Comparative Capabilities of Clinical Assessment, Diagnostic Criteria, and Polysomnography in Detecting Sleep Bruxism

Abstract

Objective: To evaluate the diagnostic capability of signs and symptoms of sleep bruxism (SB) as per the American Academy of Sleep Medicine (AASM) criteria and a diagnostic grading system proposed by international experts for assessing SB.

Methods: The study was conducted in three phases (interview, physical examination, and sleep studies). Subjects were asked about self-reported tooth grinding sounds occurring during sleep, muscle fatigue, temporal headaches, jaw muscle pain, and jaw locking. A visual examination was conducted to check for presence of abnormal tooth wear. A full-night polysomnography (PSG) was performed. After three phases, the subjects were divided into two groups matched by age and gender: Case Group, 45 SB subjects, and Control Group, 45 non-SB subjects. Diagnostic accuracy measurements were calculated for each sign or symptom individually and for the two diagnostic criteria analyzed.

Results: Muscle fatigue, temporal headaches, and AASM criteria were associated with highest sensitivity (78%, 67%, 58%, respectively) and also with highest diagnostic odds ratio (OR = 9.63, 9.25, 6.33, respectively). Jaw locking, muscle pain, and the criterion of "probable SB" were associated with the worst sensitivity (16%, 18%, 22%, respectively).

Conclusions: Presence of muscle fatigue and temporal headaches can be considered good tools to screen SB patients. None of the diagnostic criteria evaluated was able to accurately identify patients with SB. AASM criteria had the strongest diagnostic capabilities and--although they do not attain diagnostic values high enough to replace the current gold standard (PSG)--should be used as a screening tool to identify SB.

Keywords: bruxism; diagnostic grading system; polysomnography; sleep bruxism.

© 2015 American Academy of Sleep Medicine.

Figures

Figure 1. Inclusion and exclusion criteria.

SDB, sleep disordered breathing; ENT, ear; nose; and throat; RDC, research diagnostic criteria; TMD, temporomandibular disorder; OSA, obstructive sleep apnea; PSG, polysomnography.

Figure 2. Flow diagram of screening and selection criteria.

Figure 3. Forest plot with diagnostic test accuracy (sensitivity, specificity, and 95% confidence interval).

TP, true positive; FP, false positive; FN, false negative; TN, true negative.

Figure 4. Receiver operating characteristic (ROC) curve.

1 = Fatigue, 2 = Jaw locking, 3 = Muscle pain, 4 = Sounds. 5 = Temporal Headache, 6 = Tooth wear, 7 = Possible SB, 8 = Probable SB, 9 = AASM criteria.