Polysomnographic Investigation of Sleep and Respiratory Parameters in Women with Temporomandibular Pain Disorders

Abstract

Study Objectives: Temporomandibular pain disorders (TMD) and myofascial pain were linked to increased prevalence of insomnia and obstructive sleep apnea (OSA) on clinical grounds. However, the literature lacks an accurate polysomnographic (PSG) characterization of sleep abnormalities associated with TMD, given that prior studies included small or uncontrolled samples of TMD patients. The present investigation aims to objectively evaluate measures of sleep and respiratory disturbance in a large representative sample of TMD cases in comparison with matched controls. Methods: Sleep, respiration, and limb movements were measured using a 2-night attended PSG protocol in 170 women-124 TMD cases with myofascial pain and 46 demographically matched controls. The second night data were compared between the groups using ANCOVAs. In TMD cases, the relationship between pain ratings and sleep parameters was analyzed using multiple regressions. Results: In comparison to healthy controls, TMD cased evidenced a signifi cant increase in stage N1 sleep (12.2% ± 7.6% vs. 9.2% ± 5.0%, p = 0.03), which was only mild relative to normative values. TMD cases also demonstrated mild but signifi cant elevations in arousals associated with all types of respiratory events (6.0/h ± 6.1 vs. 3.5/h ± 3. S C I E N T I F I C I N V E S T I G A T I O N ST emporomandibular disorders (TMD), most often characterized by painful musculoskeletal signs and symptoms in the masticatory region, is a pain syndrome estimated to affect approximately 5% to 15% of the population, predominantly women.1-4 Subjective sleep disturbance has been consistently reported in TMD patients. 5,6 Two earlier polysomnographic (PSG) studies failed to demonstrate objective differences in sleep or respiratory measures between TMD cases with myofascial pain and control participants free from myofascial pain and signs of TMD; however, the small sample sizes and restrictive selection criteria limit their interpretability. 7,8 A recent investigation employing PSG recordings and clinical sleep interviews in an uncontrolled sample of TMD cases showed that TMD is associated with primary sleep disorders, such as insomnia and obstructive sleep apnea (OSA): nearly 36% of TMD cases met diagnostic criteria for insomnia, and over 28% met criteria for OSA. 9 In the same sample of TMD cases, sleep effi ciency on PSG was directly related to a measure of pain threshold, suggesting an association between pain and sleep disturbance in TMD.9,10 Additionally, a high prevalence of TMD was reported in clinical patients with mild to moderate OSA referred for a clinical dental evaluation, lending further support to the association between TMD and OSA.11 It was BRIEF SUMMARYCurrent Knowledge/Study Rationale: A relationship between temporomandibular pain disorders (TMD) and sleep and respiratory disturbance has been suggested; however, large-scale controlled polysomnographic studies are lacking. The present investigation used two-night polysomnography to measure sleep architecture and respiration in a large...

Depressive symptoms account for differences between self‐reported versus polysomnographic assessment of sleep quality in women with myofascial TMD

“…Cases and controls were similar in both exclusion rates and demographic composition, as reported elsewhere. 19,21 …”

Evaluation of depressive symptoms and quality of life in individuals with tinnitus and temporomandibular disorders

“…One must consider, however, that tinnitus and chronic TMD are commonly present in patients with a similar psychological profile, characterized by the presence of significant distress and impairment (HILGENBERG et al, 2012), and with a high prevalence in females (DUBROVSKY et al, 2014), the observed intensity of discomfort from tinnitus being significantly higher in women (COELHO; SANCHEZ; BENTO, 2004). Of the 44 individuals evaluated in this study, 37 (84%) were women, with a mean age of 43.2 ±2.1 years.…”

Treatment of Chronic Temporomandibular Joint Pain and Sleep Disordered Breathing by Teledontic and Telegnathic Protocol Utilizing Total Joint Replacement

“…Thus, in patients with concomitant obstructive sleep apnea and sleep bruxism, most sleep bruxism events occurred after apnea-hypopnea events, suggesting that sleep bruxism events occurring close to apnea-hypopnea events is a secondary form of sleep bruxism [29] [30]. Further evidence suggest that myofascial pain in TMJ and POF disorders is associated with mild elevation in sleep fragmentation and increased frequency of RERA events [4].…”

“…TMJ disorders (TMJD) as part of masticatory disorders (MD), most often but not always characterized by painful musculoskeletal signs and symptoms in the masticatory and associated structures in head, neck and shoulder area, estimated to affect approximately 5% to 15% of the population, predominantly women [1] [2] [3] [4].…”

“…Subjective sleep disturbance has been consistently reported in MD patients [4] [6] [7]. A recent investigation employing polysomnogram (PSG) recordings and clinical sleep interviews in a sample of MD cases showed that MD is associated with primary sleep disorders, such as insomnia and obstructive sleep apnea (OSA): nearly 36% of MD cases met diagnostic criteria for insomnia, and over 28% met criteria for OSA [8].…”