Subjective Sleep Quality in Temporomandibular Disorder Patients and Association with Disease Characteristics and Oral Health-Related Quality of Life

Aims : To measure sleep quality in temporomandibular disorder (TMD) patients, to compare it with that of control subjects, and to analyze its association with disease characteristics and oral health-related quality of life (OHRQoL). Methods: The collected data included demographics, tobacco use, the Pittsburgh Sleep Quality Index (PSQI), trauma history, presence of coexisting headaches and/or body pain, parafunctional habits, pain scores, muscle tenderness to palpation scores, and the Oral Health Impact Profile-14 (OHIP-14). Differences between groups were examined with Pearson chi-square test for categorical variables and independent t test and analysis of variance (ANOVA) for numeric variables. Significant differences were then further tested with multivariate backward stepwise linear regression analysis. Results : The final analysis was performed on 286 individuals (187 TMD patients and 99 controls). Poor sleep (PSQI global score > 5) was exhibited in 43.3% of the TMD group and in 28.3% of the control group (P =.013) (mean +/- standard deviation [SD] PSQI score = 5.53 +/- 2.85 for TMD patients and 4.41 +/- 2.64 for controls, P =.001). TMD patients had significantly worse scores in the sleep quality component of the PSQI questionnaire (P =.006). Higher PSQI global scores and poor sleep were positively associated with whiplash history (P =.009 and P =.004, respectively), coexisting headaches (P =.005 and P =.002), body pain (P =.001 and P <.001), clenching habit (P =.016 and P =.006), reduced unassisted (P =.014 and P =.042) and assisted (P =.005 and P =.006) mouth opening, higher muscle tenderness scores, higher pain scores, and higher OHIP-14 global and dimension scores. Conclusion : TMD patients had poorer sleep than controls. Sleep quality was positively associated with TMD disease characteristics, comorbid pain conditions, and poorer OHRQoL. Assessing sleep quality should be a routine part of the diagnostic work-up of TMD patients. A multidisciplinary management approach is needed to address all the factors-including sleep-that modulate pain experience.