Efeito da terapia respiratória em pacientes com bruxismo do sono e eventos respiratórios associados

Abstract

This doctoral thesis is subdivided into four articles that make up the totality of the work developed. Since the subject is related to bruxism and associated respiratory events, a systematic review on the use of respiratory training for the treatment of sleep apnea was first carried out. Obstructive sleep apnea (OSA) is a heterogeneous disorder. Pathophysiologic components include skeletal issues, enlarged tonsils and tongue, and fat deposits in the soft tissues of the neck, as well as cranial movement of the lung-bronchial-tracheal system. The heterogeneity of OSA allows for various therapies, depending on pathophysiology, severity, and patient preferences. Thus, the question for the systematic review was regarding the effect of breathing exercises in patients with Obstructive Sleep Apnea (OSA). In individuals with OSA, the respiratory muscles would be significantly weaker and with less resistance, and could benefit from this type of exercise. Next, a clinical trial protocol was designed to test the effect of this type of breathing exercise in individuals with sleep bruxism concomitant with sleep breathing events (apnea and hypopnea). A double blind randomized controlled parallel clinical trial of patients with sleep bruxism and associated respiratory events, who received inspiratory and expiratory exercise therapy (Intervention Group), and a non-intervention group (Placebo Group) was carried out, measuring the apnea-hypopnea index (AHI), the number of masseter contractions (characteristic of bruxism activity), and the number of awakenings pre and post-intervention. 17 The results were satisfactory, with a statistically significant difference between the inspiratory group and the placebo group regarding the difference in arousals pre- and post-intervention (p ≤ 0.005), as well as in the number of masseter contractions when comparing the inspiratory and expiratory groups (p ≤ 0.005) and between the inspiratory and placebo groups (p ≤ 0.005). This study points to a possible treatment option in generating positive impact on sleep bruxismrelated events in cases where the bruxism events are related to apnea.