Prevalence and Gender and Ethnic Variance of Bruxism and Gastroesophageal Reflux Disease (GERD) in Obstructive Sleep Apnea

Shyam Subramanian, MD

Assistant Professor of Medicine
Section of Pulmonary, Critical Care, and Sleep Medicine
Baylor College of Medicine
Houston, Texas

Bruxism is forcible clenching or grinding of the teeth during which may lead to abnormal tooth wear, periodontal disease, and temporomandibular disorders.[1] While daytime bruxism is felt to stem from stress and is somewhat volitional, nocturnal bruxism, occurring in about 8% of the general population, is nonvolitional and typically identified by a bed partner or dentist noticing tooth wear.[2] Risk factors associated with sleep bruxism include psychological factors such as anxiety and stress[3]; the presence of comorbid conditions such as restless legs syndrome, obstructive sleep apnea (OSA), or gastroesophageal reflux disease (GERD)[2, 4-6]; and smoking, caffeine, and alcohol consumption.[6-9] The association between sleep bruxism, OSA, and GERD is interesting. OSA involves narrowing of the upper airway passages and autonomic arousals signaling muscles in the oropharynx to reopen.[10] It is thought that during these arousals motor phenomena can occur which can explain teeth grinding.[11] Additionally, as the upper airway narrows in OSA, large thoraco-abdominal excursions loosen the esophageal sphincter, causing acid backflow and GERD. Thus there is a three-way connection between OSA, GERD and bruxism, which if understood, may facilitate optimal patient assessment and a more accurate diagnosis and treatment plan.

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