Reader response: Onabotulinum toxin-A injections for sleep bruxism: A double-blind, placebo-controlled study
Jose RZuzuarregui, Movement Disorder and Sleep Medicine Physician, University of California, San Francisco, Fresno Medical Education Program
Published March 01, 2018
Ondo et al. evaluated the use of onabotulinum toxin-A (BoNT-A) for the treatment of sleep bruxism. [1] Patients with severe obstructive sleep apnea (OSA) were excluded from this study. The global impression and visual analog scale for bruxism and pain showed significant differences four weeks after intervention in the BoNT-A group when compared to placebo.
In this study, the polysomnogram results from the BoNT-A group revealed an apnea-hypopnea index of 9.9+9.8 that mildly improved to 9.1+6.8, both of which are considered a mild OSA. [1] While the relationship between bruxism and OSA is complex and not clearly defined, one recent study showed that the risk of sleep bruxism not only was higher in patients with OSA, but also occurred more frequently. [2,3] Although Ondo et al. demonstrated that BoNT-A may be effective for sleep bruxism, mild OSA was still present after treatment. [1] Because even a mild OSA can have an adverse effect on the quality of life of a patient, I would suggest that these patients still be treated with accepted treatments for OSA, which may also help to improve sleep bruxism. [4]
1. Ondo WG, Simmons JH, Shahid MH, Hashem V, Hunter C, Jankovic J. Onabotulinum toxin-A injections for sleep bruxism: A double-blind, placebo-controlled study. Neurology 2018;90:e559-e564.
2. Manfredini D, Guarda-Nardini L, Marchese-Ragona R, Lobbezoo F. Theories on possible temporal relationships between sleep bruxism and obstructive sleep apnea events. An expert opinion. Sleep Breath 2015; 19:1459-1465.
3. Hosoya H, Kitaura H, Hashimoto T, et al. Relationship between sleep bruxism and sleep respiratory events in patients with obstructive sleep apnea syndrome. Sleep Breath 2014; 18:837-844.
4. Adult Obstructive Sleep Apnea Task Force of the American Academy of Sleep Medicine. Clinical Guideline for the Evaluation, Management and Long-term Care of Obstructive Sleep Apnea in Adults. J Clin Sleep Med 2009; 5:263-276.
Ondo et al. evaluated the use of onabotulinum toxin-A (BoNT-A) for the treatment of sleep bruxism. [1] Patients with severe obstructive sleep apnea (OSA) were excluded from this study. The global impression and visual analog scale for bruxism and pain showed significant differences four weeks after intervention in the BoNT-A group when compared to placebo.
In this study, the polysomnogram results from the BoNT-A group revealed an apnea-hypopnea index of 9.9+9.8 that mildly improved to 9.1+6.8, both of which are considered a mild OSA. [1] While the relationship between bruxism and OSA is complex and not clearly defined, one recent study showed that the risk of sleep bruxism not only was higher in patients with OSA, but also occurred more frequently. [2,3] Although Ondo et al. demonstrated that BoNT-A may be effective for sleep bruxism, mild OSA was still present after treatment. [1] Because even a mild OSA can have an adverse effect on the quality of life of a patient, I would suggest that these patients still be treated with accepted treatments for OSA, which may also help to improve sleep bruxism. [4]
1. Ondo WG, Simmons JH, Shahid MH, Hashem V, Hunter C, Jankovic J. Onabotulinum toxin-A injections for sleep bruxism: A double-blind, placebo-controlled study. Neurology 2018;90:e559-e564.
2. Manfredini D, Guarda-Nardini L, Marchese-Ragona R, Lobbezoo F. Theories on possible temporal relationships between sleep bruxism and obstructive sleep apnea events. An expert opinion. Sleep Breath 2015; 19:1459-1465.
3. Hosoya H, Kitaura H, Hashimoto T, et al. Relationship between sleep bruxism and sleep respiratory events in patients with obstructive sleep apnea syndrome. Sleep Breath 2014; 18:837-844.
4. Adult Obstructive Sleep Apnea Task Force of the American Academy of Sleep Medicine. Clinical Guideline for the Evaluation, Management and Long-term Care of Obstructive Sleep Apnea in Adults. J Clin Sleep Med 2009; 5:263-276.
For disclosures, please contact the editorial office at journal@neurology.org.