Females with Sleep Bruxism Show Lower Theta and Alpha Electroencephalographic Activity Irrespective of Transient Morning Masticatory Muscle Pain

Aims: To investigate the hypothesis that the presence of transient morning masticatory muscle pain in young, healthy sleep bruxers (SBr) is associated with sex-related differences in sleep electroencephalographic (EEG) activity. Methods: Data on morning masticatory muscle pain and sleep variables were obtained from visual analog scales and a second night of polysomnographic recordings. Nineteen normal control (CTRL) subjects were age- and sex-matched to 62 tooth-grinding SBr. Differences in sleep macrostructure (stage distribution and duration, number of sleep-stage shifts), number of rhythmic masticatory muscle activity (RMMA) events÷ hour, and EEG activity were analyzed blind to subject status. The influence of pain and gender in SBr and CTRL subjects was assessed with the Fisher's exact test, Mann-Whitney U test, two-sample t test, and analysis of variance (ANOVA). Results: Low-intensity morning transient orofacial pain was reported by 71% of SBr, with no sex difference. RMMA event frequency was higher in SB than CTRL subjects (4.5÷hour vs 1.3÷hour; P < .001). SBr had fewer sleep-stage shifts, irrespective of sex or pain status. Female SBr had significantly lower theta and alpha EEG activity compared to female CTRL subjects (P = .03), irrespective of pain. Conclusion: Female SBr had lower theta and alpha EEG activity irrespective of transient morning pain.

EEG power spectral analysis; pain; sex; sleep bruxism; theta wave activity

1. AASM. Sleep related bruxism. In: American Academy of Sleep Medicine (AASM) (ed). ICSD-2 International Classification of Sleep Disorders, ed 2: Diagnosis and Coding Manual. Westchester, Illinois: AASM, 2005:189–192.

2. Rompre PH, Daigle-Landry D, Guitard F, Montplaisir JY, Lavigne GJ. Identification of a sleep bruxism subgroup with a higher risk of pain. J Dent Res 2007;86:837–842.

3. Lavigne GJ, Rompre PH, Poirier G, Huard H, Kato T, Montplaisir JY. Rhythmic masticatory muscle activity during sleep in humans. J Dent Res 2001;80:443–448.

4. Goder R, Friege L, Fritzer G, Strenge H, Aldenhoff JB, Hinze-Selch D. Morning headaches in patients with sleep disorders: A systematic polysomnographic study. Sleep Med 2003;4:385–391.

5. Alberti A. Headache and sleep. Sleep Med Rev 2006;10: 431–437.

6. Goksan B, Gunduz A, Karadeniz D, et al. Morning headache in sleep apnoea: Clinical and polysomnographic evaluation and response to nasal continuous positive airway pressure. Cephalalgia 2009;29:635–641.

7. Chen PK, Fuh JL, Lane HY, Chiu PY, Tien HC, Wang SJ. Morning headache in habitual snorers: Frequency, characteristics, predictors and impacts. Cephalalgia 2011; 31:829–836.

8. Rains JC. Morning headache in habitual snorers. Cephalalgia 2011;31:981–983.

9. Huynh N, Khoury S, Rompré PH, Montplaisir JY, Lavigne GJ. Prevalence of headache and neck pain in a sleep bruxism population investigated in a sleep laboratory. Sleep 2006;29:A282.

10. Yachida W, Castrillon EE, Baad-Hansen L, et al. Craniofa-cial pain and jawmuscle activity during sleep. J Dent Res 2012;91:562–567.

11. Lobbezoo F, Lavigne GJ. Do bruxism and temporoman-dibular disorders have a cause-and-effect relationship? J Orofac Pain 1997;11:15–23.

12. Raphael KG, Marbach JJ, Klausner JJ, Teaford MF, Fis-choff DK. Is bruxism severity a predictor of oral splint efficacy in patients with myofascial face pain? J Oral Rehabil 2003;30:17–29.

13. Dao TT, Lund JP, Lavigne GJ. Comparison of pain and quality of life in bruxers and patients with myofascial pain of the masticatory muscles. J Orofac Pain 1994;8:350–356.

14. Benoliel R, Eliav E, Sharav Y. Self-reports of pain-related awakenings in persistent orofacial pain patients. J Orofac Pain 2009;23:330–338.

15. Lavigne GJ, Rompre PH, Montplaisir JY, Lobbezoo F. Motor activity in sleep bruxism with concomitant jaw muscle pain. A retrospective pilot study. Eur J Oral Sci 1997;105:92–95.

16. Arima T, Arendt-Nielsen L, Svensson P. Effect of jaw muscle pain and soreness evoked by capsaicin before sleep on orofacial motor activity during sleep. J Orofac Pain 2001;15:245–256.

17. Hughes JR, John ER. Conventional and quantitative electroencephalography in psychiatry. J Neuropsychiatry Clin Neurosci 1999;11:190–208.

18. Lavigne GJ, Khoury S, Laverdure-Dupont D, Denis R, Rou-leau GA. Tools and methodological issues in the investigation of sleep and pain interactions. In: Lavigne GJ, Sessle BJ, Choiniere M, Soja P (eds). Sleep and Pain. Seattle: IASP Press, 2007:235–266.

19. Achermann P, Borbely AA. Sleep homeostasis and models of sleep regulation. In: Kryger HM, Roth T, Dement WC (eds). Principles and Practice of Sleep Medicine. St Louis: Elsevier Saunders, 2011:431–444.

20. Drewes AM, Gade K, Nielsen KD, Bjerregard K, Taagholt SJ, Svendsen L. Clustering of sleep electroencephalographic patterns in patients with the fibromyalgia syndrome. Br J Rheumatol 1995;34:1151–1156.

21. Lavigne GJ, Okura K, Abe S, et al. Gender specificity of the slow wave sleep lost in chronic widespread musculoskeletal pain. Sleep Med 2011;12:179–185.

22. Parrino L, Zucconi M, Terzano GM. Sleep fragmentation and arousal in the pain patient. In: Lavigne GJ, Sessle BJ, Choiniere M, Soja PJ (eds). Sleep and Pain. Seattle: IASP Press, 2007:213–234.

23. Lavigne G, Smith MT, Denis R, Zucconi M. Pain and sleep. In: Kryger HM, Roth T, Dement WC (eds). Principles and Practice of Sleep Medicine. St Louis: Elsevier Saunders, 2011:1442–1451.

24. Moldofsky H, Scarisbrick P, England R, Smythe H. Mus-culoskeletal symptoms and non-REM sleep disturbance in patients with “fibrosis syndrome” and healthy subjects. Psychosom Med 1975;37:341–351.

25. Lavigne GJ, Rompre PH, Montplaisir JY. Sleep bruxism: Validity of clinical research diagnostic criteria in a controlled polysomnographic study. J Dent Res 1996;75:546–552.

26. Abe S, Yamaguchi T, Rompre PH, De Grandmont P, Chen YJ, Lavigne GJ. Tooth wear in young subjects: A discriminator between sleep bruxers and controls? Int J Prosthodont 2009;22:342–350.

27. Velly-Miguel AM, Montplaisir J, Rompre PH, Lund JP, Lavigne GJ. Bruxism and other orofacial movements during sleep. J Craniomand Dis Fac Oral Pain 1992;6:71–81.

28. Lavigne G, Manzini C, Huynh NT. Sleep bruxism. In: Kryger MH, Roth T, Dement WC (eds). Principles and Practice of Sleep Medicine. St Louis: Elsevier Saunders, 2011: 1129–1139.

29. Dutra KM, Pereira FJ Jr, Rompre PH, Huynh N, Fleming N, Lavigne GJ. Orofacial activities in sleep bruxism patients and in normal subjects: A controlled polygraphic and audio-video study. J Oral Rehabil 2009;36:86–92.

30. Rechtschaffen A, Kales A. A Manual of Standardized Terminology, Techniques, and Scoring System for Sleep Stages of Human Subjects. Los Angeles: Brain Information Service/Brain Research Institute, 1968.

31. Achermann P, Dijk DJ, Brunner DP, Borbely AA. A model of human sleep homeostasis based on EEG slow-wave activity: Quantitative comparison of data and simulations. Brain Res Bull 1993;31:97–113.

32. Slade GD, Bair E, By K, et al. Study methods, recruitment, sociodemographic findings, and demographic representativeness in the OPPERA study. J Pain 2011;12(11 Suppl):T12–T26.

33. Ohrbach R, Fillingim RB, Mulkey F, et al. Clinical findings and pain symptoms as potential risk factors for chronic TMD: Descriptive data and empirically identified domains from the OPPERA case-control study. J Pain 2011;12: T27–T45.

34. Dao TT, Lund JP, Lavigne GJ. Pain responses to experimental chewing in myofascial pain patients. J Dent Res 1994;73:1163–1167.

35. Torisu T, Wang K, Svensson P, et al. Effects of eccentric jaw exercise on temporal summation in jaw-closing muscles of healthy subjects. Eur J Pain 2010;14:719–724.

36. Carra MC, Huynh N, Morton P, et al. Prevalence and risk factors of sleep bruxism and wake-time tooth clench-ing in a 7- to 17-yr-old population. Eur J Oral Sci 2011; 119:386–394.

37. Smith MT, Wickwire EM, Grace EG, et al. Sleep disorders and their association with laboratory pain sensitivity in temporomandibular joint disorder. Sleep 2009;32:779–790.

38. Fillingim RB, Ohrbach R, Greenspan JD, et al. Potential psychosocial risk factors for chronic TMD: Descriptive data and empirically identified domains from the OPPERA case-control study. J Pain 2011;12:T46–T60.

39. Feinberg I, Campbell IG. Sleep EEG changes during adolescence: An index of a fundamental brain reorganization. Brain Cogn 2010;72:56–65.

40. Bland BH, Oddie SD. Theta band oscillation and synchrony in the hippocampal formation and associated structures: the case for its role in sensorimotor integration. Behav Brain Res 2001;14:119–136.

41. Perfetti B, Moisello C, Landsness EC, et al. Modulation of gamma and theta spectral amplitude and phase synchronization is associated with the development of visuomotor learning. J Neurosci 2011;31:14810–14819.

42. Scheffzuk C, Kukushka VI, Vyssotski AL, Draguhn A, Tort AB, Brankack J. Selective coupling between theta phase and neocortical fast gamma oscillations during REM-sleep in mice. PLoS One 2011;6:e284–289.

43. Carra MC, Rompre PH, Kato T, et al. Sleep bruxism and sleep arousal: An experimental challenge to assess the role of cyclic alternating pattern. J Oral Rehabil 2011;38: 635–642.

44. Carra MC, Macaluso GM, Rompre PH, et al. Clonidine has a paradoxical effect on cyclic arousal and sleep bruxism during NREM sleep. Sleep 2010;33:1711–1716.