Associação entre Bruxismo do sono e Síndrome da apneia obstrutiva do sono: uma revisão sistemática

Abstract

Sleep Bruxism (SB) and Obstructive Sleep Apnea Syndrome (OSAS) are highly prevalent sleep disorders and are associated with severe structural and systemic complications. Considering that it is believed that both disorders share a common pathophysiological pathway, the aim of this study is to elucidate the potential association and causality between SB and OSAS, providing a more effective therapeutic approach and reestablishment of patients´ general condition. This review was carried out adhering to the PRISMA checklist and registered in PROSPERO (CRD42016043324). There were included observational studies published until 15 October 2017, with no year, language, age and gender restriction were included and with the clear purpose to evaluate the association between BS and OSAS using full-night polysomnography. An individualized search strategy was developed for the PubMed, The Cochrane Library, MEDLINE, LILACS and BBO-ODO databases, the references of the pre-selected articles were checked and the gray literature accessed through Google scholar. The selection of articles was independently performed by 2 reviewers in 2 phases. In the first stage the title and abstract were evaluated and in the second stage the pre-selected articles were assessed in full text. The risk of bias and the methodological quality of the selected articles were assessed through the Qu-ATEBS Tool. A total of 198 articles were identified. After removal of duplicates, 151 were analyzed. After reading the title and abstract, 136 articles were excluded and 15 were selected for full-text reading and, finally, 6 articles were included in qualitative synthesis. Three of the included studies support the association between BS and OSAS: (a) most episodes of bruxism occur shortly after the end of apnea-hypopnea (AH) events (b) episodes of bruxism occur secondary to micro-arousals arising from AH events (c) there is a correlation between the BS frequency and AH events. Three studies do not support such association: (c) episodes of AH are related to a higher occurrence of sleep oromotor activity not specific to SB (d) episodes of bruxism are not directly associated with the end of AH episodes (e) OSAs patients do not experience more episodes of BS than the control group. There is no scientific evidence supporting a conclusive relationship between BS and OSAS. The influence of secondary factors that may induce concomitant both disorders should be further studied.