Depressive symptoms account for differences between self‐reported versus polysomnographic assessment of sleep quality in women with myofascial TMD

Abstract

Background Temporomandibular disorder (TMD) patients report poor sleep quality on the Pittsburgh Sleep Quality Index (PSQI). However, polysomnographic (PSG) studies show meager evidence of sleep disturbance on standard physiological measures. Objective The present aim was to analyze self-reported sleep quality in TMD as a function of myofascial pain, PSG parameters, and depressive symptomatology. Methods PSQI scores from 124 women with myofascial TMD and 46 matched controls were hierarchically regressed onto TMD presence, ratings of pain intensity and pain-related disability, in-lab PSG variables, and depressive symptoms (Symptoms Checklist-90). Results Relative to controls, TMD cases had higher PSQI scores, representing poorer subjective sleep, and more depressive symptoms (both P < 0.001). Higher PSQI scores were strongly predicted by more depressive symptoms (P < 0.001, R2 = 26%). Of 19 PSG variables, two had modest contributions to higher PSQI scores: longer REM latency in TMD cases (P = 0.01, R2 = 3%) and more awakenings in all participants (P = 0.03, R2 = 2%). After accounting for these factors, TMD presence and pain ratings were not significantly related to PSQI scores. Conclusion These results show that reported poor sleep quality in TMD is better explained by depressive symptoms than by PSG-assessed sleep disturbances or myofascial pain. As TMD cases lacked typical PSG features of clinical depression, the results suggest a negative cognitive bias in TMD and caution against interpreting self-report sleep measures as accurate indicators of PSG sleep disturbance. Future investigations should take account of depressive symptomatology when interpreting reports of poor sleep.

The face of Dental Sleep Medicine in the 21st century

“…In addition, such pre‐diagnostic changes in the trajectory of sleep quality support the fact that many patients with TM pain also present sleep disorders, such as insomnia, respiratory effort‐related arousal or sleep 14–16 . Furthermore, TM pain patients also tend to present more mood alteration, such as depression symptomatology, or sleep and/or awake bruxism as compared to healthy controls 17–19 …”

“…[14][15][16] Furthermore, TM pain patients also tend to present more mood alteration, such as depression symptomatology, or sleep and/or awake bruxism as compared to healthy controls. [17][18][19]…”

<p>The Evaluation of Autonomic Arousals in Scoring Sleep Respiratory Disturbances with Polysomnography and Portable Monitor Devices: A Proof of Concept Study</p>

“…Additionally, it is important to consider the potential influence that a "first night effect" and/or conditions associated with sleep fragmentation and autonomic dysfunction such as insomnia, chronic pain (eg, fibromyalgia, temporomandibular disorders), or mood disorders can have in the calculation these indexes. [33][34][35][36][37] Future investigations are needed to assess the reproducibility of these indexes across different recorded nights and to evaluate how concomitant clinical disorders can affect their value.…”

Association between sleep bruxism and anxiety symptoms in adults: A systematic review

“…27,28 A possible hypothesis for substantially conflicting results observed might be proposed based on previous observations with regard to over report of certain conditions by individuals with specific psychosocial traits, such as depression and stress. 37 Another possible explanation might be related to SB assessment methods, since instrumental approach was only made in one study. Self-report of SB may also have influenced the results, and none of the included studies assessed SB through PSG.…”