Center for TMD & Orofacial Pain, Peking University School & Hospital of Stomatology, No. 22 Zhong Guan Cun South Ave, Beijing, 100081, China.
Department of Dentistry, Ng Teng Fong General Hospital, National University Health System, Singapore, Singapore.
Clin Oral Investig. 2021 Jun;25(6):4097-4105. doi: 10.1007/s00784-020-03740-4. Epub 2021 Jan 6.
This study compared the differences in emotional disturbance, sleep, and life quality among adult patients with temporomandibular (TMD) muscle and/or joint pain.
The study involved an analytical cross-sectional design. A total of 420 consecutive patients diagnosed with pain-related TMDs based on the Diagnostic Criteria for TMDs (DC/TMD) were recruited from a TMD referral centre and stratified into three groups, namely muscle pain (MP; n = 50), joint pain (JP; n = 329), and combined muscle-joint pain (CP; n = 41). Emotional disturbance, sleep quality, and oral health-related quality of life (OHRQoL) were assessed with the Depression, Anxiety, and Stress Scale-21 (DASS-21), Pittsburgh Sleep Quality Index (PSQI), and Oral Health Impact Profile-TMDs (OHIP-TMDs) respectively. Statistical analyses were performed using the chi-square test, one-way ANOVA, and Pearson's correlation (p < 0.05).
Mean age for the three pain groups (females = 349; males = 71) ranged from 37.15 ± 14.91 to 38.60 ± 14.37 years (p = 0.973). Ranking of depression, anxiety, and stress scores was as follows: CP > MP > JP. Significant differences in emotional disturbances were observed (p < 0.001). CP patients had significantly poorer sleep quality than those with JP (p = 0.004). Moreover, OHRQoL was also significantly more impaired as compared to both MP (p = 0.006) and JP (p < 0.001) patients. Correlations between global PSQI and OHIP-TMDs scores were weak to moderate (r = 0.30-0.47).
Patients with combined muscle-joint pain presented higher levels of emotional disturbance than those with only MP or JP. They also had significantly poorer sleep quality and lower OHRQoL.
Emotional and sleep health must be considered in the management of painful TMDs.
本研究比较了伴有颞下颌（TMJ）肌肉和/或关节疼痛的成年患者在情绪障碍、睡眠和生活质量方面的差异。
本研究采用分析性横断面设计。共招募了 420 名连续诊断为基于 TMJ 诊断标准（DC/TMD）的疼痛相关 TMJ 患者，将其分为三组，即肌肉疼痛（MP）组（n = 50）、关节疼痛（JP）组（n = 329）和混合肌-关节疼痛（CP）组（n = 41）。采用抑郁、焦虑和压力量表 21 项（DASS-21）、匹兹堡睡眠质量指数（PSQI）和口腔健康影响程度量表-TMJ （OHIP-TMDs）分别评估情绪障碍、睡眠质量和口腔健康相关生活质量（OHRQoL）。采用卡方检验、单因素方差分析和 Pearson 相关性分析（p<0.05）进行统计分析。
三组疼痛患者的平均年龄（女性=349；男性=71）范围为 37.15±14.91 岁至 38.60±14.37 岁（p=0.973）。抑郁、焦虑和压力评分的排序如下：CP>MP>JP。观察到情绪障碍存在显著差异（p<0.001）。CP 患者的睡眠质量明显差于 JP 患者（p=0.004）。此外，与 MP（p=0.006）和 JP（p<0.001）患者相比，CP 患者的 OHRQoL 也明显受损。PSQI 总分与 OHIP-TMDs 评分之间的相关性为弱至中度（r=0.30-0.47）。
伴有混合肌-关节疼痛的患者比仅患有 MP 或 JP 的患者表现出更高的情绪障碍水平。他们的睡眠质量也明显更差，口腔健康相关生活质量更低。
在 TMJ 疼痛的管理中必须考虑情绪和睡眠健康。
