Sleep bruxism and pediatric obstructive sleep apnea: exploring their chronological overlap and clinical significance.

BACKGROUND

This study aimed to investigate the temporal relationship between rhythmic masticatory muscle activity (RMMA), characteristic of sleep bruxism (SB), and apnea-hypopnea (AH) events in children and adolescents diagnosed with obstructive sleep apnea (OSA). The primary research question was whether AH events temporally precede or follow RMMA events, helping to clarify potential shared mechanisms or causal links between SB and OSA.

METHODS

A retrospective review of 72 pediatric PSG records (ages 6-17) diagnosed with OSA between 2017 and 2020 was conducted. RMMA episodes were identified using submental EMG leads. Temporal associations were classified as T1 (AH before SB) or T2 (SB before AH) if events occurred within a 2-minute window. Sleep architecture and clinical variables were compared between SB and non-SB groups. Correlation analyses were performed to examine relationships between RMMA index, temporally related events, and OSA severity.

RESULTS

SB was observed in 43.1% of participants. Of all RMMA episodes, 61% had a temporal relation with AH events (T1: 54%, T2: 46%). SB participants had significantly more RMMA events and temporally related events (p < 0.001). RMMA index was highly correlated with temporally associated episodes (r = 0.90). SB participants also showed altered sleep architecture with increased time in lighter sleep stages.

CONCLUSION

A temporal association between SB and AH events was found in a pediatric OSA population, suggesting a potential shared arousal-related mechanism. However, the association appears indirect, and causality remains unconfirmed.