颞下颌关节紊乱严重程度和诊断组别：与睡眠质量和障碍的关联。
Temporomandibular disorder severity and diagnostic groups: Their associations with sleep quality and impairments.
机构信息
Center for TMD & Orofacial Pain, Peking University School & Hospital of Stomatology, Beijing, China; Department of Dentistry, Ng Teng Fong General Hospital, National University Health System, Singapore; Faculty of Dentistry, National University of Singapore, Singapore; Duke-NUS Medical School, Singapore; National Dental Research Institute Singapore, National Dental Centre Singapore, Singapore.
Center for TMD & Orofacial Pain, Peking University School & Hospital of Stomatology, Beijing, China; Department of Oral & Maxillofacial Radiology, Peking University School & Hospital of Stomatology, Beijing, China; National Clinical Research Center for Oral Diseases, Beijing, China; National Engineering Laboratory for Digital and Material Technology of Stomatology, Beijing, China; Beijing Key Laboratory of Digital Stomatology, Beijing, China.
出版信息
Sleep Med. 2021 Apr;80:218-225. doi: 10.1016/j.sleep.2021.01.063. Epub 2021 Feb 2.
OBJECTIVES
This study evaluated the impact of TMD severity on sleep quality and established the associations between TMD diagnostic groups/pain subtypes and sleep impairments.
METHODS
A total of 1151 patients from a tertiary Dental Hospital were screened for eligibility. Consenting subjects who met the inclusion criteria were directed to complete a general/health questionnaire, the Fonseca Anamnestic Index (FAI), Diagnostic Criteria for Temporomandibular disorders (DC/TMD) Symptom Questionnaire, and Pittsburgh Sleep Quality Index (PSQI) at their intake visit. Patients who screened positive for TMDs with the FAI were subjected to a protocolized physical examination and TMD diagnostic groups/subtypes were subsequently derived based on the DC/TMD "diagnostic tree" and algorithms. Statistical analyses were conducted using non-parametric methods and logistic regression (α = 0.05).
RESULTS
The final sample consisted of 845 subjects with TMDs and 116 TMD-free controls. The mean age of the TMD and TMD-free subjects were 33.17 ± 13.55 and 31.66 ± 9.50 years. Subjects with severe and moderate TMDs had significantly greater global PSQI scores than those with mild and no TMDs (p < 0.001). Those with pain-related, intra-articular, and combined TMDs reported significantly poorer sleep quality than those with no TMDs (p < 0.001). Moreover, subjects with myalgia and myalgia plus arthralgia presented significantly greater sleep impairments than their counterparts with intra-articular disorders (p < 0.001). Multivariate logistic regression indicated that pain-related (OR = 3.23; CI = 1.69-6.14) and intra-articular TMDs (OR = 1.91; CI = 1.15-3.16) were most related to poor sleep.
CONCLUSIONS
Sleep quality worsened with increasing TMD severity and the presence of painful and intra-articular TMDs increased the likelihood of poor sleep.
目的
本研究评估了 TMD 严重程度对睡眠质量的影响，并确定了 TMD 诊断组/疼痛亚型与睡眠障碍之间的关联。
方法
从一家三级牙科医院筛选了 1151 名符合条件的患者。同意参加的符合纳入标准的受试者在就诊时被要求完成一般/健康问卷、福塞卡病史指数（FAI）、颞下颌关节紊乱诊断标准（DC/TMD）症状问卷和匹兹堡睡眠质量指数（PSQI）。用 FAI 筛查出 TMD 阳性的患者进行了一项方案化的体格检查，随后根据 DC/TMD“诊断树”和算法得出 TMD 诊断组/亚型。使用非参数方法和逻辑回归（α=0.05）进行统计分析。
结果
最终样本包括 845 名 TMD 患者和 116 名 TMD 对照组。TMD 和 TMD 对照组的平均年龄分别为 33.17±13.55 岁和 31.66±9.50 岁。重度和中度 TMD 患者的全球 PSQI 评分明显高于轻度和无 TMD 患者（p<0.001）。有疼痛相关、关节内和联合 TMD 的患者报告的睡眠质量明显差于无 TMD 的患者（p<0.001）。此外，肌痛和肌痛伴关节痛患者的睡眠障碍明显大于关节内疾病患者（p<0.001）。多变量逻辑回归表明，疼痛相关（OR=3.23；CI=1.69-6.14）和关节内 TMD（OR=1.91；CI=1.15-3.16）与睡眠质量差最相关。
结论
随着 TMD 严重程度的增加，睡眠质量恶化，疼痛和关节内 TMD 的存在增加了睡眠质量差的可能性。
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