The Association between Temporomandibular Disorder and Sleep Apnea—A Nationwide Population-Based Cohort Study

Abstract

An increased incidence of temporomandibular disorders (TMD) among patients with sleep apnea (SA) has been reported. However, the association between TMD and SA has not been demonstrated in a large-scale study. This population-based cohort study with the Taiwan National Health Insurance (NHI) Research Database aimed to understand the association between SA and TMD. We identified adult patients with suspected SA (identified with diagnostic codes) and excluded those diagnosed with TMD prior to SA. Patients with SA diagnosis after polysomnography were also identified as probable SA patients. The index dates were the dates of their initial SA diagnosis. Ten control subjects were matched, by age and sex, to each SA patient, and were assigned the same index dates as the SA patients. In total, 10,408 suspected SA patients (including 4105 probable SA patients) matched to 104,080 control subjects (including 41,050 subjects matched to the probable SA patients) in this study. The TMD incidence rate was significantly higher in the SA patients than in the control subjects (2.8 vs. 1.0 per thousand-patient-year in probable SA patients vs. the corresponding control subjects, with an adjusted incidence rate ratio [95% confidence interval] = 2.5 [2.3–2.7], p < 0.0001). SA patients significantly showed a higher cumulative incidence of TMD than the corresponding control subjects (p < 0.0001). Multivariable Cox regression analysis revealed SA as an independent risk factor for the development of TMD (adjusted hazard ratio = 2.5 [1.7–3.7], p < 0.0001). In summary, this study confirmed an increased TMD incidence in the SA patients. While treating TMD patients, dentists should pay careful attention to the potential underlying SA.

Unsupervised Machine Learning Identified Distinct Population Clusters Based on Symptoms of Oral Pain, Psychological Distress, and Sleep Problems

“…These symptoms have been previously shown to be coexistent. [ 4 5 , 10 22 ] In the present study, the k -medoids algorithm partitioned the participants into five distinct clusters, confirming the associations among such symptoms.…”

“…This is in accord with findings from a large cohort study showing that poor sleep quality preceded pain. [ 22 ] It has been suggested that sleep apnea is associated with a cascade of events involving sleep deprivation, intermittent hypoxia, and generation of inflammatory mediators, resulting in pain hypersensitivity. [ 25 26 ]…”

The Relationship Between Primary Sleep Disorders and Temporomandibular Disorders: An 8-Year Nationwide Cohort Study in South Korea

“…However, most studies focus on the influence of bruxism as a contributing factor to TMD pain aggravation 52 and more recently have investigated the relationship between TMD and sleep-related breathing disorders as a single disease entity stating obstructive sleep apnea as a risk factor of developing TMD. 53 , 54 The only other primary sleep disorder to be analyzed in relation to TMD is insomnia although the existing literature is scarce in spite of the fact that insomnia disorder is the most frequently diagnosed sleep disorder in TMD patients. 29 One study reported that insomnia was associated with reduced mechanical and thermal pain thresholds in myofascial TMD patients 29 and another study showed that the increases in insomnia symptoms were succeeded by increases in average daily TMD pain in the next month.…”

Effects of Clinical Characteristics on Sleep Quality in Patients with Chronic Temporomandibular Disorders

“…There is a limit to the extended interpretation of the results of the sleep quality and high risk of OSA in patients with chronic TMD, as the relationship between OSA and TMD. Of course, a bidirectional association between OSA and TMD have been suggested 24,54 . Although the clear mechanism has not been identi ed, oral appliances used in the treatment of OSA may be the cause of TMD with continuous mandibular advancement while sleeping 55 .…”