Association of Sleep Quality and Painful Temporomandibular Disorders
Goldberg, Jeffrey I.
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Within the biopsychosocial paradigm researchers and clinicians acknowledge the role of social, cultural, psychological, as well as physiological components of chronic pain. An association between pain and sleep is well established, and people with pain related to temporomandibular disorders (TMD) typically have poor sleep quality, but the various psychosocial influences that play a role in this relationship warrant further exploration. The objective of this study was to examine the association between TMD pain, sleep quality, and responses to the Multidimensional Pain Inventory (MPI), a measure of cognitive, behavioral, and affective responses to pain. This was a retrospective study using data from 719 participants in RDC / TMD Validation Project, classified as either no-pain (controls, disc displacements, arthrosis) or pain (myofascial pain, arthralgia), based on the consensus diagnosis from the enhanced version of the Research Diagnostic Criteria for TMD used in that study. Individuals in the pain group were statistically more likely to have poor sleep quality than those in the no-pain group, using the Pittsburgh Sleep Quality Index (PSQI) to assess sleep quality (OR = 2.48, 95% CI = 1.89, 3.24, p < 0.001). This finding was consistent for six out of seven subscales of the PSQI and in the Interference Subscale, Dysfunctional Composite Scale, and Interpersonal Distress Composite Scale of the MPI. Logistic regression modeling indicated that a high score on the Dysfunctional Composite Scale is the strongest predictor of being a poor sleeper (OR = 2.22, 95% CI = 1.49, 3.31, p < 0.001, using median split method), followed by pain (OR = 2.21, 95% CI = 1.43, 3.42, p < 0.001), then by a high score on the Interference Subscale (OR = 1.49, 95% CI = 1.02, 2.18, p = 0.041). The Interpersonal Distress Composite Scale did not significantly predict poor sleep. The results confirm the association between diagnosed TMD pain and poor sleep quality, using a large, very well phenotyped study population. The MPI provides additional information which may be very useful in characterizing poor sleep in TMD patients and in developing treatment approaches which target psychosocial factors.