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      Effect of Sleep Bruxism Intensity on Blood Pressure in Normotensives

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          Abstract

          The present research aimed to investigate the influence of sleep bruxism (SB) intensity on blood pressure parameters in normotensive subjects by using an ambulatory blood pressure device. The study group included 65 normotensive individuals suspected of having SB. All participants underwent one-night video-polysomnography, and ambulatory blood pressure monitoring was performed the next day; 86.15% of them were diagnosed with SB. Statistical analysis included correlation and regression analysis. The obtained results showed that systolic blood pressure variability during sleep significantly increased in individuals with BEI > 4 (bruxism episodes index; episodes/hour) compared to those with BEI ≤ 4 (8.81 ± 3.36 versus 10.57 ± 3.39, p = 0.05). Multivariable regression analysis showed that systolic blood pressure variability at nighttime was also associated with the following independent risk factors: higher apnea-to-bruxism index, male gender, BEI > 4 episodes/hour, body mass index (BMI) ≥ 25 kg/m 2, higher arousal index, and shorter total sleep time. In summary, sleep bruxism intensity was associated with increased systolic blood pressure variability during sleep. Coincidental apnea, male gender, severe sleep bruxism (SB intensity with BEI > 4/hour), excess weight and obesity, higher arousal index, and shorter sleep time seem to be the main determinants that influence blood pressure in normotensive sleep bruxers.

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          Prospective study of the association between sleep-disordered breathing and hypertension.

          Paul E. Peppard, Terry Young, Mari Palta … (2000)
          Sleep-disordered breathing is prevalent in the general population and has been linked to chronically elevated blood pressure in cross-sectional epidemiologic studies. We performed a prospective, population-based study of the association between objectively measured sleep-disordered breathing and hypertension (defined as a laboratory-measured blood pressure of at least 140/90 mm Hg or the use of antihypertensive medications). We analyzed data on sleep-disordered breathing, blood pressure, habitus, and health history at base line and after four years of follow-up in 709 participants of the Wisconsin Sleep Cohort Study (and after eight years of follow-up in the case of 184 of these participants). Participants were assessed overnight by 18-channel polysomnography for sleep-disordered breathing, as defined by the apnea-hypopnea index (the number of episodes of apnea and hypopnea per hour of sleep). The odds ratios for the presence of hypertension at the four-year follow-up study according to the apnea-hypopnea index at base line were estimated after adjustment for base-line hypertension status, body-mass index, neck and waist circumference, age, sex, and weekly use of alcohol and cigarettes. Relative to the reference category of an apnea-hypopnea index of 0 events per hour at base line, the odds ratios for the presence of hypertension at follow-up were 1.42 (95 percent confidence interval, 1.13 to 1.78) with an apnea-hypopnea index of 0.1 to 4.9 events per hour at base line as compared with none, 2.03 (95 percent confidence interval, 1.29 to 3.17) with an apnea-hypopnea index of 5.0 to 14.9 events per hour, and 2.89 (95 percent confidence interval, 1.46 to 5.64) with an apnea-hypopnea index of 15.0 or more events per hour. We found a dose-response association between sleep-disordered breathing at base line and the presence of hypertension four years later that was independent of known confounding factors. The findings suggest that sleep-disordered breathing is likely to be a risk factor for hypertension and consequent cardiovascular morbidity in the general population.
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            Blood pressure variability and cardiovascular disease: systematic review and meta-analysis

            Sarah L Stevens, Sally Wood, Constantinos Koshiaris … (2016)
            Objective To systematically review studies quantifying the associations of long term (clinic), mid-term (home), and short term (ambulatory) variability in blood pressure, independent of mean blood pressure, with cardiovascular disease events and mortality. Data sources Medline, Embase, Cinahl, and Web of Science, searched to 15 February 2016 for full text articles in English. Eligibility criteria for study selection Prospective cohort studies or clinical trials in adults, except those in patients receiving haemodialysis, where the condition may directly impact blood pressure variability. Standardised hazard ratios were extracted and, if there was little risk of confounding, combined using random effects meta-analysis in main analyses. Outcomes included all cause and cardiovascular disease mortality and cardiovascular disease events. Measures of variability included standard deviation, coefficient of variation, variation independent of mean, and average real variability, but not night dipping or day-night variation. Results 41 papers representing 19 observational cohort studies and 17 clinical trial cohorts, comprising 46 separate analyses were identified. Long term variability in blood pressure was studied in 24 papers, mid-term in four, and short-term in 15 (two studied both long term and short term variability). Results from 23 analyses were excluded from main analyses owing to high risks of confounding. Increased long term variability in systolic blood pressure was associated with risk of all cause mortality (hazard ratio 1.15, 95% confidence interval 1.09 to 1.22), cardiovascular disease mortality (1.18, 1.09 to 1.28), cardiovascular disease events (1.18, 1.07 to 1.30), coronary heart disease (1.10, 1.04 to 1.16), and stroke (1.15, 1.04 to 1.27). Increased mid-term and short term variability in daytime systolic blood pressure were also associated with all cause mortality (1.15, 1.06 to 1.26 and 1.10, 1.04 to 1.16, respectively). Conclusions Long term variability in blood pressure is associated with cardiovascular and mortality outcomes, over and above the effect of mean blood pressure. Associations are similar in magnitude to those of cholesterol measures with cardiovascular disease. Limited data for mid-term and short term variability showed similar associations. Future work should focus on the clinical implications of assessment of variability in blood pressure and avoid the common confounding pitfalls observed to date. Systematic review registration PROSPERO CRD42014015695.
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              Hypothalamic regulation of sleep and circadian rhythms.

              Clifford B. Saper, Thomas E. Scammell, Jun Lu (2005)
              A series of findings over the past decade has begun to identify the brain circuitry and neurotransmitters that regulate our daily cycles of sleep and wakefulness. The latter depends on a network of cell groups that activate the thalamus and the cerebral cortex. A key switch in the hypothalamus shuts off this arousal system during sleep. Other hypothalamic neurons stabilize the switch, and their absence results in inappropriate switching of behavioural states, such as occurs in narcolepsy. These findings explain how various drugs affect sleep and wakefulness, and provide the basis for a wide range of environmental influences to shape wake-sleep cycles into the optimal pattern for survival.
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                Author and article information

                Contributors
                Giovanni Cammaroto: Role: Academic Editor
                Journal
                Journal ID (nlm-ta): J Clin Med
                Journal ID (iso-abbrev): J Clin Med
                Journal ID (publisher-id): jcm
                Title: Journal of Clinical Medicine
                Publisher: MDPI
                ISSN (Electronic): 2077-0383
                Publication date (Electronic): 22 March 2021
                Publication date Collection: March 2021
                Volume: 10
                Issue: 6
                Electronic Location Identifier: 1304
                Affiliations
                [1 ]Department of Internal Medicine, Occupational Diseases, Hypertension and Clinical Oncology, Wroclaw Medical University, 213 Borowska St., 50-556 Wroclaw, Poland; monika.michalek@ 123456student.umed.wroc.pl (M.M.-Z.); rafal.poreba@ 123456umed.wroc.pl (R.P.); anna.wojakowska@ 123456umed.wroc.pl (A.W.); k.goslawska@ 123456hotmail.com (K.G.); grzegorz.mazur@ 123456umed.wroc.pl (G.M.)
                [2 ]Department of Experimental Dentistry, Wroclaw Medical University, 26 Krakowska St., 50-425 Wroclaw, Poland; mieszko.wieckiewicz@ 123456umed.wroc.pl (M.W.); joanna.smardz@ 123456umed.wroc.pl (J.S.)
                [3 ]Department of Hygiene, Wroclaw Medical University, 7 Mikulicza-Radeckiego St., 50-345 Wroclaw, Poland; pawel.gac@ 123456umed.wroc.pl
                Author notes
                [* ]Correspondence: helena.martynowicz@ 123456umed.wroc.pl ; Tel.: +48-71-736-40-52
                Author information
                https://orcid.org/0000-0002-9740-011X
                https://orcid.org/0000-0001-8366-0239
                Article
                Publisher ID: jcm-10-01304
                DOI: 10.3390/jcm10061304
                PMC ID: 8004920
                PubMed ID: 33810035
                SO-VID: 7e4ba68f-d1f7-448c-b117-fafc315096e2
                Copyright © © 2021 by the authors.
                License:

                Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license ( http://creativecommons.org/licenses/by/4.0/).

                History
                Date received : 22 February 2021
                Date accepted : 17 March 2021
                Categories
                Subject: Article

                Keywords: sleep bruxism,ambulatory blood pressure monitoring,polysomnography
                Data availability:
                Keywords: sleep bruxism, ambulatory blood pressure monitoring, polysomnography

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