The Relationship Between Primary Sleep Disorders and Temporomandibular Disorders: An 8-Year Nationwide Cohort Study in South Korea

Abstract

Background While evidence is accumulating to propose a specific contribution of sleep disorders and low quality sleep in the pathogenesis of temporomandibular disorders (TMD), management of primary sleep disorders in the process of preventing and treating TMD still remains scientifically unsupported. Objective To investigate the association of primary sleep disorders with TMD risk in South Korea. Patients and Methods This study was based on the National Health Insurance Service-National Health Screening Cohort (NHIS-HEALS) of South Korea with 468,882 participants. After excluding participants diagnosed in 2002, those with a diagnosis of a primary sleep disorder in 2003–2005 were recruited. All participants diagnosed with TMD between January 1, 2006 and December 31, 2013 received follow-up. Cox proportional hazards regression was performed to determine the adjusted hazard ratios (aHR) and 95% confidence interval (CI) for TMD according to the presence or absence of a primary sleep disorder diagnosis. Results After adjusting for all covariates, primary sleep disorder patients had a 44% higher risk for TMD compared with non-sleep disorder participants (aHR 1.44, 95% CI 1.02–2.04). The incidence rate of TMD was nearly twice as high in participants with sleep disorders compared with those without (6.08 vs 3.27, per 10 4 person-years). In subgroup analysis, an association was observed with those over 60 years old or who frequently exercised physically. Conclusion Primary sleep disorders could be an important independent risk factor for the initiation and maintenance of TMD. Patients with sleep disorders should be monitored for possible co-occurrence of TMD-related symptoms that could aggravate sleep disorders in turn.

Does physical activity level have an impact on long-term treatment response in temporomandibular disorders: protocol for a prospective study

“…The accumulating evidence supports the intimate relationship between physical activity, sleep quality, and systemic inflammation which are all factors known to influence TMD symptoms in previous literature [71][72][73][74]. Through this prospective study based on objective physical activity measurements in a well-defined patient group of TMD, the resulting data will be able to support the establishment of a clinical guideline related to physical activity recommendations and the diagnostic value of such measurements in TMD prognosis.…”

Does risk of obstructive sleep apnea have interaction with chronic facial pain?

“…Because, sleep during weekdays could be influenced by diverse factors, including work, school and so on, sleep duration during weekends would be more valid factors to determine quality of the sleep. The association between insomnia and facial pain has been demonstrated, previously 15 - 19 . Patients with both TMD and insomnia with objective short sleep duration endorsed higher self-reported pain severity and functional limitation of the jaw 17 and the prevalence of primary insomnia was higher in patients with myofascial TMD compared to that in controls 15 .…”

“…Reducing total sleep time could affect pain severity and morning pain expectancy 18 . Moreover, an eight-year cohort study suggested that primary sleep disorder could be an important independent risk factor for the initiation and maintenance of TMD 19 , and treatment of underlying insomnia could result in improved chronic orofacial pain 20 . Hence, sleep deprivation may interact with the perception of chronic facial pain; however, the role of OSA in the development of chronic facial pain could not be assumed from this study.…”

Triad multisystem phenotype with high risk for developing temporomandibular disorders—characteristics and potential pathophysiology results from the Orofacial Pain: Prospective Evaluation and Risk Assessment dataset

“…Group classification was based on presence or absence of 3 categories of systemic issues: pain-related issues, psychological issues, and sleep-related issues. The 3-category construct was created based on previously identified major risk domains for TMDs 30,41,43,80,83,97,121 and for ease of conceptualization and application in clinical practice. The items were selected from the health history report because they do not depend on clinical training or clinician judgement and therefore are easily generalizable to general dentistry or primary care settings.…”