Department of Oral Medicine and Oral Diagnosis, School of Dentistry, Seoul National University, Seoul, Korea.
Department of Oral Medicine, Seoul National University Dental Hospital, Seoul, Korea.
J Oral Rehabil. 2023 Sep;50(9):830-839. doi: 10.1111/joor.13494. Epub 2023 May 24.
Sleep disturbance is a systemic symptom and at the same time a major modulating factor of temporomandibular disorders (TMD). Inflammation is known as a underlying mechanism involved in both poor sleep and increased pain.
The relationship between long-term clinical characteristics and hematologic biomarkers of hypothalamic-pituitary-adrenal axis activity and inflammation in TMD patients according to sleep duration was investigated to verify the possible role of sleep disturbance and systemic inflammation in TMD.
Inflammatory and stress mediator levels of venous blood samples were investigated in 63 female TMD patients along with comorbidity levels including stress, somatization, autonomic symptoms and sleep quality based on structured questionnaires. Differences in long-term clinical characteristics and hematologic variables following conservative treatment were analysed according to total sleep time as normal, short and long sleep groups. Also, clinical and hematologic indices related to favourable treatment response were sought out.
Significantly less patients in the long sleep group reported pain on voluntary mandibular movement (p = .042) while depression (p = .043) and somatization levels (p = .002) were significantly higher in the short sleep group. Norepinephrine levels of the long sleep group were significantly lower than other groups. Decrease in pain intensity with treatment was smallest in the short sleep group. Erythrocyte sedimentation rate was associated with significant pain improvement at 3 months post-treatment and interleukin-1β, -4, and -8 levels could predict favourable treatment response.
Short sleep is associated with more comorbidities and unfavourable long-term treatment response in TMD which may be mediated by systemic inflammation. Effective management of sleep is necessary for successful TMD management.
睡眠障碍是一种全身症状，同时也是颞下颌关节紊乱（TMD）的主要调节因素。炎症是与睡眠质量差和疼痛加剧有关的潜在机制之一。
根据睡眠时间，研究 TMD 患者下丘脑-垂体-肾上腺轴活动和炎症的长期临床特征与血液生物标志物之间的关系，以验证睡眠障碍和全身炎症在 TMD 中的可能作用。
对 63 名女性 TMD 患者的静脉血样进行炎症和应激介质水平的检测，同时根据结构化问卷调查包括应激、躯体化、自主症状和睡眠质量在内的共病水平。根据总睡眠时间将患者分为正常、短睡和长睡组，分析保守治疗后长期临床特征和血液学变量的差异。还寻找与治疗反应良好相关的临床和血液学指标。
长睡眠时间组报告自愿下颌运动时疼痛的患者明显较少（p = .042），而短睡眠时间组的抑郁（p = .043）和躯体化水平（p = .002）明显更高。长睡眠时间组的去甲肾上腺素水平明显低于其他组。短睡眠时间组治疗后疼痛强度的降低最小。治疗 3 个月后红细胞沉降率与疼痛显著改善相关，白细胞介素-1β、-4 和-8 水平可预测治疗反应良好。
TMD 患者中，短睡眠与更多的共病和不利的长期治疗反应相关，这可能是由全身炎症介导的。有效的睡眠管理对于成功的 TMD 管理是必要的。
