects and Complications

• MAD therapy may cause short-term side effects including:
  • Hypersalivation, dry mouth, dental pain, gingival irritation 6
  • Myofascial pain and temporomandibular disorder (TMD) discomfort 6
• Most complications of MAD therapy are mild and temporary, typically occurring during the adaptation period 6
• TMD disorders can be an obstacle to using MADs, though they are usually transient and pain tends to decrease with continued use 6
• Mandibular exercises may improve discomfort during the adaptation period 6

Follow-up and Monitoring

• Patients using MADs should be followed up by a qualified dentist every 6 months for the first year and at least annually thereafter 6
• If symptoms of worsening OSA are observed during annual assessment, the dentist should communicate this to the patient's physician 6
• Treatment of OSA should be evaluated by a sleep physician through appropriate sleep testing 6

Clinical Implications

• Sleep bruxism should not be viewed as only an oral health-related problem in OSA patients but as part of a broader sleep-related breathing disorder 2
• Interdisciplinary interventions involving both sleep medicine specialists and dental professionals are crucial for effectively treating patients with coexisting OSA and bruxism 2
• Screening for OSA should be considered in patients presenting with sleep bruxism 1