Evaluation of a Proton Pump Inhibitor for Sleep Bruxism: A Randomized Clinical Trial
Evaluation of a Proton Pump Inhibitor for Sleep Bruxism: A Randomized Clinical Trial
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DOI：
10.1177/0022034516662245
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发表时间：
2016-12-01
影响因子：
7.6
通讯作者：
Miyawaki, S.
中科院分区：
文献类型：
--
作者：
Ohmure, H.;Kanematsu-Hashimoto, K.;Miyawaki, S.
磨牙症是一种重复性的下颌肌肉活动，其特征在于牙齿的紧咬或研磨和/或下颌骨的支撑或推压。最近的进展澄清了胃食管反流和睡眠磨牙症（SB）之间的关系。然而，药理学消除胃酸分泌对SB的影响尚未得到证实。作者旨在评估质子泵抑制剂（PPI）对SB的疗效，并检查SB患者的胃肠道（GI）症状和上消化道内镜检查结果。作者在鹿儿岛大学医院进行了一项随机双盲安慰剂对照交叉研究。12例多导睡眠图（PSG）诊断为SB的患者使用胃食管反流病（FSSG）和食管胃镜检查症状的频率量表进行GI症状评估。在基线（i.例如，干预前），肌电图（EMG）爆发和节律性咀嚼肌活动（RMMA）发作的平均频率分别为65.4 +/- 49.0爆发/h和7.0 +/- 4.8发作/h，并且在所有参与者中证实了至少1次RMMA发作伴研磨噪声。平均FSSG评分为8.4 ± 5.6，41.7%的患者被诊断为胃食管反流病。轻度反流性食管炎6例。在给予10 mg PPI（雷贝拉唑）或安慰剂的第4天和第5天进行PSG，包括左咬肌的EMG和音频-视频记录。PPI给药显著降低了EMG爆发、RMMA发作和研磨噪声的频率。在吞咽事件和睡眠变量方面没有观察到显著差异。由于PPI治疗SB的临床应用目前应保持暂停，因此本试验的结果突出了药物胃食管反流病治疗SB患者的潜在应用。需要进行更大规模的研究来证实这些发现。(UMIN临床试验注册处：UMIN 000004577）。
Bruxism is a repetitive jaw-muscle activity characterized by clenching or grinding of the teeth and/or bracing or thrusting of the mandible. Recent advances have clarified the relationship between gastroesophageal reflux and sleep bruxism (SB). However, the influence of pharmacological elimination of gastric acid secretion on SB has not been confirmed. The authors aimed to assess the efficacy of a proton pump inhibitor (PPI) on SB and to examine the gastrointestinal (GI) symptoms and endoscopic findings of the upper GI tract in SB patients. The authors performed a randomized double-blind placebo-controlled crossover study at Kagoshima University Hospital. Twelve patients with polysomnography (PSG)-diagnosed SB underwent an assessment of GI symptoms using the frequency scale for the symptoms of gastroesophageal reflux disease (FSSG) and esophagogastroduodenoscopy. At baseline (i. e., before interventions), the mean frequencies of electromyography (EMG) bursts and rhythmic masticatory muscle activity (RMMA) episodes were 65.4 +/- 49.0 bursts/h and 7.0 +/- 4.8 episodes/h, respectively, and at least 1 RMMA episode with grinding noise was confirmed in all participants. The mean FSSG score was 8.4 +/- 5.6, and 41.7% of patients were diagnosed with gastroesophageal reflux disease. Mild reflux esophagitis was confirmed in 6 patients. PSG, including EMG of the left masseter muscle and audio-video recording, was performed on days 4 and 5 of administration of 10 mg of the PPI (rabeprazole) or placebo. PPI administration yielded a significant reduction in the frequency of EMG bursts, RMMA episodes, and grinding noise. No significant differences were observed regarding the swallowing events and sleep variables. Since the clinical application of PPI for SB treatment should remain on hold at present, the results of this trial highlight the potential application of pharmacological gastroesophageal reflux disease treatment for SB patients. Larger scale studies are warranted to corroborate these findings. (UMIN Clinical Trials Registry: UMIN000004577).