Effects of botulinum toxin type A on sleep quality in patients with awake and sleep bruxism: a prospective study

The aim was to investigate the effects of botulinum toxin type A (BTX-A) treatment on sleep quality in patients diagnosed with probable sleep bruxism and awake bruxism. A prospective observational study was conducted on 40 female patients. All participants received standardized BTX-A injections (30 units in the masseter muscles, 20 units in the temporalis muscles). Sleep quality was assessed pre- and post-treatment using the Pittsburgh Sleep Quality Index (PSQI). Statistical analyses compared pre- and post-treatment PSQI scores and included subgroup analyses. Significant improvements were observed in subjective sleep quality and in sleep latency, efficiency, duration, and disturbance (all P < 0.05). The proportion of patients with good sleep quality (PSQI ≤5) increased from 17.5% pre-treatment to 60% post-treatment (P < 0.001). Daytime function also improved significantly (P = 0.002). BTX-A treatment was associated with improved sleep quality in patients with probable bruxism, including reductions in sleep latency and disturbances, along with enhanced sleep duration and efficiency. Although the lack of a control group limits causal inference and the placebo effect remains unknown, the study findings suggest BTX-A injections may be an effective therapeutic approach for bruxism-related sleep impairments, highlighting the relationship between awake bruxism and sleep quality.