Reliability of a portable device for the detection of sleep bruxism (original) (raw)
Related papers
Journal of Oral Rehabilitation, 2014
SummaryRecent polysomnographic (PSG) studies showed that the sleep bruxism (SB) event is preceded by a sudden shift in autonomic cardiac activity. Therefore, heart rate could be the simplest‐to‐record parameter for use in addition to portable home EMG monitoring to improve the accuracy in automatic detection of SB events. The aim of the study was to compare the detection of SB episodes by combined surface electromyography and heart rate (HR) recorded by a compact portable device (Bruxoff®), with the scoring of SB episodes by a PSG recording. Twenty‐five subjects (14 ‘probable’ bruxers and 11 non‐bruxers) were selected for the study. Each subject underwent the Bruxoff and the PSG recordings during the same night. Rhythmic masseter muscle activities (RMMAs) were scored according to published criteria. Correlation coefficients and the Bland–Altman plots were calculated to measure the correlation and agreement between the two methods. Results showed a high correlation (Pearson's r =...
IEEE journal of biomedical and health informatics, 2013
Diagnosis of bruxism is difficult since not all contractions of masticatory muscles during sleeping are bruxism episodes. In this paper, we propose the use of both EMG and ECG signals for the detection of sleep bruxism. Data have been acquired from 21 healthy volunteers and 21 sleep bruxers. The masseter surface EMGs were detected with bipolar concentric electrodes and the ECG with monopolar electrodes located on the clavicular regions. Recordings were made at the subjects' homes during sleeping. Bruxism episodes were automatically detected as characterized by masseter EMG amplitude greater than 10% of the maximum and heart rate increasing by more than 25% with respect to baseline within 1 s before the increase in EMG amplitude above the 10% threshold. Furthermore, the subjects were classified as bruxers and nonbruxers by a neural network. The number of bruxism episodes per night was 24.6 ± 8.4 for bruxers and 4.3 ± 4.5 for controls ( P < 0.0001). The classification error bet...
Clocks & Sleep , 2023
Background: The gold standard for diagnosing sleep bruxism (SB) and obstructive sleep apnea (OSA) is polysomnography (PSG). However, a final hypermotor muscle activity often occurs after apnea episodes, which can confuse the diagnosis of SB when using portable electromyography (EMG) devices. This study aimed to compare the number of SB episodes obtained from PSG with manual analysis by a sleep expert, and from a manual and automatic analysis of an EMG and electrocardiography (EKG) device, in a population with suspected OSA. Methods: Twenty-two subjects underwent a polysomnographic study with simultaneous recording with the EMG-EKG device. SB episodes and SB index measured with both tools and analyzed manually and automatically were compared. Masticatory muscle activity was scored according to published criteria. Patients were segmented by severity of OSA (mild, moderate, severe) following the American Academy of Sleep Medicine (AASM) criteria. ANOVA and the Bland–Altman plot were used to quantify the agreement between both methods. The concordance was calculated through the intraclass correlation coefficient (ICC). Results: On average, the total events of SB per night in the PSG study were (8.41 ± 0.85), lower than the one obtained with EMG-EKG manual (14.64 ± 0.76) and automatic (22.68 ± 16.02) analysis. The mean number of SB episodes decreases from the non-OSA group to the OSA group with both PSG (5.93 ± 8.64) and EMG-EKG analyses (automatic = 22.47 ± 18.07, manual = 13.93 ± 11.08). However, this decrease was minor in proportion compared to the automatic EMG-EKG analysis mode (from 23.14 to 22.47). The ICC based on the number of SB episodes in the segmented sample by severity degree of OSA along the three tools shows a moderate correlation in the non-OSA (0.61) and mild OSA (0.53) groups. However, it is poorly correlated in the moderate (0.24) and severe (0.23) OSA groups: the EMG-EKG automatic analysis measures 14.27 units more than PSG. The results of the manual EMG-EKG analysis improved this correlation but are not good enough. Conclusions: The results obtained in the PSG manual analysis and those obtained by the EMG-EKG device with automatic and manual analysis for the diagnosis of SB are acceptable but only in patients without OSA or with mild OSA. In patients with moderate or severe OSA, SB diagnosis with portable electromyography devices can be confused due to apneas, and further study is needed to investigate this. Keywords: bruxism; electromyography; sleep apnea; polysomnography; sleep bruxism; sleep–wake disorders; electrocardiography; portable device
Instrumental assessment of sleep bruxism: A systematic review and meta-analysis
Instrumental assessment of sleep bruxism: A systematic review and meta-analysis, 2024
This systematic review and meta-analysis (MA) aimed to evaluate the diagnostic validity of portable electromyography (EMG) diagnostic devices compared to the reference standard method polysomnography (PSG) in assessing sleep bruxism. This systematic review was completed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) statement and was registered with PROSPERO prior to the accomplishment of the main search. Ten clinical studies on humans, assessing the diagnostic accuracy of portable instrumental approaches with respect to PSG, were included in the review. Methodological shortcomings were identified by QUADAS-2 quality assessment. The certainty of the evidence analysis was established by different levels of evidence according to the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) framework. A meta-analysis of diagnostic test accuracy was performed with multiple thresholds per study applying a two-stage random effects model, using the thresholds offered by the studies and based on the number of EMG bruxism events per hour presented by the participants. Five studies were included. The MA indicated that portable EMG diagnostic devices showed a very good diagnostic capacity, although a high variability is evident in the studies with some outliers. Very low quality of evidence due to high risk of bias and high heterogeneity among included studies suggests that portable devices have shown high sensitivity and specificity when diagnosing sleep bruxism (SB) compared to polysomnography. The tests performed in the MA found an estimated optimal cutoff point of 7 events/hour of SB with acceptably high sensitivity and specificity for the EMG portable devices.
Agreement between clinical and portable EMG/ECG diagnosis of sleep bruxism
The aim of this study was to compare clinical sleep bruxism (SB) diagnosis with an instrumental diagnosis obtained with a device providing electromyography/electrocardiography (EMG/ECG) recordings. Forty-five (N = 45) subjects (19 males and 26 females, mean age 28 AE 11 years) were selected among patients referring to the Gnathology Unit of the Dental School of the University of Torino. An expert clinician assessed the presence of SB based on the presence of one or more signs/symptoms (i.e. transient jaw muscle pain in the morning, muscle fatigue at awakening, presence of tooth wear, masseter hypertrophy). Furthermore, all participants underwent an instrumental recording at home with a portable device (Bruxoff â ; OT Bioelettronica, Torino, Italy) allowing a simultaneous recording of EMG signals from both the masseter muscles as well as heart frequency. Statistical procedures were performed with the software Statistical Package for the Social Science v. 20.0 (SPSS 20.0 â ; IBM, Milan, Italy). Based on the EMG/ECG analysis, 26 subjects (11 males, 15 females, mean age 28 AE 10 years) were diagnosed as sleep bruxers, whilst 19 subjects (7 males, 12 females, mean age 30 AE 10 years) were diagnosed as non-bruxers. The correlation between the clinical and EMG/ECG SB diagnoses was low (/ value = 0Á250), with a 62Á2% agreement (28/45 subjects) between the two approaches (kappa = 0Á248). Assuming instrumental EMG/ECG diagnosis as the standard of reference for definite SB diagnosis in this investigation, the false-positive and false-negative rates were unacceptable for all clinical signs/symptoms. In conclusion, findings from clinical assessment are not related with SB diagnosis performed with a portable EMG/ECG recorder.
Diagnostic accuracy of sleep bruxism scoring in absence of audio-video recording: a pilot study
Sleep and Breathing, 2014
Purpose Based on the most recent polysomnographic (PSG) research diagnostic criteria, sleep bruxism is diagnosed when >2 rhythmic masticatory muscle activity (RMMA)/h of sleep are scored on the masseter and/or temporalis muscles. These criteria have not yet been validated for portable PSG systems. This pilot study aimed to assess the diagnostic accuracy of scoring sleep bruxism in absence of audio-video recordings. Methods Ten subjects (mean age 24.7±2.2) with a clinical diagnosis of sleep bruxism spent one night in the sleep laboratory. PSG were performed with a portable system (type 2) while audio-video was recorded. Sleep studies were scored by the same examiner three times: (1) without, (2) with, and without audio-video in order to test the intra-scoring and intraexaminer reliability for RMMA scoring. Results The RMMA event-by-event concordance rate between scoring without audio-video and with audio-video was 68.3 %. Overall, the RMMA index was overestimated by 23.8 % without audio-video. However, the intra-class correlation coefficient (ICC) between scorings with and without audio-video was good (ICC=0.91; p<0.001); the intraexaminer reliability was high (ICC=0.97; p<0.001). The clinical diagnosis of sleep bruxism was confirmed in 8/10 subjects based on scoring without audio-video and in 6/10 subjects with audio-video.
Validation of the BiteStrip screener for sleep bruxism
Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology, and Endodontology, 2007
Objective. The aim of this study was to validate a small electronic electromyographic device (BiteStrip) designed to screen masseter electromyographic events that indicate sleep bruxism (SB) against traditional masseter electromyographic events (MEMG). Study design. Six SB treatment-seeking patients, 4 obstructive sleep apnea (OSA) patients and 8 symptom-free controls, underwent overnight polysomnography, including MEMG and BiteStrip recordings. Total BiteStrip and MEMG scores and indices (events per hour) based on total recording time (TRT) and total sleep time (TST) were computed. Measures of accuracy, Spearman's rho correlations, and nonparametric group comparisons were performed. Results. BiteStrip average sensitivity was 0.72, average positive predictive value was 0.75. Correlations between left BiteStrip and MEMG total scores, TRT, and TST indices were r ϭ 0.81, r ϭ 0.79, and r ϭ 0.79, respectively. Bland-Altman plots showed good agreement between indices. Significant group differences were observed for total scores and indices. Conclusions. BiteStrip and MEMG scores showed strong relationships. Sensitivity and positive predictive value were acceptable. The BiteStrip is a viable screener for identifying masseter electromyographic events that indicate SB. (Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2007;104:e32-e39)
Assessment of interobserver concordance in polysomnography scoring of sleep bruxism
Sleep Science, 2015
Introduction: Objective evaluation of sleep bruxism (SB) using whole-night polysomnography (PSG) is relevant for diagnostic confirmation. Nevertheless, the PSG electromyogram (EMG) scoring may give rise to controversy, particularly when audiovisual monitoring is not performed. Therefore, the present study assessed the concordance between two independent scorers to visual SB on a PSG performed without audiovisual monitoring. Methods: Fifty-six PSG tests were scored from individuals with clinical history and polysomnography criteria of SB. In addition to the protocol of conventional whole-night PSG, electrodes were also placed bilaterally on the masseter and temporal muscles. Visual EMG scoring without audio video monitoring was scored by two independent scorers (Dentist 1 and Dentist 2) according the recommendations formulated in the AASM manual (2007). Kendall Tau correlation was used to assess interobserver concordance relative to variables "total duration of events (seconds), "shortest events", "longest events" and index in each phasic, tonic or mixed event. Results: The correlation was positive and significant relative to all the investigated variables, being T40.54. Conclusion: It was found a good inter-examiner concordance rate in SB scoring in absence of audio video monitoring.
Journal of Oral Rehabilitation, 2008
The aim of this study was to quantify the time-variant nature of sleep bruxism (SB) and to discuss its consequences. Six clinically diagnosed bruxers and six non-bruxers participated. Four ambulatory polysomnographic (PSG) recordings were obtained for every participant. As SB outcome variables, the number of episodes per hour of sleep (Epi h )1 ), the number of bursts per hour (Bur h )1 ) and the bruxism time index (BTI: the percentage of total sleep time spent bruxing) were established. To quantify the time-variant nature of SB, standard errors of measurement (SEMs) were calculated. For the nonbruxers, the SEMs for Epi h )1 , Bur h )1 and BTI were 1AE0, 5AE7 and 0AE1. For the bruxers, the respective values were 2AE1, 14AE9 and 0AE4. In the discussion, arguments are given that because of the time-variant nature of the PSG recordings, cut-off bands around cut-off points might be useful for the recognition of SB.
Objectives: This study aimed to assess frequency and multiple-night variability of sleep bruxism (SB) as well as sleep-time masticatory muscle activities (sMMA) in the home environment in healthy young adults using a portable device that provides electrocardiographic (ECG) and surface electromyographic (EMG) recordings from the masticatory muscles. Methods: The study was performed on 27 subjects (11 males, 16 females; mean age 28.3 ± 1.7 years) selected from a sample of healthy young students. Evaluation was carried out for four nights to record data on masticatory muscle activities using a compact portable device that previously showed an excellent agreement with polysomnography (PSG) for the detection of SB events. The number of SB episodes per sleep hour (bruxism index), and the number of tonic, phasic and mixed sMMA events per hour were assessed. A descriptive evaluation of the frequency of each condition was performed on all individuals, and gender comparison was investigated. Results: Mean sleep duration over the four recording nights was 7 ± 1.3 h. The average SB index was 3.6 ± 1.2. Most of the sMMA were tonic (49.9%) and phasic (44.1%). An ANOVA test showed the absence of significant differences between the four nights. No significant gender differences were detected for the SB index, phasic or tonic contractions; conversely, gender differences were detected for mixed sMMA events (p < 0.05). Conclusion: This investigation supports the concept that sMMA events are quite frequent in healthy adults. Differences over the four-night recording span were not significant. These data could be compared to subjects with underlying conditions that may lead to an additive bruxism activity and possible clinical consequences.