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Biomedical subjects

Gilles J Lavigne

Publications and source records attributed to Gilles J Lavigne.

14 recordsLinked to original sources
PubMed2006

The effect of 2 sympatholytic medications--propranolol and clonidine--on sleep bruxism: experimental randomized controlled studies.

STUDY OBJECTIVE: To examine whether 2 sympatholytic medications decrease sleep bruxism and prevent the rise in sympathetic activity preceding the onset of sleep bruxism: propranolol, a nonselective adrenergic beta-blocker, and clonidine, a selective alpha2-agonist. DESIGN: Experimental randomized controlled crossover studies with placebo and active treatments (propranolol 120 mg; clonidine 0.3 mg). SETTING: Hospital-based sleep research laboratory. PATIENTS: Twenty-five subjects with a history and diagnosis of SLEEP BRUXISM (11 men, 14 women; age range, 21 to 31 years). INTERVENTION: Polygraphic study. MEASUREMENTS AND RESULTS: Polygraphic sleep laboratory recordings were done for 4 nights: the first night was habituation, the second, sleep bruxism diagnosis; and 3 and 4 were study nights. The sleep bruxism index was estimated using masseter muscle activity. Heart rate variability was estimated with spectral analysis of RR intervals. Sleep and sleep bruxism variables were not significantly influenced by propranolol. A reduction of the mean RR intervals and of the sympathetic dominance (p < .05) was seen. Under clonidine, duration of sleep stage 2 was prolonged, whereas REM sleep was suppressed in 14 of 16 subjects with sleep bruxism. The sleep bruxism index was reduced by 61% (p < .05). Under clonidine, a reduction in heart rate and sympathetic dominance was observed in stable sleep and in the minute preceding the onset of sleep bruxism (p < .05). CONCLUSION: Although propranolol did not affect sleep bruxism, clonidine decreased sympathetic tone in the minute preceding the onset of sleep bruxism, thus reducing sleep bruxism by preventing the sequence of autonomic to motor activation of sleep bruxism. This further supports the role of sympathetic activity in the pathophysiology of sleep bruxism. Because morning hypotension was seen in 19% of patients, further dose-dependant research is required to assess the safety of clonidine for the management of sleep bruxism.

Adrenergic alpha-Agonists↗
PubMed2005

Quantitative analysis of surface EMG activity of cranial and leg muscles across sleep stages in human.

OBJECTIVE: The aim of this study was to make a quantitative analysis of the changes in cranial and limb muscle activity from wakefulness to light and deep sleep stages and during rapid eye movement (REM) sleep of normal subjects. METHODS: Polysomnographic recordings were made of the sleep of 9 healthy human subjects, including electromyograms of the suprahyoid, temporalis and masseter cranial muscles and the anterior tibialis limb muscle. Quantitative assessments of EMG activity were carried out with root mean square (RMS) and frequency-spectral analysis (FSA) methods. RESULTS: From wakefulness to sleep, a significant reduction (-25.2 to -71.2%; P < 0.01) was observed in EMG activity (for both RMS and FSA) of the 3 cranial muscles using both methods of analysis. The EMG activity of suprahyoid muscle further decreased from non-REM to REM sleep (-17.8 to -43.0%; P < 0.01). In contrast, the EMG activity of the anterior tibialis muscle was only slightly reduced across sleep stages and did not further reduce during REM sleep. During REM sleep, all the 4 muscles maintained minimal activity. CONCLUSIONS: The maintenance of muscle activity during REM sleep suggests that a minimal level of activity is required to preserve physiological functions (e.g. airway patency, posture) related to homeostasis and bodily protection. SIGNIFICANCE: This study suggests that quantitative sleep EMG analysis is important for understanding the mechanisms of sleep-related movement disorders or when objective assessment of changes in EMG activity are needed for diagnostic purposes or for the assessment of drug efficiency.

Adult↗
PubMed2004

Prevalence of spontaneous oral dyskinesia in the elderly: a reappraisal.

The prevalence and status of spontaneous oral dyskinesia (SOD), clinically defined as the presence of oral stereotypies of no apparent cause, remain controversial in the elderly. The reported high prevalence of SOD in institutionalized demented cases, the apparent similarity between SOD and tardive dyskinesia (TD), and the role of aging in both conditions, are used as arguments to minimise the prevalence of TD and causal role of antipsychotics. We observed 1,018 (69.3% women) noninstitutionalized, frail elderly subjects attending day care centers to document the prevalence and phenomenology of SOD. A total of 38 subjects, including 29 women, were suspected of having SOD, for a prevalence rate of 3.7% (95% confidence interval, 2.6-4.9%), 4.1% for women and 2.9% for men. A survey covering medical and dental issues was filled out by 508 volunteers. Subjects with suspected SOD reported more frequent ill-fitting dental devices (P = 0.002; odds ratio [OR] = 3.5), oral pain (P = 0.01; OR = 3.0), and a lower rate of perception of good oral health (P = 0.04; OR = 0.4) compared to nondyskinetics. Individuals with suspected SOD typically presented with mild stereotyped masticatory or labial movements compared to the more complex phenomenology of probable TD cases. Thus, SOD is comparatively infrequent in the elderly. The relation between its distinct orodental health profile and stereotyped manifestations warrants further attention.

Age Factors↗
PubMed2003

Association between sleep bruxism, swallowing-related laryngeal movement, and sleep positions.

STUDY OBJECTIVE: To describe the relationships of sleep bruxism to swallowing and sleep positions. DESIGN: Controlled descriptive study. SETTING: Polysomnography and audio-video recordings were done in a hospital sleep laboratory. PARTICIPANTS: Nine patients with sleep bruxism and 7 normal subjects were matched for age and sex. INTERVENTIONS: n/a. MEASUREMENTS AND RESULTS: During sleep, patients with sleep bruxism showed a higher frequency of rhythmic masticatory muscle activity episodes (6.8 +/- 1.0 [SEM]/h) than did normals (0.5 +/- 0.1/h, p < 0.01). Swallowing-related laryngeal movements occurred more frequently in sleep of patients with sleep bruxism (6.8 +/- 0.8/h) than in normals (3.7 +/- 0.3/h, p < 0.01). In both groups, during sleep, close to 60% of rhythmic masticatory muscle activity episodes were associated with swallowing. In sleep bruxism patients, 68% of swallowing events occurred during rhythmic masticatory muscle activity episodes, while only 10% of swallowing events were associated with rhythmic masticatory muscle activity in normal subjects. Sleep bruxism patients and normals spent 95.5% and 87.3% of sleeping time in the supine and lateral decubitus positions, respectively. In both groups, up to 96% of rhythmic masticatory muscle activity and swallowing were observed in the supine and lateral decubitus position. In sleep bruxism patients, although sleeping time did not differ between the 2 sleeping body positions, 74% of rhythmic masticatory muscle activity and swallowing events were scored in the supine position compared to 23% in the lateral decubitus position. CONCLUSIONS: During sleep, rhythmic masticatory muscle activity is often associated with swallowing. In sleep bruxism patients, most of these oromotor events are observed in the supine position. The physiologic link between rhythmic masticatory muscle activity and swallowing and the clinical relevance of sleep position in sleep bruxism management need to be investigated.

Adult↗
PubMed2003

Topical review: sleep bruxism and the role of peripheral sensory influences.

Sleep bruxism (SB) is an unusual orofacial movement described as a parafunction in dentistry and as a parasomnia in sleep medicine. Since several peripheral influences could be involved in sleep-wake regulation and the genesis of rhythmic jaw movements, the authors have reviewed the relevant literature to facilitate understanding of mechanisms possibly involved in SB genesis. Various animal and human studies indicate that during either wakefulness or anesthesia, orofacial sensory inputs (e.g., from periodontium, mucosa, and muscle) could influence jaw muscle activity. However, the role of these sensory inputs in jaw motor activity during sleep is unclear. Interestingly, during sleep, the jaw is usually open due to motor suppression; tooth contact most likely occurs in association with sleep arousal. Recent physiologic evidence supports an association between sleep arousal and SB; a sequential change from autonomic (cardiac) and brain cortical activities precede SB-related jaw motor activity. This suggests that the central and/or autonomic nervous systems, rather than peripheral sensory factors, have a dominant role in SB genesis. However, some peripheral sensory factors may exert an influence on SB through their interaction with sleep-wake mechanisms. The intent of this review is to integrate various physiologic concepts in order to better understand the mechanisms underlying the genesis of SB.

Afferent Pathways↗
PubMed2002

The significance of saliva during sleep and the relevance of oromotor movements.

Saliva is an essential component of the oroesophageal milieu and allows for normal speech, taste, mastication, food bolus formation and swallowing. Saliva has important functions in protecting the hard and soft tissues of the oral cavity from acids and pathogenic microbes. A large number of people suffer either subjective or objective alterations in quantity and/or quality of their saliva that may be secondary to disease, medications, medical treatments or emotional events. Sleep-related xerostomia is a sensation of dry mouth associated with a report of either mouth and/or throat discomfort that induces awakenings for water intake. The prevalence of self-reported dry mouth complaint during sleep (associated with awakening and water intake) in a Canadian survey was estimated at 23%. The biological significance of decreased saliva during sleep is unknown and it is unclear how the oral cavity compensates for this period of relative dryness. The amount of saliva produced is greatest during the waking hours of the day and diminishes dramatically during sleep and may represent another process in the human body that displays a circadian rhythmicity. Salivary secretion during wakefulness is, in part, associated with oromotor activity involving the masticatory muscles. Rhythmic masticatory muscle activity and swallowing are non-disruptive events that occur during normal sleep. We hypothesize herein that lubrication from saliva is necessary during sleep to protect tissue integrity and health of oroesophageal structures.

Bruxism↗
PubMed1998

Memories of chronic pain and perceptions of relief.

Clinicians and researchers often ask patients to remember their past pain. They also use patient's reports of relief from pain as evidence of treatment efficacy, assuming that relief represents the difference between pretreatment pain and present pain. We have estimated the accuracy of remembering pain and described the relationship between remembered pain, changes in pain levels and reports of relief during treatment. During a 10-week randomized controlled clinical trial on the effectiveness of oral appliances for the management of chronic myalgia of the jaw muscles, subjects recalled their pretreatment pain and rated their present pain and perceived relief. Multiple regression analysis and repeated measures analyses of variance (ANOVA) were used for data analysis. Memory of the pretreatment pain was inaccurate and the errors in recall got significantly worse with the passage of time (P < 0.001). Accuracy of recall for pretreatment pain depended on the level of pain before treatment (P < 0.001): subjects with low pretreatment pain exaggerated its intensity afterwards, while it was underestimated by those with the highest pretreatment pain. Memory of pretreatment pain was also dependent on the level of pain at the moment of recall (P < 0.001). Ratings of relief increased over time (P < 0.001), and were dependent on both present and remembered pain (Ps < 0.001). However, true changes in pain were not significantly related to relief scores (P = 0.41). Finally, almost all patients reported relief, even those whose pain had increased. These results suggest that reports of perceived relief do not necessarily reflect true changes in pain.

Adolescent↗
PubMed1995

Is myofascial pain of the temporal muscles relieved by oral sumatriptan? A cross-over pilot study.

There is evidence that serotonin may be implicated in the pathophysiology of myofascial pain (MFP). Because of this, we used oral sumatriptan (Imitrex, Glaxo), a peripherally acting agonist of 5-HT1D receptors, in a double-blind, randomized, placebo-controlled double crossover pilot study of 7 patients with episodic MFP of the temporalis muscles. The results showed that there was a significant reduction in pain intensity and increase in pain relief over time with both the active medication and the placebo, but no significant difference between treatments. All but 1 patient reported that they are not interested in retaking the same medication. These data suggest that oral sumatriptan may not be the drug of choice in the control of episodic MFP.

Administration, Oral↗
PubMed1994

The efficacy of oral splints in the treatment of myofascial pain of the jaw muscles: a controlled clinical trial.

Oral splints are widely used in the treatment of myofascial pain of masticatory muscles, even though their mechanism of action is unknown. The present study evaluated the therapeutic efficacy of splints using a parallel, randomized, controlled and blind design. Following a sample size estimation, 63 subjects were recruited and assigned to 3 groups: (1) passive control: full occlusal splint worn only 30 min at each appointment; (2) active control: palatal splint worn 24 h/day; and (3) treatment: full occlusal splint worn 24 h/day. On each of 7 visits over 10 weeks, subjects rated on 100 mm visual analogue scales their pain intensity and unpleasantness at rest and after experimental mastication. The effect of pain on the quality of life was also rated on category scales. All pain ratings decreased significantly with time, and quality of life improved for all 3 groups. However, there were no significant differences between groups in any of the variables. These data suggest that the gradual reduction in the intensity and unpleasantness of myofascial pain, as well as the improvement of quality of life during the trial, was non-specific and not related to the type of treatment.

Adolescent↗
PubMed1989

Comparison of verbal and visual analogue scales for measuring the intensity and unpleasantness of experimental pain.

Although the multidimensional nature of pain is now well recognized, there are, nevertheless, very few quantitative tests to measure the separate dimensions of pain and little data concerning their relative sensitivity. The present study compares 2 currently available methods, verbal descriptor and visual analogue scales. Eight subjects rated painful and near-painful heat stimuli by using visual analogue scales for intensity or unpleasantness and by choosing the most appropriate phrases from lists of intensity or unpleasantness descriptors. In the intensity dimension, the relationship between perception and stimulus temperature was essentially identical whether calculated from the visual analogue or verbal descriptor scales. However, data derived from the verbal descriptor scales revealed that subjects rated the painful temperatures as relatively more intense than unpleasant; this difference could not be detected using the visual analogue scales. These results confirm that both visual analogue and verbal descriptor techniques successfully quantify sensory intensity and affective aspects of pain, but that verbal descriptors may provide the more sensitive tool for separating intensity and unpleasantness.

Adult↗
PubMedDate not supplied

Aggravation of respiratory disturbances by the use of an occlusal splint in apneic patients: a pilot study.

PURPOSE: This pilot study was designed to test the hypothesis that the use of a single oral splint may aggravate respiratory disturbance in sleep apneic patients. MATERIALS AND METHODS: A group of 10 patients with a history of snoring and a recording night confirming a diagnosis of sleep apnea were included. Patients were then invited to spend 2 nights in the sleep laboratory: night 2 to establish baseline data (baseline night) and night 3, 1 week later, to assess the influence of an occlusal maxillary splint on sleep (splint night). The following variables were analyzed under blind conditions: total sleep time, sleep efficiency and number of awakenings, microarousals, apnea-hypopnea index per hour of sleep (AHI), respiratory disturbances index per hour of sleep (RDI), and percentage of sleeping time with snoring. RESULTS: No statistically significant difference in AHI was noted between baseline and splint nights. However, four patients experienced an aggravation in apnea diagnosis category on the night they used the splint. The AHI was increased by more than 50% in 5 of the 10 patients. The RDI showed a 30% increase from baseline to splint nights. The percentage of sleeping time with snoring also increased by 40% with the splint. CONCLUSION: This open study suggested that the use of an occlusal splint is associated with a risk of aggravation of respiratory disturbances. It may therefore be relevant for clinicians to question patients about snoring and sleep apnea when recommending an occlusal splint.

Adult↗
PubMedDate not supplied

Oral dyskinesia: a clinical overview.

PURPOSE: Dentists may be the first health care professionals to recognize unusual and abnormal oral movements collectively termed oral dyskinesias. The aims of this clinical overview are to raise the dental community's awareness about this important and complex topic and describe the clinical features and management of the main entities. MATERIALS AND METHODS: A MEDLINE search of the different entities reported in the English and French literature was conducted. The main findings of a field study on oral dyskinesia were also reviewed. RESULTS: Involuntary movement disorders are often drug related. In other cases, excessive oral movements may occur at any age in relation to various neuropsychiatric conditions. Orofacial dystonia apparently triggered by dental procedures has also been reported. Edentulousness has been associated with oral stereotypes. In a survey of 352 edentulous elderly individuals attending daycare centers, only 7% displayed visible oral sterotypes, and ill-fitting dentures were suggested as a possible triggering factor for the majority. CONCLUSION: A multidisciplinary evaluation is desirable in the care of individuals with oral dyskinesia and in the selection of those who may benefit from a prosthodontic approach. A good knowledge of potentially offending drugs may allow avoidance of unnecessary procedures.

Bruxism↗
PubMedDate not supplied

Reduction of sleep bruxism using a mandibular advancement device: an experimental controlled study.

PURPOSE: The objective of this experimental study was to compare the effect on sleep bruxism and tooth-grinding activity of a double-arch temporary custom-fit mandibular advancement device (MAD) and a single maxillary occlusal splint (MOS). MATERIALS AND METHODS: Thirteen intense and frequent bruxors participated in this short-term randomized crossover controlled study. All polygraphic recordings and analyses were made in a sleep laboratory. The MOS was used as the active control condition and the MAD was used as the experimental treatment condition. Designed to temporarily manage snoring and sleep apnea, the MAD was used in 3 different configurations: (1) without the retention pin between the arches (full freedom of movement), (2) with the retention pin in a slightly advanced position (< 40%), and (3) with the retention pin in a more advanced position (> 75%) of the lower arch. Sleep variables, bruxism-related motor activity, and subjective reports (pain, comfort, oral salivation, and quality of sleep) were analyzed with analysis of variance and the Friedman test. RESULTS: A significant reduction in the number of sleep bruxism episodes per hour (decrease of 42%, P < .001) was observed with the MOS. Compared to the MOS, active MADs (with advancement) also revealed a significant reduction in sleep bruxism motor activity. However, 8 of 13 patients reported pain (localized on mandibular gums and/or anterior teeth) with active MADs. CONCLUSIONS: Short-term use of a temporary custom-fit MAD is associated with a remarkable reduction in sleep bruxism motor activity. To a smaller extent, the MOS also reduces sleep bruxism. However, the exact mechanism supporting this reduction remains to be explained. Hypotheses are oriented toward the following: dimension and configuration of the appliance, presence of pain, reduced freedom of movement, or change in the upper airway patency.

Adult↗