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Journal of Dental Research
DOI: 10.1177/154405910708600906 2007; 86; 837 J DENT RES
P.H. Rompré, D. Daigle-Landry, F. Guitard, J.Y. Montplaisir and G.J. Lavigne Identification of a Sleep Bruxism Subgroup with a Higher Risk of Pain
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INTRODUCTION
Sleep bruxism was recently classified as a movement disorder during sleep
(AASM, 2005). In 1996, we proposed sleep bruxism research diagnostic
criteria (SB-RDC) for polygraphic recording of sleep bruxism motor activity
(Lavigne et al., 1996). These criteria were based on a small sample size (18
sleep bruxers and 18 control individuals). They were derived from
electromyographic and audio-video recognition of jaw muscle activity in
relation to: (1) a positive report of tooth grinding during sleep; and (2) the
presence of sleep bruxism in a sleep laboratory. The criteria were: > 4 sleep
bruxism episodes/hr of sleep, > 25 sleep bruxism bursts/hr of sleep, and > 1
sleep bruxism episode with tooth-grinding sounds.
Over the last 15 years, we have made sleep laboratory recordings of 100
individuals with a positive home history of tooth grinding. Interestingly, half
of the persons presented a low frequency of sleep bruxism episodes per hour
of sleep (lower than 4 episodes/hr) and few tooth-grinding episodes, in spite
of their sleep partners' complaints of frequent grinding noise. One
explanation may be that these persons experienced pain, which caused them
to have fewer orofacial activities, in accordance with the pain adaptation
model (Lund, 1995; Lavigne et al., 1997). Therefore, the objectives of this
paper were to validate the 1996 SB-RDC in a large number of control
individuals and sleep bruxers recorded in the sleep laboratory, and to
challenge the hypothesis that pain is associated with lower frequencies of
orofacial activities.
MATERIALS & METHODS
ParticipantsData from 100 sleep bruxers and 43 control individuals, recorded in the sleep
laboratory since 1990, were used for the analysis. Sleep bruxers were chosen
based on: (1) a history of frequent tooth grinding occurring at least 3 nights perweek for the preceding 6 mos, as confirmed by a sleep partner; (2) clinical
presence of tooth wear; (3) masseter muscle hypertrophy; and (4) report of jaw
muscle fatigue or tenderness in the morning (American Sleep Disorders
Association, 1997; AASM, 2005; Lavigne et al., 2005). Control individuals
were selected on the basis of the absence of a history of tooth grinding during
sleep and of other clinical evidence of sleep bruxism (American Sleep Disorders
Association, 1997; AASM, 2005; Lavigne et al., 2005). Exclusion criteria for
both sleep bruxers and control individuals were TMD as a primary complaint, a
medical history of neurological disorders, mental disorders, or sleep disorders
(e.g., apnea, periodic leg movements, insomnia). At the time of recordings, none
of the participants was taking medication, or was under the influence of alcohol,
nicotine, or caffeine. All participants provided informed consent according to the
institutional rules (Hôpital du Sacré-Coeur).
Polygraphic RecordingsIndividuals were studied in the sleep laboratory for two consecutive nights. The
ABSTRACT Sleep bruxism research diagnostic criteria (SB-
RDC) have been applied since 1996. This study
was performed to validate these criteria and to
challenge the hypothesis that pain is associated
with lower frequencies of orofacial activities.
Polygraphic recordings were made of 100
individuals presenting with a clinical diagnosis of
sleep bruxism and 43 control individuals.
TwoStep Cluster analyses (SPSS) were performed
with sleep bruxism variables to reveal groupings
among sleep bruxers and control individuals.
Participants completed questionnaires during
screening, diagnosis, and recording sessions.
Cluster analysis identified three subgroups of
sleep bruxers. Interestingly, 45 of the 46 sleep
bruxers with values below SB-RDC were
classified in the low-frequency cluster. These
individuals were more likely to complain of pain
and fatigue of masticatory muscles than were the
higher-frequency sleep bruxers (odds ratios > 3.9,
p < 0.01). Sleep bruxers were distributed among
three heterogeneous groups. Sleep bruxers with
low frequencies of orofacial activities were more
at risk of reporting pain.
KEY WORDS: sleep bruxism, polygraphy, cluster
analysis, diagnostic criteria, tooth grinding, pain.
Received February 14, 2006; Last revision April 18, 2007;
Accepted May 8, 2007
A supplemental appendix to this article is published
electronically only at http://www.dentalresearch.org.
Identification of a Sleep Bruxism Subgroup with a Higher Risk of Pain
P.H. Rompré1, D. Daigle-Landry1, F. Guitard1, J.Y. Montplaisir2, and G.J. Lavigne1,2*1Faculty of Dental Medicine, Université de Montréal, C.P.6128, succ. Centre-Ville, Montréal, Canada, H3C 3J7; and2Centre d'étude du sommeil et des rythmes biologiques,Hôpital du Sacré-Coeur, Canada; *corresponding author,[email protected]
J Dent Res 86(9):837-842, 2007
RESEARCH REPORTSClinical
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838 Rompré et al. J Dent Res 86(9) 2007
first night allowed them to adapt to the laboratory setting and
permitted researchers to rule out sleep disorders. On the second
night, sleep bruxism and sleep were analyzed. Polygraphic
recordings, with surface electrodes, included two
electroencephalograms (EEG; C3A
2, O
2A
1), bilateral electro-
oculograms, an electrocardiogram, and electromyograms (EMG)
from chin/suprahyoid, bilateral masseter, temporalis, and tibialis
muscles. Respiration was monitored with a nasal flow sensor. All
signals were amplified and recorded at a sampling rate of 128 Hz
and stored for off-line analysis by Harmonie Software (Stellate
Systems, Montréal, Canada). Audio and video recordings were
carried out simultaneously to distinguish sleep bruxism episodes
from non-specific orofacial activities (Velly-Miguel et al., 1992;
Kato et al., 1999).
Sleep and Sleep Bruxism ScoringSleep was scored according to standard criteria (Rechtschaffen and
Kales, 1968). A micro-arousal was defined as an abrupt EEG
frequency shift (> 3 sec) without complete awakening (American
Sleep Disorders Association, 1991). Sleep bruxism episodes were
scored into phasic (3 EMG bursts or more, each lasting 0.25 to 2.0
sec), tonic (one EMG burst > 2.0 sec), or mixed (both types of
bursts) episodes (Lavigne et al., 1996). Tonic activities were
analyzed for both groups, even though most episodes in control
individuals are phasic or mixed, designated as Rhythmic
Masticatory Muscle Activity (RMMA; Lavigne et al., 2001b).
Scoring was performed blind to participant status.
QuestionnairesParticipants answered questions concerning awareness of sleep
bruxism, sleep habits, anxiety, stress, fatigue, nervousness, current
facial pain intensity, painful jaw upon awakening, and fatigue of
masticatory muscles at different moments. Participants answered a
selection questionnaire during a telephone interview. Then, a
questionnaire was completed during diagnosis, in the dental clinic.
Finally, questionnaires were completed in the sleep laboratory
before bedtime in the evening, and after awakening in the
morning.
Statistical AnalysesSleep and sleep bruxism variables that were not normally
distributed were normalized with a logarithm. For these variables,
groups were compared by two-sample t tests or one-way
ANOVA, followed by Tukey pair-wise mean comparisons (Systat
11). Answers to questionnaires were analyzed by Fisher's exact
test and odds ratio. Answers on a VAS scale were evaluated with
the Mann-Whitney U test. A p < 0.05 was considered statistically
significant. TwoStep Cluster analyses (SPSS 14.0) were
performed with sleep bruxism variables to reveal natural
groupings (or clusters) among sleep bruxers and control
individuals separately. The algorithm tested a range of the number
of clusters. The optimal number of clusters was determined by the
software, with Schwarz's Bayesian Criterion (Norusis, 2006;
SPSS, 2006).
Table 1. Differences in Sleep and Bruxism between Subgroups
Sleep Bruxers/ Sleep Bruxers/ Control Individuals/ Control Individuals/ Contrasts*Included (n = 54) Excluded (n = 46) Included (n = 34) Excluded (n= 9 ) pa < 0.05
SleepSleep duration (min) 446.5 ± 5.9b 445.6 ± 6.0 450.3 ± 7.2 442.7 ± 9.9 0.94Sleep efficiency (%) 96.6 [85.1-99.3] 96.3 [83.7-99.4] 96.0 [79.2-99.3] 95.6 [84.6-98.2] 0.31Sleep latency 7.0 [0.3-69.3] 7.5 [1.3-42.3] 11.3 [2.3-41.7] 9.7 [2.3-23.3] 0.22Awakenings 24.0 ± 1.7 25.3 ± 1.5 23.3 ± 1.9 29.2 ± 5.6 0.56Micro-arousals/hr 8.4 [0.4-23.5] 6.9 [3.0-16.4] 5.7 [3.1-21.3] 6.0 [1.9-14.0] 0.70Stage 1 (%) 7.7 ± 0.6 8.2 ± 0.6 7.9 ± 0.7 7.3 ± 0.9 0.89 Stage 2 (%) 59.9 ± 1.2 59.4 ± 1.0 58.1 ± 1.5 59.8 ± 1.9 0.76Stage 3+4 (%) 11.0 ± 1.1 10.2 ± 1.0 13.3 ± 1.2 11.2 ± 1.6 0.30Stage REM (%) 21.4 ± 0.7 22.2 ± 0.7 20.8 ± 0.9 21.8 ± 1.3 0.67
Bruxism episodesEpisodes/hr 5.9 [3.7-15.2] 2.1 [0.1-4.5] 1.0 [0.0-4.0] 4.3 [1.3-7.3] < 0.001 1,2,3,4,5,6Phasic episodes/hr 4.0 [0.5-8.5] 0.9 [0.0-3.0] 0.2 [0.0-2.3] 2.7 [1.0-6.3] < 0.001 1,2,4,5,6Mixed episodes/hr 2.6 [0.0-7.8] 0.8 [0.0-2.6] 0.5 [0.0-2.0] 1.1 [0.1-3.9] < 0.001 1,2,3Tonic episodes/hr 0.0 [0.0-1.6] 0.1 [0.0-1.9] 0.1 [0.0-0.8] 0.0 [0.0-0.4] 0.81Episodes with noise 12 [0-84] 1 [0-12] 0 [0-5] 1 [0-39] < 0.001 1,2,3,4,6Episodes with movement 31 [6-92] 11.5 [1-29] 7 [0-23] 24 [10-34] < 0.001 1,2,4,5,6
Bruxism burstsBursts/hr 46.2 [21.0-136.8] 12.6 [0.5-23.4] 4.5 [0.0-33.4] 35.8 [8.2-48.8] < 0.001 1,2,4,5,6Phasic bursts/hr 43.1 [17.1-126.3] 11.1 [0.4-22.0] 3.2 [0.0-31.0] 31.6 [8.1-46.9] < 0.001 1,2,4,5,6Tonic bursts/hr 3.6 [0.0-11.9] 1.1 [0.1-4.7] 0.9 [0.0-8.1] 1.5 [0.1-5.9] < 0.001 1,2Bursts/episode 6.8 [4.2-13.2] 5.4 [3.0-10.7] 4.6 [0.0-19.5] 6.6 [5.4-11.5] < 0.001 1,2,6
* Contrasts: 1 = included bruxers-excluded bruxers, 2 = included bruxers-included control individuals, 3 = included bruxers-excluded controlindividuals, 4 = excluded bruxers-included control individuals, 5 = excluded bruxers-excluded control individuals, 6 = included controlindividuals-excluded control individuals.
a One-way ANOVA, followed by Tukey pairwise mean comparisons.b Mean ± SE or median [min-max] when data were normalized.
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J Dent Res 86(9) 2007 Sleep Bruxism Subgroups Identification 839
RESULTSParticipants were
young, with a mean
age around 25 yrs old
(bruxers, mean ± SE
= 26.5 ± 0.6; control
individuals, 24.5 ±
0.9, p = 0.07). There
was a significantly
higher proportion of
women among
bruxers (60%) and of
men among control
individuals (62.8%, p
= 0.02).
Participants were
included in or
excluded from
further studies based
on an analysis of
results from the
second night in the
sleep laboratory. Bruxers were included when they displayed
values higher than 2 of the 3 previously established cut-offs: 4
sleep bruxism episodes/hr, 25 sleep bruxism bursts/hr, 1
episode with grinding noise. Control individuals were included
when they had values lower than or equal to 2 of the 3 cut-offs.
Based on these EMG criteria, 54 bruxers were included for
further studies, while 46 were excluded. Similarly, 34 control
individuals were included for further studies, while nine were
excluded.
Sleep and sleep bruxism variables for these four subgroups
(included bruxers, excluded bruxers, included control
individuals, and excluded control individuals) are presented in
Table 1. Sleep variables revealed few differences among
subgroups. The number of micro-arousals per hour was
marginally higher in included bruxers than in included control
individuals (47% higher), but this did not reach statistical
significance in these young participants. However, sleep
bruxism variables revealed clear differences among the four
subgroups. All subgroups differed regarding the number of
episodes/hr, since all paired comparisons were statistically
significant. Excluded control individuals showed more
episodes/hr than did excluded bruxers (median 4.3 and 2.1,
respectively, p < 0.05). All paired comparisons involving
phasic episodes/hr, phasic bursts/hr, and bursts/hr were
significant, except the comparison between included bruxers
and excluded control individuals. No significant difference in
the number of episodes with noise was observed between
excluded bruxers and excluded control individuals, while other
comparisons were significant. Paired comparisons among
groups for mixed episodes/hr, tonic bursts/hr, and
bursts/episodes were significant mostly between included
bruxers and excluded bruxers, and included bruxers and
included control individuals. All groups had few tonic
episodes/hr (median near 0, p = 0.81).
TwoStep cluster analysis for bruxers identified three
subgroups of bruxers who differed in sleep bruxism frequency:
low, moderate, and high (Table 2). Box plots for the three
clusters are shown on the Fig. Dotted lines indicate cut-off
values of the SB-RDC. Groups were well-defined, and most
individuals in the low cluster (n = 49) had values lower than
cut-off for episodes/hr (cut-off = 4), bursts/hr (cut-off = 25),
and episodes with noise (cut-off = 1). Interestingly, 45 of the
46 excluded bruxers were classified in this cluster. The
importance of each variable in the three clusters is presented in
the APPENDIX.
Cluster analysis performed in control individuals identified
two clusters (Table 2). Most individuals in the high cluster had
values above cut-off (Fig.). Seven of the nine control
individuals who were excluded were classified in this cluster.
The importance of each variable in the two clusters is given in
the APPENDIX.
Answers to questionnaires (Table 3) revealed that excluded
bruxers were significantly more likely than included bruxers to
complain of clenching, with an odds ratio (OR) and 95%
confidence interval of 4.9 (1.3-18.6). Awareness of tooth
grinding, grinding noise, and tooth wear did not differ between
excluded bruxers and included bruxers. Analyses revealed that
both subgroups differed regarding complaint of pain. Excluded
bruxers were more likely than included bruxers to complain of
painful jaw upon awakening and fatigue of masticatory muscles
(OR over 3.9, Table 3). The level of pain of excluded bruxers
was slightly higher than that of included bruxers (median of
10.0 compared with 0.0 on a 0-100 VAS, p = 0.06). Evaluation
of the psychological state "During the day before recording"
showed no significant difference between subgroups. "Just
before recording", excluded bruxers reported stress and
nervousness in a higher proportion than did included bruxers
(OR 3.5 for stress, Table 3), and stress and fatigue in a higher
proportion than reported by included control individuals (p <
0.04, not shown). No significant difference in psychological
state was observed between included bruxers and control
individuals, either during the day before recording or just
before recording (p > 0.1, not shown).
DISCUSSIONIn a study published in 1996, the selection criteria for sleep
bruxers included having exhibited grinding sounds during sleep
at least 5 nights a wk in the preceding 6 mos (Lavigne et al.,
Table 2. Clusters for Sleep Bruxers (n = 99) and Control Individuals (n = 42)
Cluster 1 Cluster 2 Cluster 3 p
Sleep bruxers low, n = 49 moderate, n = 37 high, n = 13Episodes/hr 2.3 ± 0.2 [0.1-4.5]b 6.2 ± 0.3 [4.3-9.8] 9.6 ± 0.8 [5.9-15.2] < 0.001a
Bursts/hr 13.5 ± 1.0 [0.5-27.7] 41.3 ± 1.9 [21.8-67.3] 83.7 ± 6.1 [56.5-136.8] < 0.001a
Episodes with noise 2.5 ± 0.5 [0-12] 10.5 ± 1.3 [0-26] 39.2 ± 6.0 [10-84]% Participants with > 1 46.9 (n = 23) 89.2 (n = 33) 100.0 (n = 13) < 0.001a
episode with noise
Control individuals low, n = 34 high, n = 8Episodes/hr 1.3 ± 0.2 [0.0-4.0] 5.1 ± 0.5 [3.3-7.3] < 0.001Bursts/hr 6.5 ± 1.0 [0.0-24.7] 38.4 ± 2.7 [29.1-48.8] < 0.001Episodes with noise 0.5 ± 0.2 [0-5] 8.9 ± 4.7 [0-39] 0.06% Participants with > 1 11.8 (n = 4) 50.0 (n = 4)episode with noise
a One-way ANOVA, followed by Tukey's pairwise mean comparisons. Otherwise, two-sample t test was used.b Mean ± SE [min-max].
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840 Rompré et al. J Dent Res 86(9) 2007
1996). Moderate to severe sleep bruxers were recruited, as
shown by their number of sleep bruxism episodes/hr (mean ±
SE, 5.4 ± 0.6) and number of bursts/hr (40.7 ± 6.7). These
values are comparable with those of sleep bruxers included for
further studies and with those of the moderate cluster. Over the
years, to have access to a larger pool
of potential participants, investigators
have reduced the criterion for reported
grinding sounds during sleep from 5 to
3 nights a wk. Based on this criterion,
46 sleep bruxers recorded in the sleep
laboratory were excluded from further
studies, according to the SB-RDC.
Consequently, the sensitivity and
specificity of the SB-RDC established
in 1996 would be lower if re-evaluated
based on the total sample of sleep
bruxers (n = 100) and control
individuals (n = 46), due to the low
sleep bruxers and control individuals
with high frequencies of activities. For
example, the cut-off of 4 episodes/hr
would lead to lower sensitivity (55%
instead of 72%) and specificity (84%
instead of 94%). Lower values of cut-
off (2.5 episodes/hr instead of 4.0)
would be required to have sensitivity
and specificity around 70%. However,
the classification established by the
SB-RDC closely matches that of the
cluster analyses. Sleep bruxers in the
low cluster and control individuals in
the high cluster are those excluded by
the SB-RDC. These persons displayed
frequencies of activities different from
those typical of their clinical group.
Their inclusion in sleep laboratory
studies is therefore not suitable.
Close to 50% of persons with a
clinical history of tooth grinding
presented low frequencies of jaw
muscle contractions (episodes/hr,
bursts/hr) and tooth-grinding events
in the sleep laboratory. A high
proportion of these participants
reported painful jaw and fatigue of
masticatory muscles, although they
did not complain of or present TMD
(temporomandibular muscle or joint
pain or dysfunction). Other studies
have reported that sleep bruxers
frequently present with low pain
intensity in jaw and neck muscles, or
temporal headaches upon waking
(Bader et al., 1997; Lavigne et al.,1997; Camparis et al., 2006; Huynh
et al., 2006). The possibility that this
episodic pain and headache occurred
in relation to the recording in the
sleep laboratory may have con -
tributed to a reduction in the motor
activity, as suggested by the Pain Adaptation Model (Lund,
1995). Another explanation could be the natural variability in
the occurrence of sleep bruxism over time. We noted that the
variability in the number of episodes/hr of sleep was 25%,
while the variability in the number of episodes with grinding
Figure. Subgroups identified by cluster analysis based on sleep bruxism frequency. (a) Sleep bruxerswere divided into three clusters: low (n = 49), moderate (n = 37), and high (n = 13). (b) Controlindividuals were divided into two clusters: low (n = 34) and high (n = 8). Box plots combined withsymmetrical dot densities are shown. Dotted lines indicate cut-off values of the SB-RDC.
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J Dent Res 86(9) 2007 Sleep Bruxism Subgroups Identification 841
sound was over 50% (Lavigne et al., 2001a).
Conversely, approximately 20% (8/42) of control
individuals displayed a high frequency of orofacial activities
and were classified in the 'high control' cluster. Seven of these
control individuals had more than 4 episodes/hr of sleep, eight
reported more than 25 bursts/hr of sleep, and four presented at
least 2 episodes with grinding sounds. This last finding may be
surprising, but can be explained by the fact that some control
individuals, who are young (mean age = 25 yrs old), may grind
their teeth very rarely. Persons may also sleep alone or with a
sleep partner who is not disturbed by their grinding sounds,
thus providing an unreliable report of absence of tooth grinding
at home.
A correlation of sleep bruxism with stress and anxiety from
situational or psychological sources has been suggested (Rugh
and Harlan, 1988; Hicks et al., 1990; AASM, 2005). However,
this association remains controversial (Harness and Peltier,
1992; Pierce et al., 1995; Watanabe et al., 2003). The present
sleep study does not support this association, since the levels of
stress and anxiety did not differ between included sleep bruxers
and control individuals.
The observation of 3 clusters in sleep bruxers and of 2 in
control individuals further supports the suggestion that jaw
muscle contractions during sleep are a natural activity, with a
wide spectrum of frequency (number of episodes/hr). In a
previous study, control individuals presented from 0.1 to 12.6
episodes/hr of jaw muscle contraction during sleep, while sleep
bruxers presented from 1.2 to 15.2 episodes/hr (Lavigne et al.,2001b). It was also observed that the probability of jaw muscle
contraction during sleep is related to intrinsic physiological
cardiac and brain-related arousals called 'micro-arousals'
(Macaluso et al., 1998; Kato et al., 2001, 2003). From the
above observations, we suggested that these contractions are
probably distributed over a continuum, from a low-frequency
range to intermediate and high ranges, with coincidental tooth
grinding (Lavigne et al., 2003).
This study provides confirmation that the SB-RDC
developed ten years ago facil i tates a high level of
discrimination between sleep bruxers and control individuals.
The SB-RDC distinguishes low sleep bruxers and high
control individuals from the other individuals within their
group. Furthermore, pain is frequently reported among sleep
bruxers who display low frequencies of jaw muscle
contractions.
ACKNOWLEDGMENTSThis study was supported by the Canadian CIHR and the Québec
FRSQ. The authors thank Mrs. Christiane Manzini and Nelly
Table 3. Differences in Answers* to Questionnaires between Included and Excluded Sleep Bruxers
OR (95% CI)Sleep Bruxers/ Sleep Bruxers/ Sleep Bruxers Excluded/ Control Individuals/Included (n = 54) Excluded (n = 46) pa Sleep Bruxers Included Included (n = 34)
Complaint of sleep bruxismClenching 74.0 (37/50) 93.3 (42/45) 0.014 4.9 (1.3-18.6) 32.3 (10/31)Tooth grinding 81.3 (39/48) 67.5 (27/40) 0.15 0 (0/23)Grinding noise 97.7 (42/43) 100.0 (37/37) 1.00 0 (0/22)Tooth wear 74.4 (32/43) 88.2 (30/34) 0.16 13.6 (3/22)
Complaint of painPainful jaw upon awakening 48.9 (22/45) 78.9 (30/38) 0.006 3.9 (1.5-10.4) 0 (0/22)Fatigue of masticatory muscles 31.3 (15/48) 70.0 (28/40) 0.001 5.1 (2.1-12.8) 9.1 (2/22)Restless legs 29.5 (13/44) 58.3 (21/36) 0.013 3.3 (1.3-8.4) 6.3 (1/16)Current facial pain intensity(0-100 VAS)b 0.0 (0.0-80.0) 10.0 (0.0-70.0) 0.06c 0.0 (0.0-0.0)
Psychological stateDuring the day before recording
Anxiety 48.1 (13/27) 50.0 (14/28) 1.00 25.0 (2/8)Stress 55.6 (15/27) 64.3 (18/28) 0.59 37.5 (3/8)Fatigue 63.0 (17/27) 71.4 (20/28) 0.57 37.5 (3/8)Nervousness 33.3 ( 9/27) 50.0 (14/28) 0.28 37.5 (3/8)
Just before recordingAnxiety 18.5 ( 5/27) 35.7 (10/28) 0.23 12.5 (1/8)Stress 22.2 ( 6/27) 50.0 (14/28) 0.05 3.5 (1.1-11.3) 0 (0/8)Fatigue 59.3 (16/27) 71.4 (20/28) 0.40 25.0 (2/8)Nervousness 14.8 ( 4/27) 39.3 (11/28) 0.07 0 (0/8)
* Proportions of participants who answered yes, followed by their number, are shown. Values of included control individuals are listed for contrast.a p values for comparison between included and excluded sleep bruxers.b Median (min-max); otherwise, % of participants is shown.c Mann-Whitney U test; otherwise, Fisher's Exact Test was used.
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842 Rompré et al. J Dent Res 86(9) 2007
Huynh for their help in recruiting participants. We appreciate Dr.
Alice Petersen's contribution to editing of this paper.
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