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Randomized Controlled Trial
. 2010 Dec;33(12):1711-6.
doi: 10.1093/sleep/33.12.1711.

Clonidine has a paradoxical effect on cyclic arousal and sleep bruxism during NREM sleep

Maria Clotilde Carra  1 , Guido M Macaluso, Pierre H Rompré, Nelly Huynh, Liborio Parrino, Mario Giovanni Terzano, Gilles J Lavigne
Affiliations
Randomized Controlled Trial

Clonidine has a paradoxical effect on cyclic arousal and sleep bruxism during NREM sleep

Maria Clotilde Carra et al. Sleep. 2010 Dec.

Abstract

Study objective: Clonidine disrupts the NREM/REM sleep cycle and reduces the incidence of rhythmic masticatory muscle activity (RMMA) characteristic of sleep bruxism (SB). RMMA/SB is associated with brief and transient sleep arousals. This study investigates the effect of clonidine on the cyclic alternating pattern (CAP) in order to explore the role of cyclic arousal fluctuation in RMMA/SB.

Design: Polysomnographic recordings from a pharmacological study.

Setting: University sleep research laboratory.

Participants and interventions: Sixteen SB subjects received a single dose of clonidine or placebo at bedtime in a crossover design.

Measurements and results: Sleep variables and RMMA/SB index were evaluated. CAP was scored to assess arousal instability between sleep-maintaining processes (phase A1) and stronger arousal processes (phases A2 and A3). Paired t-tests, ANOVAs, and cross-correlations were performed. Under clonidine, CAP time, and particularly the number of A3 phases, increased (P≤0.01). RMMA/SB onset was time correlated with phases A2 and A3 for both placebo and clonidine nights (P≤0.004). However, under clonidine, this positive correlation began up to 40 min before the RMMA/SB episode.

Conclusions: CAP phase A3 frequency increased under clonidine, but paradoxically, RMMA/SB decreased. RMMA/SB was associated with and facilitated in CAP phase A2 and A3 rhythms. However, SB generation could be influenced by other factors besides sleep arousal pressure. NREM/REM ultradian cyclic arousal fluctuations may be required for RMMA/SB onset.

Keywords: Clonidine; cyclic alternating pattern; rhythmic masticatory muscle activity; sleep bruxism.

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Figures

Figure 1
Figure 1
Distribution over NREM/REM sleep cycles of CAP phases A1, A2, and A3 (number/h), and RMMA/SB activity (episodes/h) for placebo (black circles) and clonidine (white circles) nights. Vertical dotted lines delimit each NREM/REM sleep cycle. Mean values (SEM) are shown. C1 = first sleep cycle; C2 = second sleep cycle; C3 = third sleep cycle; C4 = fourth sleep cycle; RMMA/SB = rhythmic masticatory muscle activity/sleep bruxism.
Figure 2
Figure 2
Cross-correlation plots between RMMA/SB episodes and CAP phases A1, A2, and A3 for placebo (A) and clonidine (B) nights. Horizontal upper and lower lines denote significant P value at 0.05. The vertical line denotes lag 0, or RMMA/SB onset. Each lag lasts 4 minutes (minus 40 min before SB onset and plus 40 min after SB onset).
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