On the Pharmacotherapy of Sleep Bruxism: Placebo-Controlled Polysomnographic and Psychometric Studies with Clonazepam

Vol. 51, No. 4, 2005

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Original Paper

On the Pharmacotherapy of Sleep Bruxism: Placebo-Controlled Polysomnographic and Psychometric Studies with Clonazepam
Alexander Saletu^a, Silvia Parapatics^b-d, Bernd Saletu^{b, d}, Peter Anderer^b, Wolfgang Prause^b, Hanna Putz^d, Josef Adelbauer^d, Gerda Maria Saletu-Zyhlarz^{b, d}

Departments of
^aDental Medicine,
^bPsychiatry and
^cMedical Cybernetics and Artificial Intelligence, Medical University of Vienna, and
^dRudolfinerhaus, Vienna, Austria

Address of Corresponding Author

Neuropsychobiology 2005;51:214-225 (DOI: 10.1159/000085917)

Key Words

Sleep bruxism
Pharmacotherapy
Clonazepam
Polysomnography
Awakening quality
Thymopsyche
Noopsyche
Periodic limb movements
Respiratory variables
Arousals

Abstract

Objectives: Sleep bruxism (SB) is a parasomnia defined as a stereotyped movement disorder characterized by grinding or clenching of the teeth during sleep. Pathophysiologically, SB is the result of biological and psychosocial influences. Treatment comprises behavioral, orthodontic and pharmacological interventions. While benzodiazepines and muscle relaxants have been reported by clinicians to reduce bruxism-related motor activity, placebo-controlled studies are lacking. Thus, the aim of the present study was to investigate the acute effects of clonazepam (Rivotril^®) as compared with placebo, utilizing polysomnography and psychometry. Method: Ten drug-free outpatients (6 females, 4 males), aged 46.5 ± 13.1 years, suffering from SB (ICD-10: F45.8; ICSD: 306.8) and having been treated by bite splints were included in the trial. Comorbidity was high: 7 patients presented nonorganic insomnia related to adjustment or anxiety disorders (5 patients) or depression (2 patients); all patients had a concomitant movement disorder (6 restless legs syndrome, 4 periodic leg movement disorder). After one adaptation night, patients received placebo and 1 mg clonazepam 1/2 hour before lights out in a single-blind, nonrandomized study design. Objective sleep quality was determined by polysomnography, subjective sleep and awakening quality by rating scales, objective awakening quality by psychometric tests. Clinical evaluation was based on the Pittsburgh Sleep Quality Index (PSQI), the Zung Depression (SDS) and Anxiety (SAS) Scales, the Quality of Life Index, the Epworth Sleepiness Scale and the International Restless Legs Syndrome Study Group (IRLSSG) Scale. Results: On admission, SB patients exhibited deteriorated PSQI, SAS, SDS and IRLSSG measures. As compared with placebo, 1 mg clonazepam significantly improved the mean bruxism index from 9.3 to 6.3/h of sleep. Furthermore, it significantly improved the total sleep period, total sleep time, sleep efficiency, sleep latency and time awake during the total sleep period, and increased stage 2 sleep and movement time. Periodic leg movements decreased significantly, while the apnea index and apnea-hypopnea index increased marginally, but remained within normal limits. Subjective sleep quality improved as well, while in mood, performance and psychophysiology no changes were observed. Conclusion: Acute clonazepam therapy significantly improved not only the bruxism index but also objective and subjective sleep quality, with unchanged mood, performance and psychophysiological measures upon awakening, suggesting good tolerability of the drug.

Author Contacts

Univ. Ass. DDr. Alexander Saletu, MD, Clinic of Dentistry
Department of Periodontology, Medical University of Vienna
Währinger Strasse 25a, AT-1090 Vienna (Austria)
Tel. +43 1 42 77 67 211, Fax +43 1 42 77 67 205
E-Mail alexander.saletu@meduniwien.ac.at

Article Information

Published online: May 23, 2005
Number of Print Pages : 12
Number of Figures : 3, Number of Tables : 7, Number of References : 87

Medline Abstract (ID 15915004)

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