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• W2419164028 abstract "Free AccessLetter to the EditorError in Calculation of Predictive Values in Paper on Screening for Sleep Bruxism Karen G. Raphael, PhD Karen G. Raphael, PhD Address correspondence to: Karen G. Raphael, PhD, New York University College of Dentistry, Oral and Maxillofacial Pathology, Radiology and Medicine, 380 Second Avenue, Suite 301, New York, NY 10010(212) 992-7043(212) 992-7130 E-mail Address: [email protected] New York University College of Dentistry, New York, NY Search for more papers by this author Published Online:February 15, 2016https://doi.org/10.5664/jcsm.5504Cited by:4SectionsPDF ShareShare onFacebookTwitterLinkedInRedditEmail ToolsAdd to favoritesDownload CitationsTrack Citations AboutINTRODUCTIONThe paper by Palinkas et al.1 examining alternate methods for detecting sleep bruxism (SB) represents an important contribution, by showing the relative poor yields from traditionally used measures such as tooth wear, compared to gold standard polysomnographic (PSG) measurement. Ultimately, they recommend that the AASM criteria be used as the best screening tool for SB. This is based in part on a relatively high reported PPV of 76% and NPV of 66%. When looking for a screening measure having clinical utility, it seems reasonable to support one that, when yielding a positive result, is likely to accurately predictive positive PSG findings of SB more than three-quarters of the time. Unfortunately, the authors have overlooked the fact that prevalence of a condition affects predictive values (e.g.,2). This is why statistics that are independent of prevalence, like sensitivity and specificity, are typically presented in studies such as theirs, even though predictive values are more clinically useful. Recent research suggests that the population prevalence of SB is low. One population-based study suggests a prevalence of 7%,3 while a smaller study not selecting participants on the basis of PSG findings4 suggests PSG-based prevalence rates closer to 10%. However, Palinkas et al.1 created a case and control group of equal sizes, so that the combined sample has a 50% prevalence of gold standard PSG-assessed SB. If we were to assume that prevalence of PSG-assessed SB was 10% rather than 50%, as is more likely in the general population, the high PPV for the AASM criteria of 76% drops to 26%. Thus, the clinical utility of AASM criteria in a more representative sample of individuals is likely to have been overstated as an artifact of the study's sampling methods. The same problem is true for other potentially promising screening tools, such as temporal headache or muscle fatigue (PPV of 29% and 24% respectively, recomputed based on a 10% population prevalence rate). Thus, it does not appear that any of the proposed screening methods are likely to have clinical utility, given their low PPVs. Recalculation of NPVs based on a 10% gold standard prevalence of SB indicates that NPVs will be quite good for many of the screening measures. However, in the absence of a screening measure having high PPV, it would appear that none would be clinically useful to screen for PSG-assessed SB.DISCLOSURE STATEMENTThe author has indicated no financial conflicts of interest.CITATIONRaphael KG. Error in calculation of predictive values in paper on screening for sleep bruxism. J Clin Sleep Med 2016;12(2):277.REFERENCES1 Palinkas M, De Luca Canto G, Rodrigues LAet al.Comparative capabilities of clinical assessment, diagnostic criteria, and polysomnography in detecting sleep bruxism. J Clin Sleep Med; 2015;11:1319-25, 26235152. LinkGoogle Scholar2 Eusebi PDiagnostic accuracy measures. Cerebrovasc Dis; 2013;36:267-72, 24135733. CrossrefGoogle Scholar3 Maluly M, Andersen ML, Dal-Fabbro Cet al.Polysomnographic study of the prevalence of sleep bruxism in a population sample. J Dent Res; 2013;927 Suppl:97S-103S, 23690359. CrossrefGoogle Scholar4 Raphael KG, Sirois DA, Janal MNet al.Sleep bruxism and myofascial temporomandibular disorders: a laboratory-based polysomnographic investigation. J Am Dent Assoc; 2012;143:1223-31, 23115152. CrossrefGoogle Scholar Previous article Next article FiguresReferencesRelatedDetailsCited by Questions on the clinical applicability on the international consensus on the assessment of bruxismSkármeta N and Hormazabal Navarrete F Journal of Oral Rehabilitation, 10.1111/joor.12891, Vol. 47, No. 2, (255-257), Online publication date: 1-Feb-2020. Validity of different tools to assess sleep bruxism: a meta-analysisCasett E, Réus J, Stuginski-Barbosa J, Porporatti A, Carra M, Peres M, de Luca Canto G and Manfredini D Journal of Oral Rehabilitation, 10.1111/joor.12520, Vol. 44, No. 9, (722-734), Online publication date: 1-Sep-2017. The Real Role of Sensitivity, Specificity and Predictive Values in the Clinical AssessmentPalinkas M, De Luca Canto G, Rodrigues L, Bataglion C, Siéssere S, Semprini M and Regalo S Journal of Clinical Sleep Medicine, Vol. 12, No. 02, (279-280), Online publication date: 15-Feb-2016. Is bruxism a disorder or a behaviour? Rethinking the international consensus on defining and grading of bruxismRaphael K, Santiago V and Lobbezoo F Journal of Oral Rehabilitation, 10.1111/joor.12413, Vol. 43, No. 10, (791-798), Online publication date: 1-Oct-2016. Volume 12 • Issue 02 • February 15, 2016ISSN (print): 1550-9389ISSN (online): 1550-9397Frequency: Monthly Metrics History Submitted for publicationNovember 1, 2015Accepted for publicationNovember 1, 2015Published onlineFebruary 15, 2016 Information© 2016 American Academy of Sleep MedicinePDF download" @default.
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