Self-Reported Sleep Bruxism and Nocturnal Gastroesophageal Reflux Disease in Patients with Obstructive Sleep Apnea: Relationship to Gender and Ethnicity§

Sean Hesselbacher 1, 2, Shyam Subramanian 3, Shweta Rao 4, Lata Casturi 4, Salim Surani*, 5
1 Sentara Healthcare, Virginia Beach, VA, USA
2 Eastern Virginia Medical School, Norfolk, VA, USA
3 Mercy Health System, Cincinnati, Ohio, USA
4 Baylor College of Medicine, Houston, Texas, USA
5 Texas A&M University, Texas, USA

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© Hesselbacher et al.; Licensee Bentham Open.

open-access license: This is an open access article licensed under the terms of the Creative Commons Attribution Non-Commercial License ( which permits unrestricted, non-commercial use, distribution and reproduction in any medium, provided the work is properly cited.

* Address correspondence to this author at the 7613 Lake Bolsena, Corpus Christi, Texas 78413, USA; Tel: 1-361-885-7722; Fax: 1-361-850-7563; E-mail:
§ This material was presented in part at the American College of Chest Physicians Annual Meeting, November 2009, San Diego, CA, and at the American Professional Sleep Societies meeting, June 2014, Minneapolis, MN, USA.


Study Objectives :

Nocturnal bruxism is associated with gastroesophageal reflux disease (GERD), and GERD is strongly associated with obstructive sleep apnea (OSA). Gender and ethnic differences in the prevalence and clinical presentation of these often overlapping sleep disorders have not been well documented. Our aim was to examine the associations between, and the symptoms associated with, nocturnal GERD and sleep bruxism in patients with OSA, and to examine the influence of gender and ethnicity.

Methods :

A retrospective chart review was performed of patients diagnosed with OSA at an academic sleep center. The patients completed a sleep questionnaire prior to undergoing polysomnography. Patients with confirmed OSA were evaluated based on gender and ethnicity. Associations were determined between sleep bruxism and nocturnal GERD, and daytime sleepiness, insomnia, restless legs symptoms, and markers of OSA severity in each group.

Results :

In these patients with OSA, the prevalence of nocturnal GERD (35%) and sleep bruxism (26%) were higher than the general population. Sleep bruxism was more common in Caucasians than in African Americans or Hispanics; there was no gender difference. Nocturnal GERD was similar among all gender and ethnic groups. Bruxism was associated with nocturnal GERD in females, restless legs symptoms in all subjects and in males, sleepiness in African Americans, and insomnia in Hispanics. Nocturnal GERD was associated with sleepiness in males and African Americans, insomnia in females, and restless legs symptoms in females and in Caucasians.

Conclusion :

Patients with OSA commonly have comorbid sleep bruxism and nocturnal GERD, which may require separate treatment. Providers should be aware of differences in clinical presentation among different ethnic and gender groups.

Keywords: Gastroesophageal reflux, obstructive sleep apnea, sleep bruxism..