Department of Oral and Maxillofacial Pathology, Radiology and Medicine, NYU College of Dentistry, New York, NY ; Center for Sleep Disorders Medicine and Research, Division of Pulmonary and Critical Care Medicine New York Methodist Hospital, Brooklyn, NY.
Department of Oral and Maxillofacial Pathology, Radiology and Medicine, NYU College of Dentistry, New York, NY.
J Clin Sleep Med. 2014 Feb 15;10(2):195-201. doi: 10.5664/jcsm.3452.
Temporomandibular pain disorders (TMD) and myofascial pain were linked to increased prevalence of insomnia and obstructive sleep apnea (OSA) on clinical grounds. However, the literature lacks an accurate polysomnographic (PSG) characterization of sleep abnormalities associated with TMD, given that prior studies included small or uncontrolled samples of TMD patients. The present investigation aims to objectively evaluate measures of sleep and respiratory disturbance in a large representative sample of TMD cases in comparison with matched controls.
Sleep, respiration, and limb movements were measured using a 2-night attended PSG protocol in 170 women-124 TMD cases with myofascial pain and 46 demographically matched controls. The second night data were compared between the groups using ANCOVAs. In TMD cases, the relationship between pain ratings and sleep parameters was analyzed using multiple regressions.
In comparison to healthy controls, TMD cased evidenced a significant increase in stage N1 sleep (12.2% ± 7.6% vs. 9.2% ± 5.0%, p = 0.03), which was only mild relative to normative values. TMD cases also demonstrated mild but significant elevations in arousals associated with all types of respiratory events (6.0/h ± 6.1 vs. 3.5/h ± 3.3 p = 0.02) and in respiratory effort related arousals (RERAs, 4.3/h ± 4.3 vs. 2.6/h ± 2.7, p = 0.02). Myofascial pain predicted a lower sleep efficiency (p = 0.01), more frequent awakenings (p = 0.04), and higher RERA index (p = 0.04) among TMD cases.
Myofascial pain in TMD is associated with mild elevation in sleep fragmentation and increased frequency of RERA events. Further research is required to evaluate the clinical significance of these findings.
基于临床依据，颞下颌疼痛障碍（TMD）和肌筋膜疼痛与失眠和阻塞性睡眠呼吸暂停（OSA）的发病率增加有关。然而，鉴于先前的研究包括 TMD 患者的小样本或无对照样本，文献中缺乏 TMD 相关睡眠异常的准确多导睡眠图（PSG）特征。本研究旨在通过 2 晚的多导睡眠图协议，客观评估大量 TMD 病例与匹配对照组的睡眠和呼吸障碍指标。
170 名女性，其中 124 名 TMD 患者为肌筋膜疼痛患者，46 名为年龄匹配的对照组，使用 2 晚的多导睡眠图协议测量睡眠、呼吸和肢体运动。使用方差分析（ANCOVA）比较两组间的第二晚数据。在 TMD 患者中，使用多元回归分析疼痛评分与睡眠参数之间的关系。
与健康对照组相比，TMD 患者的 N1 期睡眠（12.2%±7.6%vs.9.2%±5.0%，p=0.03）显著增加，这仅比正常值略高。TMD 患者还表现出与所有类型呼吸事件（6.0/h±6.1 vs.3.5/h±3.3，p=0.02）和呼吸努力相关觉醒（RERAs，4.3/h±4.3 vs.2.6/h±2.7，p=0.02）相关的轻度但显著增加的觉醒。肌筋膜疼痛预测 TMD 患者的睡眠效率较低（p=0.01）、觉醒频率更高（p=0.04）和 RERA 指数更高（p=0.04）。
TMD 中的肌筋膜疼痛与睡眠碎片化轻度升高和 RERA 事件频率增加有关。需要进一步研究评估这些发现的临床意义。
