Resultados de la operación del prototipo SCS

Patients with migraine and cluster headache may report headache attacks occurring during sleep (Culebras 2005). The onset of nocturnal migraine has been associated with an abrupt decline of sero-tonin levels during REM sleep (Dexter & Weitz-man 1970, Biondi 2001, Rasmussen 1993).

Cluster headache has been linked to REM stage and sleeping in, and is characterized by severe

Table 6.1 Clinical predictors and differential diagnosis of SB.

Clinical predictors of SB Clinical consideration and differential diagnosis Grinding or tapping sounds reported

by bed partner

Sleep bruxism

Other sounds caused by other orofacial movements (e.g. temporomandibular joint clicking, throat grunting)

Dental wear facets Sleep bruxism Coarse diet Acidic diet

Past dental restorative work Tooth wear due to normal aging Fractures in teeth and/or dental

restorations

Sleep bruxism

Coarse diet (e.g. popcorn kernels) Occlusal trauma

Tooth mobility Sleep bruxism

Periodontal disease or occlusal trauma independent of SB Tooth discomfort or sensitivity upon

waking

Sleep bruxism

Dental or periodontal problems independent of SB Masticatory muscle pain upon

waking

Sleep bruxism

Chronic masticatory myalgia or facial pain independent of SB Localized myofascial pain

Fibromyalgia or widespread pains Masseter hypertrophy Sleep bruxism

Inflammatory swellings Tumor

Parotid-masseter syndrome (blockade of parotid ducts by sustained contraction of the masseter muscle – characterized by: episodic swelling, pain, inflammation, and abnormal mouth dryness

TMJ locking and clicking upon waking

Sleep bruxism

TMJ disc adherences or displacement TMJ disc displacement, independent of SB

Waking headache Sleep bruxism

Sleep apnea and/or upper airway resistance syndrome (limitation or cessation of airflow with daytime sleepiness¼ medical hazard)

Insomnia (greater than 20 minutes required to fall asleep or difficulty resuming sleep if waking during the night)

Raised intracranial pressure Tongue and/or cheek indentation Sleep bruxism

Tongue pushing

unilateral temporal, malar and periorbital pain with associated features of forehead perspiration, nasal congestion, lacrimation and rhinorrhea (Culebras 2005). Interestingly, a recent report estimated that a diagnosis of sleep apnea is 8.8 times more likely in cluster headache patients when compared to controls and that a body mass index of over 25 kg/m²and an age greater than

40 years increase the risk of OSA by 24 and 13 times respectively (Nobre et al 2005). Hypox-emia has been postulated as a headache trigger in cluster headache patients when morning head-ache is reported, although there is debate on whether the duration of hypoxemia relates to headache complaints in sleep apnea patients (Chervin et al 2000, Greenough et al 2002).

Table 6.2 Literature evaluating a possible relationship between SB and headaches.

Authors Study design EBM

level*

Conclusion

Rugh & Harlan 1988 Expert opinion 5 Temporal tension headaches are an effect of SB due to excessive temporal muscle contraction.

Bailey 1990 Expert opinion 5 Headaches are a common finding in SB patients.

Kampe et al 1997a Case series n¼ 29

Patient survey for reported symptoms and health history

4 A statistically significant correlation between headaches and SB was found.

Kampe et al 1997b Case series n¼ 29

Personality inventory (Karolinska Scales of Personalities)

4 A statistically significant correlation between headaches and SB was found.

Magnusson et al 2000 Case series n¼ 135 Clinical examination and

questionnaire

4 Weak and non-significant correlation was found between headaches and oral parafunction, including SB.

Biondi 2001 Expert opinion 5 SB can cause headaches, which are muscular in origin.

Macfarlane et al 2001 Case control n¼ 317 Questionnaire collecting

socio-demographic, mechanical and psychological factors

3a Frequent headaches are part of the pain dysfunction syndrome (PDS). Nocturnal teeth grinding was significantly associated with PDS.

Miller et al 2003 Case series n¼ 118

Children’s Sleep Habits Questionnaire and standardized questionnaire for headache characteristics

4 The frequency of migraines is positively related to SB.

Watanabe et al 2003 Case series n¼ 12

Correlation between a telemetric system to monitor SB and patient’s rating of symptoms

4 Headache pain or sleep disturbances were not found to be related to SB.

*Levels of evidence for etiology/harm (Oxford Centre for Evidence-based Medicine): 1a. Systematic review of randomized controlled studies (RCT);

1b. Individual RCT (with narrow confidence interval); 2a. Systematic review of cohort studies; 2b. Individual cohort studies (including low-quality RCT; e.g.,< 80% follow up); 2c. ‘Outcomes’ research; ecologic studies; 3a. Systematic review of case control studies; 3b. Individual case control study; 4. Case series (and poor-quality cohort and case control studies); 5. Expert opinion without explicit critical appraisal, or based on physiology, bench research, or ‘proof of principle study’.

Tension-type headache

Tension-type headaches related to sleep disor-ders tend to be present on morning waking (Bader et al 1997, Kampe et al 1997a). They may be epi-sodic or chronic and characterized by pressing, aching, non-pulsating pain. Sleep disorders related to this type of headache are reported to include sleep apnea, SB, insomnias, parasomnias, UARS and periodic limb movement disorder (Biondi 2001, Guilleminault et al 2005, Kayed

& Sjaastad 1985, Poceta 2003).

The sleep quality of patients with tension-type headaches is frequently reported to be poor dur-ing headache periods (Jennum & Jensen 2002).

Interestingly, experimental studies in humans have shown that nitric oxide (NO) may play a critical role in initiating primary headaches and a recent study suggests that infusion of glyceryl trinitrate (a nitric oxide donor) may trigger the production of NO in patients with chronic ten-sion-type headache (Ashina et al 2004). Further research is required to elucidate whether this molecule influences the sleep quality of patients with chronic headache complaints.

In a recent study, headache was reported by 48% and 49% of patients with a definitive diag-nosis of insomnia and OSA respectively; and in OSA patients the headaches had a tension-type pattern (Alberti et al 2005). Morning headaches lasting< 2 hours occurred in 74% of the patients with OSA, compared to 40% of insomnia patients. Patients with morning headache also showed greater oxygen desaturation (SaO2¼ 82.5%) than patients without headache (SaO₂ ¼ 86.1%), but interestingly REM sleep and total sleep time under desaturation (SaO2

< 90%) was similar in both groups (Greenough et al 2002, Alberti et al 2005). An additional study (Gold et al 2003) found headache symp-toms in 15–25% of patients with mild to severe OSA and in slightly greater than 50% of patients with UARS. Moreover, the prevalence of SB

was also slightly greater than 50% in patients with UARS and the general prevalence of SB was greatest in UARS patients compared to those patients with mild to severe OSA (Gold et al 2003).

Chronic paroxysmal hemicrania