Diagnostic accuracy of ambulatory polysomnography with electroencephalogram for detection of sleep bruxism-related masticatory muscle activity

Abstract

Study objectives: This study investigated the diagnostic accuracy of Sleep Profiler, which relies on ambulatory polysomnography (PSG) with electroencephalogram for sleep bruxism (SB) and examined its episode-by-episode agreement in comparison to PSG equipped with audiovisual recordings (avPSG).

Methods: This prospective 2-gate study recruited 10 individuals with probable SB and 10 healthy volunteers. Overnight experimental recordings were performed simultaneously using the ambulatory PSG with masseter electromyography and avPSG with masseter and temporalis electromyography. Sleep staging was performed manually for avPSG and automatically or manually for ambulatory PSG. SB episodes were manually scored based on electromyography signals with reference to sleep stages. The episode-by-episode agreement was analyzed by setting avPSG as the reference standard. The sensitivity, specificity, and accuracy for the diagnosis of SB were calculated after optimizing the cutoff values of the episode index and the burst index.

Results: Regarding the episode-by-episode agreement, median sensitivities were 0.825 and positive predictive values were approximately 0.6, regardless of the sleep staging procedure, indicating that approximately 40% of the overall total SB episodes scored by the ambulatory PSG were false positives. Because of overestimation of SB episodes, the optimal cutoff values for the episode index and the burst index were approximately 1.5 times higher than the avPSG-based cutoff values and dramatically improved the diagnostic precision metrics for the ambulatory PSG.

Conclusions: Sleep Profiler can eliminate events during wakefulness by electroencephalogram and may provide a definitive diagnosis in patients with possible SB by applying optimized cutoff values. However, the risk of overestimation must be recognized.

Clinical trial registration: Registry: UMIN Clinical Trials Registry; Name: Accuracy of Portable PSG Device for Detection of Sleep Bruxism-Related Masseter EMG Muscle Activity; URL: https://center6.umin.ac.jp/cgi-open-bin/ctr_e/ctr_view.cgi?recptno=R000037380; Identifier: UMIN000032793.

Citation: Abe Y, Nakazato Y, Takaba M, Kawana F, Baba K, Kato T. Diagnostic accuracy of ambulatory polysomnography with electroencephalogram for detection of sleep bruxism-related masticatory muscle activity. J Clin Sleep Med. 2023;19(2):379-392.

Keywords: diagnosis; polysomnography; portable sleep monitoring device; sleep bruxism; validation.