Polysomnographic Evaluation of Sleep Bruxism Intensity and Sleep Architecture in Nonapneic Hypertensives: A Prospective, Observational Study

Round 1

Reviewer 1 Report

The author's team did a great job in conducting and publishing the findings, I recommend incorporating the required revisions before being considered for publication.

Title: the study information is pointing toward a "trial".... as per CONSORT guidelines study design should be mentioned in the title.

Abstract

1. remove headings and numbers from the text, it is required to be non-structured.
2. as per mdpi format...the "p" is in italic.

Introduction

1. please the justification of this study in the last paragraph. that is how the findings of this study will help future researchers and clinicians.
2. The null hypothesis of the study was that hypertensives had increased SB intensity and altered sleep architecture. lines 89 and 90. revise there can either be a difference in the findings or no difference between BP and SB, sleep architecture, etc, as proven by the statistical tests later on.

Materials and methods

1. The test need to be further divided according to subheadings for cohesion of events and clarity.
2. A flow diagram mentioning the subject's number, randomization, blinding, grouping, and dropout of candidates need to be added.
3. please mention whether the trial was registered in a reputable WHO directory or not.

Discussion

1. The limitation needs to be incorporated in the discussion section, also including the strengths of this study and future direction or recommendations for fellow researchers.

References

1. The references are not uniform and in accordance to the journal format.

Author Response

 The author's team did a great job in conducting and publishing the findings, I recommend incorporating the required revisions before being considered for publication.

 Dear Reviewer,

On behalf of our research team, I would like to attach our response below. I would like to thank you for your review of our article and your suggestions which helped us to improve our manuscript.

 Title: the study information is pointing toward a "trial".... as per CONSORT guidelines study design should be mentioned in the title.

Response: Thank you for the suggestion, we have modified the title.

Abstract

1. remove headings and numbers from the text, it is required to be non-structured.

Response: The abstract has been modified, thank you for noticing. 

2. as per mdpi format...the "p" is in italic.

Response:  Thank you, we changed it.

 Introduction

1. please the justification of this study in the last paragraph. that is how the findings of this study will help future researchers and clinicians.

Response: we have already clarified the presence of this study, thank you for your notice. 

2. The null hypothesis of the study was that hypertensives had increased SB intensity and altered sleep architecture. lines 89 and 90. revise there can either be a difference in the findings or no difference between BP and SB, sleep architecture, etc, as proven by the statistical tests later on.

Response: Thank you for rising that point, we have revised it as you suggested. 

Materials and methods

1. The test need to be further divided according to subheadings for cohesion of events and clarity.

Response: We have divided the Materials and methods to subheadings in our manuscript, thank you for your notice. 

2. A flow diagram mentioning the subject's number, randomization, blinding, grouping, and dropout of candidates need to be added.

Response: According to your suggestions, we have added a flow diagram. 

3. please mention whether the trial was registered in a reputable WHO directory or not.

Response: Thank you for the suggestion, we added that information in the text. 

Discussion

1. The limitation needs to be incorporated in the discussion section, also including the strengths of this study and future direction or recommendations for fellow researchers.

Response: Thank you, we incorporated the limitations into the discussion section.

 References

1. The references are not uniform and in accordance to the journal format.

Response: We have already corrected the references, thank you for your notice. 

The authors could mention the study design in the methodology

Response: Thank you for that comment, we added the study design in the Materials and Methods section.

Reviewer 2 Report

Appreciate the efforts of authors in conducting the present study. The readers will benefit with the information. Most of the findings have been addressed too . However, I have a 2 suggestions 

1. The authors could mention the study design in the methodology
2. As per the findings in this present study, the Oxygen saturation Index was higher in hypertensives compared to normotensives, while there was no statistical significance in  mean heart rate between the study groups. I think this portion of the result needs slight clarification. Is there a possibility of increase in oxygen saturation levels and normal heart rate in hypertensives?

Author Response

This is very important and valuable comment, thank you. The oxygen desaturation index was indeed higher among the hypertensives group, and that can be explained by the fact that hypertensive patients have also other causes of presenting the desaturation, such as higher body mass index or respiratory events.

Taking the heart rate into consideration, there are many more other compounds affecting this parameters such as increased sympathetic activity, age, other medical conditions, medications, diet, fitness level and psychological factors. As you have suggested, we have discussed it, thank you.

Reviewer 3 Report

We have to congratulate the authors for a well written manuscript. There is a serious issue that we are surprised authors did not have into account.

Conclusions: Nonapneic hypertensives had higher SB intensity, altered sleep architecture, decreased mean oxygen satura-tion, and increased snoring compared to normotensives

The study group with high blood pressure is mainly based in men and the control group is based in women. High blood pressure is more prevalent in men so we are surprised why authors did not homogenize both groups before doing the investigation.

On the other hand, we can not understand why BMI was not evaluated in both groups as perse is a risk factor for high blood pressure. There can be the option that the high blood pressure group was formed by high bmi patients and this was a significant bias in the investigation.

Patient with temporomandibular issues should be excluded from investigation.

Author Response

Dear Reviewer,

On behalf of our research team, I would like to attach our detailed response below. I would like to take this opportunity to thank you for your time and thorough review of our manuscript. We have found your thoughtful and constructive comments very helpful. We are aware of the fact that the study group representing hypertensive patients consisted of 14 men and 17 women whereas the control group was mostly represented by women and it is an evident limitation for this research.

What is more, unfortunately BMI was not evaluated in both groups although it plays  important role as a risk factor for high blood pressure. We discussed it in the limitation of this study and we think that it is definitely a factor that need to be taken into consideration when doing more research concerning this topic. As you have suggested, we have discussed it and stated those as the limitation for the research.

Thank you very much for your valuable comments.

Round 2

Reviewer 1 Report

The authors have improved the paper as per recommendations, 

Reviewer 3 Report

Authors have corrected the issues suggested by this reviewer.