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Study Title and Description

Risk factors for sleep bruxism in the general population.



Key Questions Addressed
1 For [population], is caffeine intake above [exposure dose], compared to intakes [exposure dose] or less, associated with adverse effects on behavior*?
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Primary Publication Information
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TitleData
Title Risk factors for sleep bruxism in the general population.
Author MM Ohayon,KK Li,C Guilleminault,
Country
Year 2001
Numbers

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There are currently no secondary publications defined for this study.


Extraction Form: Behavior - Design Details - INCLUDED Studies
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Design Details
Question... Follow Up Answer Follow-up Answer
Refid 11157584
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What outcome is being evaluated in this paper? Behavior
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What is the objective of the study (as reported by the authors)? The present study aimed to document the prevalence of sleep bruxism, the associated risk factors, and its possible link to other health-related and sleep-related issues in the general population.
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Provide a general description of the methods as reported by the authors. Information should be extracted based on relevance to the SR (i.e., caffeine related methods) Cross-sectional telephone survey using the Sleep-EVAL knowledge based system. Settings: Representative samples of three general populations (United Kingdom, Germany, and Italy) consisting of 158 million inhabitants. Participants: Thirteen thousand fifty-seven subjects aged > 15 years (United Kingdom, 4,972 subjects; Germany, 4,115 subjects; and Italy, 3,970 subjects). Intervention: None. Measurements: Clinical questionnaire on bruxism (using the International Classification of Sleep Disorders [ICSD] minimal set of criteria) with an investigation of associated pathologies (ie, sleep, breathing disorders, and psychiatric and neurologic pathologies). Lay interviewers performed the telephone interviews with the help of the Sleep-EVAL expert system.18–20 The task of the interviewers was to read to the subjects the questions displayed on the computer screen and to enter the answers in the Sleep-EVAL system. This software is a nonmonotonic, level-2 expert system endowed with a "causal reasoning" mode. It is specially designed to conduct epidemiologic studies on sleep, sleep habits, and mental disorders in the general population and is designed to direct both the epidemiologic study as well as the administration of the questionnaire. Interviews typically began with a standard questionnaire. It consisted of sociodemographic information, sleep/wake schedule, physical health queries, and questions related to sleep and mental disease symptoms. Once the answers were collected, the system looked for a series of plausible diagnostic hypotheses (ie, the causal reasoning process). Further questioning and deductions of the consequences of each answer allowed the system to confirm or reject these hypotheses (nonmonotonic, level-2 feature). The system contained all questions required for entire diagnostic descriptions according to the International Classification of Sleep Disorders (ICSD)22 and the Diagnostic and Statistical Manual of Mental Disorders, fourth edition (DSM-IV),23 classifications. The differential diagnosis process was based on a series of key rules allowing or prohibiting the co-occurrence of two diagnoses in accordance with ICSD and DSM-IV prescriptions. The interview ended once all diagnostic possibilities were exhausted.20 The Sleep-EVAL system was tested within several designs. The latest validation study was conducted at the Stanford University Sleep Disorders Center (Palo Alto, CA) and at the Regensburg University Sleep Disorders Center (Germany). The validation study consisted of 105 patients interviewed twice: once by a physician using the Sleep- EVAL system and once by a senior sleep specialist. All of the interviewers were blinded to the diagnosis made by the Sleep- EVAL system. The Sleep-EVAL diagnoses were later compared to those of the sleep specialists using polysomnographic recordings to confirm their diagnoses. A k of 0.93 was obtained between the Sleep-EVAL system and the sleep specialists on obstructive sleep apnea syndrome (OSAS). The duration of interviews ranged from 10 to 333 min (mean 6 SD, 40 6 20 min). The longest interviews involved subjects with sleep disorders associated with mental disorders. Interviews were completed over two or more sessions if the duration of the interview exceeded 60 min. Variables Sleep bruxism was studied in relation to the following four main classes of variables: (1) sociodemographic information; (2) other sleep variables (eg, sleep/wake schedule, hypnagogic and hypnopompic hallucinations, snoring, nocturnal awakenings, violent or injurious behaviors during sleep, sleep talking, restlessness on awakening, morning headaches, mouth dryness, automatic behaviors in the daytime, daytime sleepiness, and ICSD sleep disorder diagnoses); (3) the use of psychoactive substances (eg, tobacco, alcohol, caffeine, or medications for sleep, depression and anxiety); and (4) psychological and psychiatric variables (eg, life stress, hallucinations, and DSM-IV mental disorder diagnoses). The ICSD22 suggests the following as minimal criteria for sleep bruxism: (1) the presence of teeth grinding during sleep; and (2) at least one of the following associated features: abnormal tooth wear, muscular discomfort, or sound associated with the tooth grinding. Subsequently, the sample was divided into the following three groups: (1) subjects who met the minimal criteria proposed by the ICSD classification for sleep bruxism (including the associated features); (2) the tooth grinding-alone group, consisting of subjects who reported tooth grinding during sleep but without associated features; and (3) the no-tooth-grinding group, including subjects who did not grind their teeth during sleep. Data Analysis To compensate for any potential bias from such factors as an uneven response rate across demographic groups, a weighting procedure was applied to correct for disparities in the geographical, age, and gender distribution between the sample and the population as per the national census figures for the noninstitutionalized population aged $ 15 years for each country. Logistic regression25 was used to compute the odd ratios (ORs) associated with sleep tooth grinding. Logistic regressions were performed using the software (SUDAAN; Research Triangle Institute; Research Triangle Park, NC) that allows an appropriate estimate of the SEs from stratified samples by means of a Taylor series linearization method. Reported differences were significant at </= 0.05.
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How many outcome-specific endpoints are evaluated? 1
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What is the (or one of the) endpoint(s) evaluated? (Each endpoint listed separately) sleep
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List additional health endpoints (separately).
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List additional health endpoints (separately)
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Notes Bruxism and tooth-grinding
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Clinical
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Physiological Physiological
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Other
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What is the study design? Cross-sectional
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Randomized or Non-Randomized?
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What were the diagnostics or methods used to measure the outcome? Subjective
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Optional: Name of Method or short description Lay interviewers performed the telephone interviews with the help of the Sleep-EVAL expert system.18–20 The task of the interviewers was to read to the subjects the questions displayed on the computer screen and to enter the answers in the Sleep-EVAL system. This software is a nonmonotonic, level-2 expert system endowed with a "causal reasoning" mode. It is specially designed to conduct epidemiologic studies on sleep, sleep habits, and mental disorders in the general population and is designed to direct both the epidemiologic study as well as the administration of the questionnaire.
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Caffeine (general) Caffeine (general)
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Coffee Coffee
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Chocolate
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Energy drinks
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Gum
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Medicine/Supplement
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Soda
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Tea
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Measured
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Self-report Self-report
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Children
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Adolescents
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Adults Adults
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Pregnant Women
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What was the reference, comparison, or control group(s)? (e.g. high vs low consumption, number of cups, etc.) Grouping of caffeine consumption ranged from 0 - >/= 6 cups of coffee per day.
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What were the listed confounders or modifying factors as stated by the authors? (e.g. multi-variable components of models.  Copy from methods) we decided for the final model to combine the sleep bruxism diagnosis group and the tooth grinding-alone group as one group for analysis. The list of significant variables introduced into the model can be found in Table 5 (Age, alcohol intake, caffeine intake, smoking, snoring, restfulness, daytime sleepiness, parasomnias, life stress, gustatory hallucinations, presence of mental disorders).
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Provide a general description of results (as reported by the authors). Subjects in the sleep bruxism diagnosis group and the tooth grinding-alone group were found to drink alcohol at bedtime significantly more often than the no-tooth-grinding group (p < 0.005) (Table 3). They also reported drinking one glass of alcohol or more during the day more frequently (p < 0.0001), drinking at least six cups of coffee daily (p < 0.0001), and smoking daily (p < 0.0001) more frequently than the no-tooth-grinding group (Table 3). Daily caffeine intake >/= 6 cups Crude Odds Ratio = 2.0 (95% CI = 1.7-2.5), adjusted OR=1.4 (1.2-1.8).
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Did the authors perform a dose-response analysis (or trend/related analysis)? No
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What were the authors's observations re: trend analysis?
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What were the author's conclusions? Significant associations were also found with the daily use of alcohol, tobacco, and caffeine. The quantity was significant only for caffeine. Only heavy coffee drinkers (ie, six cups or more) were at greater risk. These substances are known factors for increasing the risk of sleep tooth grinding.
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What were the sources of funding? Supported by the Fond de la Recherche en Sante´ du Quebec (grant No. 971067) and by an educational grant from Synthelabo Group.
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What conflicts of interest were reported? N/A
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Does the exposure (dose) need to be standardized to the SR? Yes
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Provide calculations/conversions for the exposure based on the decision tree in the guide (for all endpoints/exposure levels of interest). 1 cup of coffee = 95 mg/8 oz serving 6 cups = 570 mg
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List all the endpoint(s) followed by the dose (mg) which will be used in comparison to Nawrot.  Characterize value as LOAEL/NOAEL, etc. if possible.  sleep (bruxism and teeth grinding) - LOAEL = 570 mg/day
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Notes regarding selection/listing of endpoints and exposures/doses to be compared to Nawrot. considered bruxism to be a component of sleep quality. paper does not specify volume of coffee considered to be a "cup" so assumed 8 oz = 1 cup.
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What is the importance of the study with respect to the adverseness of the outcome? Low
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