OSA, GERD, and bruxism oh my!
OSA has a strong association with GERD, and GERD with nocturnal bruxism. Hesselbacher 2014 ORMJ
Sleep Bruxism is the grinding or clenching of teeth during sleep, which is preceded by sleep arousals. Sleep Arousal is a naturally occurring 3-10 second shift occurring during deep sleep, which is accompanied by an increase in muscle tone. This motor activity causing clenching and grinding activity of jaw muscles is believed to be an attempt to open the constricted airway. Sleep bruxism occurs in multiple episodic bursts throughout the night. Some episodes may produce audible grinding noise.
Obstructive Sleep Apnea
- Mandibular advancement splint treatment
Mandibular advancement splint treatment
Mandibular advancement splint (MAS) works well for helping those with OSA. Mostafiz 2019 AJO They also appear to help type 2 diabetes patients lower HbA1 levels. However, there is selection bias here as anyone in this experiment is likely doing other things to help themselves as well as no control. Baslas JPros 2019. There are some risks to this treatment, such as jaw/bite changes and pain.
Obtrusive sleep apnea in children
Proper sleep is obviously very important for growing children. Normal sleep cycle includes rapid eye movement (REM) and non-REM sleep. Non-REM has 3 stages from light to deep sleep. With sleep apnea the brain is struggling to get oxygen and does not get to REM or deep levels of non-REM.
Top signs to look for in children with sleep apnea
There is a BEARS sleep screening questionnaire that someone can take.
- High and narrow palatal vault
- Mouth breathing
- Clenching or grinding and tooth wear
- Enlarged tonsils and adenoids
- Allergic rhinitis or prevalence of allergy symtpoms
- Tongue tie or lip tie
- Maxillary and mandibular deficiency
If these are present then questions to ask the parents are:
- Does your child snore?
- Do they stop breathing for short periods of time when sleeping? Parents can watch for 20 minutes to determine this.
- How rested does your child seem upon waking?
- Any behavior issues at home or school? Especially fidgeting, emotional outbursts and short attention spans.
What are the symptoms in children with sleep apnea?
There are both physical and behavioral characteristics. Behavioral characteristics include the following:
- Hyperactivity – attention deficit disorder
- Behavioral challenges
- Trouble focusing
- Learning disorders
- Impaired growth
- Tendency towards aggressive behavior
- Anxiety disorders
Physical signs result from the body struggling to get air. The main change is the kids will be doing more mouth breathing and this impacts growth. Changes include the following:
- High palatal vault
- Narrow arch form
- Anterior open bites
- Mouth breathing
- Long and narrow faces
- Habitual open mouth
- Venous pooling, especially under the eyes
Treatment for children with sleep apnea
All treatments are meant to give more breathing room. Some kids will simply grow out of it as they get bigger, some will not.
- Oral myofunctional therapy
- Positive airway appliance
esophagus). Sleep Apnea episodes are often implicated as a contributing etiology of GERD and SB. Increased negative pressure in intra thoracic space during apneic episode causes gastric
acid expelled into the esophagus. This triggers microarousals leading to Sleep Bruxism.
1. Rouse, Jeffrey S. “The Bruxism Triad.” Inside Dentistry (2010): 32-44.
2. Park, John G., Kannan Ramar, and Eric J. Olson. “Updates on definition, consequences, and management of obstructive sleep apnea.” Mayo Clinic Proceedings. Vol. 86. No. 6. Elsevier, 2011.
3. Miyawaki, Shouichi, et al. “Association between nocturnal bruxism and gastroesophageal reflux.” Sleep New York Then Westchester- 26.7 (2003): 888-892.