Investigation of Snoring and Obstructive Sleep Apnea Using Portable Polysomnography in Patients with Temporomandibular Disorder

Abstract

Objective: To investigate snoring and obstructive sleep apnea (OSA) in patients with temporomandibular disorder (TMD) using portable polysomnography and identify sex-based differences in clinical features and sleep-related results.

Methods: Seventy consecutive patients (44 female; mean age, 46.6918.18 years) with myofascial pain-associated TMD, diagnosed based on the criteria for TMD Axis I, were enrolled. Sleep quality and quantity were measured using portable polysomnography. Clinical characteristics were investigated using well-structured standardized reports on clinical signs and symptoms, questionnaires, and clinical examination by TMD specialists.

Results: Among 70 TMD patients, 50.0% had OSA and 15.7% had snoring, with no sex-based differences. The mean Mallampati scores for OSA prediction (2.69±1.12 vs. 1.70±0.82, p<0.001), mean body mass index (BMI) (24.94±1.78 vs. 22.02±2.24, p<0.001), and ratio of overweight patients (57.7 vs. 11.4%) with BMI ≥25 were significantly higher in males than in females (all p<0.001). Conversely, the mixed sleep apnea index was significantly higher in females than in males (0.81±0.80 vs. 0.44±0.54, p=0.022). Female sex was associated with the absence of snoring (OR=0.146, p=0.022). Based on the area under curve (AUC) value for snoring prediction, Mallampati score was the strongest predictor (AUC>0.932, p<0.001), followed by BMI, overweight, and obstructive sleep apnea index (AUC>0.8, all p<0.001).

Conclusions: Our results support the necessity of investigating sex-based differences when examining sleep problems, including snoring and OSA, in TMD patients. Mallampati scoring could be a useful tool for physical examination prior to polysomnography. Sleep and biopsychosocial factors are important for the diagnosis and treatment of TMD.

Keywords: Mallampati score; Obstructive sleep apnea; Overweight; Polysomnography; Snoring; Temporomandibular disorder.

Figure 1:

Distribution of Mallampati score according to sex in TMD patients. Class 1: Faucial/tonsillar pillars, uvula, and soft palate are all visible. Class 2: Partial visibility of the faucial/tonsillar pillars, uvula, and soft palate. Class 3: Base of the uvula, soft palate, and hard palate are visible. Class 4: Only the hard palate is visible.

Figure 2:

Schematic diagram of a study participant equipped with portable polysomnography

Figure 3:

ROC analysis of significant predictors of snoring. (A) Factors related to Mallampati score, (B) factors related to OSA ROC, receiver operating characteristic; OSA, obstructive sleep apnea; BMI, body mass index; AUC, area under ROC curve; REI, respiratory event index; OAI, obstructive apnea index; CAI, central apnea index; SpO₂, saturation of percutaneous oxygen.