Associations between obstructive sleep apnea and painful temporomandibular disorder: a systematic review

Abstract

The relationship between obstructive sleep apnea (OSA) and diverse types of pain conditions have been proposed. However, no consensus on the relationship between OSA and painful temporomandibular disorders (TMDs) has been established. Therefore, this systematic review has been conducted to review the existing literatures and provide comprehensive synthesis of such literatures about OSA and painful TMDs using the evidence-based methodology. A literature search was conducted using two electronic databases, Scopus, and PubMed. Risk of bias was assessed using the risk-ofbias assessment tool for non-randomized study version 2.0. A total of 158 articles were screened from the initial search and eventually, 5 articles were included in this systematic review. One study adopted both the longitudinal prospective cohort and case-control designs and other 4 articles adopted the cross-sectional design. Two studies employed polysomnography (PSG) for the diagnosis of OSA and mentioned the results from the PSG. All crosssectional studies demonstrated higher OSA prevalence among patients with TMD, and one cohort study suggested OSA as a risk factor for TMD. OSA appears to have potential influences on the development of TMD; however, the role of TMD in the development of OSA remains to be unknown owing to the lack of high-quality evidences.

Causal effects of educational attainment on temporomandibular disorders and the mediating pathways: A Mendelian randomization study

“…Similarly, our UVMR findings revealed no causal links of genetically determined education with autoimmune traits including SLE and Sjogren's syndrome, despite adults with immune‐mediated rheumatic diseases showing a significant relevance to TMDs. The disparities between MR and observational studies may, in part, be attributed to genetic variance in the former and potential bias from residual confounding or reverse causation in the latter 23 . Furthermore, certain lifestyles and socioeconomic factors, such as initial smoking, smoking history and average household income, were excluded from our mediation analyses due to their significant bidirectional causal associations with education, part of which are in line with a recent MR study between education and socioeconomic status 12,14 .…”

“…The disparities between MR and observational studies may, in part, be attributed to genetic variance in the former and potential bias from residual confounding or reverse causation in the latter. 23 Furthermore, certain lifestyles and socioeconomic factors, such as initial smoking, smoking history and average household income, were excluded from our mediation analyses due to their significant bidirectional causal associations with education, part of which are in line with a recent MR study between education and socioeconomic status. 12,14 As a potential risk factor for TMDs, underweight was not identified as the mediator in our study.…”

“…The candidate mediators included nine psychology‐related traits (depression, feeling lonely, miserable, guilty, fed‐up, nervous, worry, hurt, and tense), 19,20 four smoking and dietary behaviours (ever smoked, smoking initial, cigarettes smoked per day, alcohol intake frequency), 21 three adiposity traits (body mass index [BMI], waist‐to‐hip ratio [WHR], body fat percentage), 22 five sleep‐related traits (apnea, snoring, insomnia, daytime sleepiness, sleep duration), 23,24 one physical activity (moderate to vigorous physical activity levels), 19 two autoimmune disorders (systemic lupus erythematosus [SLE], Sjogren's syndrome [SS]), 25 insufficient Vitamin D (vitamin D supplement, serum 25‐Hydroxyvitamin D levels), 25 estradiol levels in females and males, 26 lower back pain 27 and average total household income 28 . Detailed information on all GWAS included in our study is shown in Table S2.…”

Efficacy of orofacial myofunctional therapy combined with myofascial release in patients with mild obstructive sleep apnoea: a randomized controlled trial

“…Moreover, about the 51% of OSA patients showed signs and symptoms of TMD and about 30% of TMD patients met the diagnostic criteria for insomnia and OSA 29,30 . The linkage among these conditions may be found in the hyperalgesia that OSA patients might experience, in relation to the fragmented sleep and hypoxemia that might enhance peripheral and central pain sensitization, thus increasing spontaneous pain 29,31,32 .…”

“…28 Moreover, about the 51% of OSA patients showed signs and symptoms of TMD and about 30% of TMD patients met the diagnostic criteria for insomnia and OSA. 29,30 The linkage among these conditions may be found in the hyperalgesia that OSA patients might experience, in relation to the fragmented sleep and hypoxemia that might enhance peripheral and central pain sensitization, thus increasing spontaneous pain. 29,31,32 However, a recent crosssectional study performed by Bartolucci et al 33 showed that the prevalence of TMDs in adults with OSA was not significantly higher compared to healthy controls in their cohort; therefore, further studies should confirm this potential correlation providing reliable evidence on the role of conservative treatments for TMD in patients affected by OSA.…”