Subjective Sleep Quality Deteriorates Before Development of Painful Temporomandibular Disorder

Sanders, Anne E.; Akinkugbe, Aderonke A.; Bair, Eric; Fillingim, Roger B.; Greenspan, Joel D.; Ohrbach, Richard; Dubner, Ronald; Maixner, William; Slade, Gary D.

doi:10.1016/j.jpain.2016.02.004

Cited by 67 publications

(79 citation statements)

References 38 publications

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“…28 However, perceived stress was shown to mediate the link between the PSQI and TMD onset, while the PSQI did not mediate the role of stress in TMD development. 29 Similarly, our findings underscore the importance of psychological variables in the PSQI-TMD relationship and suggest that differences in the baseline PSQI and subsequent sleep ratings preceding the TMD onset 28,29 may not reflect differences in PSG-measured sleep parameters but represent negative cognitive bias and depressive symptomatology.…”

Section: Discussionmentioning

confidence: 94%

“…A large longitudinal study assessing risk factors for the development of TMD revealed that the elevated PSQI and the subsequent reduction in subjective sleep quality predict future onset of TMD independently of stress or comorbid conditions (28). However, perceived stress was shown to mediate the link between the PSQI and TMD onset, while the PSQI did not mediate the role of stress in TMD development (29).…”

Section: Zero-order Correlationsmentioning

confidence: 99%

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

Dubrovsky

Janal

Lavigne

et al. 2017

J of Oral Rehabilitation

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Background Temporomandibular disorder (TMD) patients report poor sleep quality on the Pittsburgh Sleep Quality Index (PSQI). However, polysomnographic (PSG) studies show meager evidence of sleep disturbance on standard physiological measures. Objective The present aim was to analyze self-reported sleep quality in TMD as a function of myofascial pain, PSG parameters, and depressive symptomatology. Methods PSQI scores from 124 women with myofascial TMD and 46 matched controls were hierarchically regressed onto TMD presence, ratings of pain intensity and pain-related disability, in-lab PSG variables, and depressive symptoms (Symptoms Checklist-90). Results Relative to controls, TMD cases had higher PSQI scores, representing poorer subjective sleep, and more depressive symptoms (both P < 0.001). Higher PSQI scores were strongly predicted by more depressive symptoms (P < 0.001, R2 = 26%). Of 19 PSG variables, two had modest contributions to higher PSQI scores: longer REM latency in TMD cases (P = 0.01, R2 = 3%) and more awakenings in all participants (P = 0.03, R2 = 2%). After accounting for these factors, TMD presence and pain ratings were not significantly related to PSQI scores. Conclusion These results show that reported poor sleep quality in TMD is better explained by depressive symptoms than by PSG-assessed sleep disturbances or myofascial pain. As TMD cases lacked typical PSG features of clinical depression, the results suggest a negative cognitive bias in TMD and caution against interpreting self-report sleep measures as accurate indicators of PSG sleep disturbance. Future investigations should take account of depressive symptomatology when interpreting reports of poor sleep.

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Section: Discussionmentioning

confidence: 94%

Section: Zero-order Correlationsmentioning

confidence: 99%

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

Dubrovsky

Janal

Lavigne

et al. 2017

J of Oral Rehabilitation

View full text Add to dashboard Cite

show abstract

“…In contrast, sleep quality remained stable among participants who did not develop TMD. 45 That analysis had investigated whether the putative effect of sleep quality was mediated by increased sensitivity to experimental pain, but found no evidence of such mediation. 45 Because of the overlap and temporal ambiguity between sleep disturbance, perceived stress, and pain, it is not surprisingly that different causal configurations have been proposed.…”

Section: Discussionmentioning

confidence: 99%

“…45 That analysis had investigated whether the putative effect of sleep quality was mediated by increased sensitivity to experimental pain, but found no evidence of such mediation. 45 Because of the overlap and temporal ambiguity between sleep disturbance, perceived stress, and pain, it is not surprisingly that different causal configurations have been proposed. For example, in a study of persistent pain nested within the prospective North Staffordshire Osteoarthritis Project, investigators reported that pain interference mediated the effect of sleep disturbance on probable depression, as well as the effect of probable depression on sleep disturbance.…”

Section: Discussionmentioning

confidence: 99%

Causal Mediation in the Development of Painful Temporomandibular Disorder

Sanders

Akinkugbe

Fillingim

et al. 2017

The Journal of Pain

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We explored causal mediation of sleep quality and perceived stress in development of painful temporomandibular disorder (TMD). Sleep quality and perceived stress were assessed at baseline and quarterly intervals thereafter in 2,737 initially TMD-free adults in the Orofacial Pain Prospective Evaluation and Risk Assessment study (OPPERA) prospective cohort study. During follow-up, incident TMD cases were classified using research diagnostic criteria. Mediation analysis was conducted using a weighted Cox proportional hazards regression model that estimated hazard ratios (HRs) and 95% confidence limits (CL) of first-onset TMD. Models determined whether: 1) poor sleep quality during follow-up mediated the effect of baseline perceived stress on first-onset TMD, and 2) perceived stress during follow-up mediated the effect of baseline poor sleep quality on first-onset TMD. In both analyses, the total effect was decomposed into natural direct and indirect effects. Poor baseline sleep quality led to heightened perceived stress that then contributed to TMD development. When the total effect of poor sleep quality (HR = 2.10, CL = 1.76, 2.50) was decomposed, 34% of its effect was mediated by perceived stress (indirect effect HR = 1.29, CL = 1.06, 1.58). The effect of perceived stress on first-onset TMD was not mediated by sleep quality. Improving sleep may avert escalation of stress, limiting effects of both factors on TMD development.

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“…Another requirement was that individuals be reliably and unambiguously classified into meaningful categories based on their risk profiles. The method Sanders et al (2016). Sleep quality was rated on a scale of 0 to 10 (0 = worst sleep, 10 = best sleep) in questionnaires completed once every quarter during follow-up of first-onset TMD cases (n = 220) and controls (n = 193) in the OPPERA nested case-control study.…”

Section: Putting It All Together: Finding the Forest Among The Treesmentioning

confidence: 99%

Painful Temporomandibular Disorder

et al. 2016

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In 2006, the OPPERA project (Orofacial Pain: Prospective Evaluation and Risk Assessment) set out to identify risk factors for development of painful temporomandibular disorder (TMD). A decade later, this review summarizes its key findings. At 4 US study sites, OPPERA recruited and examined 3,258 community-based TMD-free adults assessing genetic and phenotypic measures of biological, psychosocial, clinical, and health status characteristics. During follow-up, 4% of participants per annum developed clinically verified TMD, although that was a "symptom iceberg" when compared with the 19% annual rate of facial pain symptoms. The most influential predictors of clinical TMD were simple checklists of comorbid health conditions and nonpainful orofacial symptoms. Self-reports of jaw parafunction were markedly stronger predictors than corresponding examiner assessments. The strongest psychosocial predictor was frequency of somatic symptoms, although not somatic reactivity. Pressure pain thresholds measured at cranial sites only weakly predicted incident TMD yet were strongly associated with chronic TMD, cross-sectionally, in OPPERA's separate case-control study. The puzzle was resolved in OPPERA's nested case-control study where repeated measures of pressure pain thresholds revealed fluctuation that coincided with TMD's onset, persistence, and recovery but did not predict its incidence. The nested case-control study likewise furnished novel evidence that deteriorating sleep quality predicted TMD incidence. Three hundred genes were investigated, implicating 6 single-nucleotide polymorphisms (SNPs) as risk factors for chronic TMD, while another 6 SNPs were associated with intermediate phenotypes for TMD. One study identified a serotonergic pathway in which multiple SNPs influenced risk of chronic TMD. Two other studies investigating gene-environment interactions found that effects of stress on pain were modified by variation in the gene encoding catechol O-methyltransferase. Lessons learned from OPPERA have verified some implicated risk factors for TMD and refuted others, redirecting our thinking. Now it is time to apply those lessons to studies investigating treatment and prevention of TMD.

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Subjective Sleep Quality Deteriorates Before Development of Painful Temporomandibular Disorder

Cited by 67 publications

References 38 publications

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

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

Causal Mediation in the Development of Painful Temporomandibular Disorder

Painful Temporomandibular Disorder

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