Document Detail

Sleep disorders and their association with laboratory pain sensitivity in temporomandibular joint disorder.
MedLine Citation:
PMID:  19544755     Owner:  NLM     Status:  MEDLINE    
STUDY OBJECTIVES: We characterized sleep disorder rates in temporomandibular joint disorder (TMD) and evaluated possible associations between sleep disorders and laboratory measures of pain sensitivity.
DESIGN: Research diagnostic examinations were conducted, followed by two consecutive overnight polysomnographic studies with morning and evening assessments of pain threshold.
SETTING: Orofacial pain clinic and inpatient sleep research facility.
PARTICIPANTS: Fifty-three patients meeting research diagnostic criteria for myofascial TMD.
MEASUREMENTS AND RESULTS: We determined sleep disorder diagnostic rates and conducted algometric measures of pressure pain threshold on the masseter and forearm. Heat pain threshold was measured on the forearm; 75% met self-report criteria for sleep bruxism, but only 17% met PSG criteria for active sleep bruxism. Two or more sleep disorders were diagnosed in 43% of patients. Insomnia disorder (36%) and sleep apnea (28.4%) demonstrated the highest frequencies. Primary insomnia (PI) (26%) comprised the largest subcategory of insomnia. Even after controlling for multiple potential confounds, PI was associated with reduced mechanical and thermal pain thresholds at all sites (P < 0.05). Conversely, the respiratory disturbance index was associated with increased mechanical pain thresholds on the forearm (P < 0.05).
CONCLUSIONS: High rates of PI and sleep apnea highlight the need to refer TMD patients complaining of sleep disturbance for polysomnographic evaluation. The association of PI and hyperalgesia at a nonorofacial site suggests that PI may be linked with central sensitivity and could play an etiologic role in idiopathic pain disorders. The association between sleep disordered breathing and hypoalgesia requires further study and may provide novel insight into the complex interactions between sleep and pain-regulatory processes.
Michael T Smith; Emerson M Wickwire; Edward G Grace; Robert R Edwards; Luis F Buenaver; Stephen Peterson; Brendan Klick; Jennifer A Haythornthwaite
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Publication Detail:
Type:  Journal Article; Research Support, N.I.H., Extramural    
Journal Detail:
Title:  Sleep     Volume:  32     ISSN:  0161-8105     ISO Abbreviation:  Sleep     Publication Date:  2009 Jun 
Date Detail:
Created Date:  2009-06-23     Completed Date:  2009-07-20     Revised Date:  2013-06-02    
Medline Journal Info:
Nlm Unique ID:  7809084     Medline TA:  Sleep     Country:  United States    
Other Details:
Languages:  eng     Pagination:  779-90     Citation Subset:  IM    
Johns Hopkins University School of Medicine, Department of Psychiatry and Behavioral Sciences, Baltimore, MD, USA.
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MeSH Terms
Bruxism / diagnosis,  epidemiology,  psychology
Cross-Sectional Studies
Hyperalgesia / diagnosis,  epidemiology,  psychology
Longitudinal Studies
Middle Aged
Nocturnal Myoclonus Syndrome / diagnosis,  epidemiology,  psychology
Pain Threshold*
Sleep Apnea, Obstructive / diagnosis,  epidemiology,  psychology
Sleep Disorders / diagnosis*,  epidemiology*,  psychology
Sleep Initiation and Maintenance Disorders / diagnosis,  epidemiology,  psychology
Temporomandibular Joint Dysfunction Syndrome / diagnosis*,  epidemiology*,  psychology
Young Adult
Grant Support

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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