Sleep quality in temporomandibular disorder cases

Abstract

Objective: The aim of this study was to characterize self-reported sleep quality (SQ) in cases with temporomandibular disorder (TMD) and to compare their results with those of healthy controls.

Methods: The Pittsburgh Sleep Quality Index (PSQI) was used to measure SQ in a convenience sample of 609 TMD cases and 88 controls. The Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD) Axis I diagnostic nomenclature was used, but Axis I diagnoses were based on the consensus of two reliable criterion examiners and not the RDC/TMD algorithms. The PSQI scores for TMD cases were calculated also for the RDC/TMD Axis II measures assessing chronic pain and disability, depression, and nonspecific physical symptoms. PSQI scores of the TMD cases were compared with those from controls.

Results: TMD cases with one to five TMD diagnoses (n = 609) had a mean PSQI score of 7.0 [95% confidence interval (CI) = 6.7-7.4]. In comparison, the mean score was 5.2 (95% CI = 4.6-5.9) for control subjects. For the subset of TMD cases with pain-free diagnoses (n = 113), the PSQI score was similar to controls with 5.1 (95% CI = 4.5-5.6), whereas it was significantly different for cases with pain-related diagnoses 7.5 (95% CI = 6.6-8.3; n = 87). Although the number of TMD diagnoses and participant age had some influence on SQ, psychosocial status, and pain-related impairment assessed with RDC/TMD Axis II measures had the strongest association with SQ, in particular, dysfunctional chronic pain.

Conclusion: SQ is impaired in TMD patients with pain-related diagnoses, and even more in those with dysfunctional pain. This relationship between sleep and pain suggests that SQ should be assessed in TMD pain patients, especially in those with significant Axis II involvement.

Keywords: Dysfunctional pain; Facial pain; Pittsburgh Sleep Quality Index; Questionnaire; Sleep quality; Temporomandibular disorder.

Fig. 1

Bar graphs represent mean Pittsburgh Sleep Quality Index (PSQI) values [±95% confidence intervals (CI)] for sex, age, race/ethnicity, and education. Statistically significant results of independent-samples t tests are displayed for sex, race/ethnicity, and education (A, C, and D, respectively). Statistical significance by analysis of variance is displayed for the age quartiles (B). The p values displayed confirm whether differences between/across groups of TMD cases were statistically significant (p < 0.05).

Fig. 2

(Left to right) Bar graphs represent mean Pittsburgh Sleep Quality Index (PSQI) ± 95% confidence intervals (CI) for the following: comparison of sleep quality in temporomandibular disorder (TMD) cases with only pain-free Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD) Axis I diagnoses versus only pain-related Axis I diagnoses; sleep quality in TMD cases, who had only one Axis I physical diagnosis; and comparison of sleep quality in cases with one to four different physical Axis I diagnoses. According to the RDC/TMD nomenclature, the eight physical diagnoses are as follows: Myofascial pain without limited opening (Ia); Myofascial pain with limited opening (Ib); Disc displacement with reduction (IIa); Disc displacement without reduction, with limited opening (IIb); Disc displacement without reduction, without limited opening (IIc); Arthralgia (IIIa); Osteoarthritis of the TMJ (IIIb); and, Osteoarthrosis of the TMJ (IIIc). Group differences were statistically assessed using a t test (panel A) and analysis of variance (panels B and C) and presented with their p values.

Fig. 3

Mean PSQI scores ± 95% CI for TMD cases related to Axis II constructs: depression, nonspecific physical symptoms (ie, somatization), and chronic pain level assessed with the Graded Chronic Pain Scale (GCPS), are displayed. Statistical significances of ANOVA tests are also displayed. The displayed p-values confirmed whether differences between/across subgroups of TMD cases were statistically significant (p < 0.05).