Skip to main content

Advertisement

SpringerLink
Log in

Prevalence of signs and symptoms of temporo-mandibular disorder in patients with sleep apnea

  • Sleep Breathing Physiology and Disorders • Original Article
  • Published:
Sleep and Breathing Aims and scope Submit manuscript

Abstract

Purpose

The aim of the present study was to detect the prevalence of temporomandibular disorders (TMD) in patients with untreated obstructive sleep apnea (OSA) and to compare the results with healthy controls, matched for sex and age.

Methods

Forty-one consecutive patients with OSA were prospectively recruited from the Department of Otorhinolaryngology at the A. Gemelli Hospital prior to undergoing any treatment for OSA and independently of OSA severity. All patients underwent a complete TMD examination according to the diagnostic criteria for temporomandibular disorders (DC/TMD) protocol. The same examination was performed on 41 healthy controls matched for sex and age. Chi-squared test was used to compare results between the two groups.

Results

Of the 41 patients with OSA, 21 (51%) presented signs and/or symptoms of TMD compared to 13 of 41 subjects (32%) from the control group. Headache attributed to TMD and disc displacement with reduction were the most common diagnoses, with a statistically significant difference between the two groups (p<0.05).

Conclusions

The prevalence of TMD signs and symptoms is significantly higher in untreated patients with OSA compared to healthy controls.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

Abbreviations

AHI:

Apnea-hypopnea index

BMI:

Body mass index

DC/TMD:

Diagnostic criteria for temporomandibular disorders

DISE:

Drug-induced sleep endoscopy

ESS:

Epworth sleepiness scale

MAD:

Mandibular advancement device

OSA:

Obstructive sleep apnea

PSG:

Polysomnographic study

TMD:

Temporomandibular disorders

TMJ:

Temporomandibular joint

References

  1. Seneratna CV, Perret JL, Lodge CJ, Lowe AJ, Campbell BE, Matheson MC, Hamilton GS, Dharmage SC (2017) Prevalence of obstructive sleep apnea in the general population: a systematic review. Sleep Med Rev 34:70–81

    Article  Google Scholar 

  2. Heinzer R, Vat S, Marques-Vidal P, Marti-Soler H, Andries D, Tobback N, Mooser V, Preisig M, Malhotra A, Waeber G, Vollenweider P, Tafti M, Haba-Rubio J (2015) Prevalence of sleep-disordered breathing in the general population: the HypnoLaus study. Lancet Respir Med 3:310–318

    Article  CAS  Google Scholar 

  3. Yaggi HR, Strohl KP (2010) Adult obstructive sleep apnea/hypopnea syndrome: definitions, risk factors, and pathogenesis. Clin Chest Med 31:179–186

    Article  Google Scholar 

  4. Edwards C, Mukherjee S, Simpson L, Palmer LJ, Almeida OP, Hillman DR (2015) Depressive symptoms before and after treatment of obstructive sleep apnea in men and women. J Clin Sleep Med 11:1029–1038

    Article  Google Scholar 

  5. Sanchez-de-la-Torre M, Campos-Rodriguez F, Barbé F (2013) Obstructive sleep apnoea and cardiovascular disease. Lancet Respir Med 1:61–72

    Article  Google Scholar 

  6. Young T, Finn L, Peppard PE, Szklo-Coxe M, Austin A, Nieto J, Stubbs R, Hla KM (2008) Sleep disordered breathing and mortality: eighteen-year follow-up of the Wisconsin sleep cohort. Sleep 31:1071–1078

    Article  Google Scholar 

  7. Almoznino G, Benoliel R, Sharav Y, Haviv Y (2017) Sleep disorders and chronic craniofacial pain: characteristics and management possibilities. Sleep Med Rev 33:39–50

    Article  Google Scholar 

  8. Creed F (2020) A review of the incidence and risk factors for fibromyalgia and chronic widespread pain in population-based studies. Pain 161:1169–1176

    Article  Google Scholar 

  9. De Leeuw R, Klasser GD (eds) (2013) Orofacial pain: guidelines for assessment, diagnosis, and management, 5th edn. Quintessence Pub. Co, Chicago

    Google Scholar 

  10. National Institute of Dental and Craniofacial Research (2017) Prevalence of TMJD and Its Signs and Symptoms

  11. Sener S, Guler O (2012) Self-reported data on sleep quality and psychologic characteristics in patients with myofascial pain and disc displacement versus asymptomatic controls. Int J Prosthodont 25:348–252

    PubMed  Google Scholar 

  12. Rener-Sitar K, John MT, Pusalavidyasagar SS, Bandyopadhyay D, Schiffman EL (2016) Sleep quality in temporomandibular disorder cases. Sleep Med 25:105–112

    Article  Google Scholar 

  13. Sanders AE, Essick GK, Fillingim R, Knott C, Ohrbach R, Greenspan JD, Diatchenko L, Maixner W, Dubner R, Bair E, Miller VE, Slade GD (2013) Sleep apnea symptoms and risk of temporomandibular disorder: OPPERA cohort. J Dent Res 92(7 suppl):70S–77S

    Article  CAS  Google Scholar 

  14. Cunali PA, Almeida FR, Santos CD, Valdrighi NY, Nacimento LS et al (2009) Prevalence of Temporomandibular disorders in obstructive sleep apnea patients referred for oral appliance therapy. J Orofac Pain 23:339–344

    PubMed  Google Scholar 

  15. Epstein LJ, Kristo D, Strollo PJ, Friedman N, Malhotra A et al (2009) Clinical guideline for the evaluation, management and long-term care of obstructive sleep apnea in adults. J Clin Sleep Med 5:263–276

    Article  Google Scholar 

  16. Kapur VK, Auckley DH, Chowdhuri S, Kuhlmann DC, Mehra R, Ramar K, Harrod CG (2017) Clinical practice guideline for diagnostic testing for adult obstructive sleep apnea: an American academy of sleep medicine clinical practice guideline. J Clin Sleep Med 13:479–504

    Article  Google Scholar 

  17. Johns MW (1991) A new method for measuring daytime sleepiness: the Epworth sleepiness scale. Sleep 14:540–545

    Article  CAS  Google Scholar 

  18. Netzer NC, Stoohs RA, Netzer CM, Clark K, Strohl KP (1999) Using the Berlin questionnaire to identify patients at risk for the sleep apnea syndrome. Ann Intern Med 131:485–491

    Article  CAS  Google Scholar 

  19. Schiffman E, Ohrbach R, Truelove E, Look J, Anderson G, Goulet JP, List T, Svensson P, Gonzalez Y, Lobbezoo F, Michelotti A, Brooks SL, Ceusters W, Drangsholt M, Ettlin D, Gaul C, Goldberg LJ, Haythornthwaite JA, Hollender L, Jensen R, John MT, de Laat A, de Leeuw R, Maixner W, van der Meulen M, Murray GM, Nixdorf DR, Palla S, Petersson A, Pionchon P, Smith B, Visscher CM, Zakrzewska J, Dworkin SF, International RDC/TMD Consortium Network, International association for Dental Research, Orofacial Pain Special Interest Group, International Association for the Study of Pain (2014) Diagnostic Criteria for Temporomandibular Disorders (DC/TMD) for clinical and research applications: recommendations of the International RDC/TMD Consortium Network and Orofacial Pain Special Interest Group. J of Oral & Facial Pain and Headache 28:6–27

    Article  Google Scholar 

  20. Cooper BC, Kleinberg I (2007) Examination of a large patient population for the presence of symptoms and sings of temporomandibular disorders. Cranio 25:114–126

    Article  Google Scholar 

  21. Lautenbacher S, Kundermann B, Krieg JC (2006) Sleep deprivation and pain perception. Sleep Med Rev 10:357–369

    Article  Google Scholar 

  22. Iodice G, Cimino R, Vollaro S, Lobbezoo F, Michelotti A (2019) Prevalence of temporomandibular disorder pain, jaw noised and oral behaviours in an adult Italian population sample. J Oral Rehabil 00:1–8

    Google Scholar 

  23. Gesch D, Bernhardt O, Alte D, Schwahn C, Kocher T, John U, Hensel E (2004) Prevalence of signs and symptoms of temporomandibular disorders in an urban and rural German population: results of a population-based study of health in Pomerania. Quintessence Int. 35:143–150

    PubMed  Google Scholar 

  24. Dıraçoǧlu D, Yıldırım NK, Saral İ, Özkan M, Karan A, Özkan S, Aksoy C (2016) Temporomandibular dysfunction and risk factors for anxiety and depression. J Back Musculoskelet Rehabil 29:487–491

    Article  Google Scholar 

  25. Bartolucci ML, Bortolotti F, Martina S, Corazza G, Michelotti A, Alessandri-Bonetti G (2019) Dental and skeletal long-term side effects of mandibular advancement devices in obstructive sleep apnea patients: a systematic review with meta-regression analysis. Eur J Orthod 41:89–100

    Article  Google Scholar 

  26. Alessandri-Bonetti G, Bortolotti F, Bartolucci ML, Marini I, D’Antò V, Michelotti A (2016) The effects of mandibular advancement device on pressure pain threshold of masticatory muscles: a prospective controlled cohort study. J Oral Facial Pain Headache 30:234–240

    Article  Google Scholar 

  27. Alessandri-Bonetti A, Bortolotti F, Moreno-Hay I, Michelotti A, Cordaro M, Alessandri-Bonetti G, Okeson JP (2019) Effects of mandibular advancement device for obstructive sleep apnea on temporomandibular disorders: A systematic review and meta-analysis. Sleep Med Rev 48:101211

    Article  Google Scholar 

  28. Walsh TP, Arnold JB, Evans AM, Yaxley A, Damarell RA, Shanahan EM (2018) The association between body fat and musculoskeletal pain: a systematic review and meta-analysis. BMC Musculoskelet Disord 19:233

    Article  Google Scholar 

  29. Manfredini D, Guarda-Nardini L, Marchese-Ragona R, Lobbezoo F (2015) Theories on possible temporal relationships between sleep bruxism and obstructive sleep apnea events. An expert opinion. Sleep Breath 19:1459–1465

    Article  Google Scholar 

  30. Choy EHS (2015) The role of sleep in pain and fibromyalgia. Nat Rev Rheumatol 11:513–520

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Institute of Dental Clinic and Maxillofacial Surgery, A. Gemelli University Policlinic IRCCS, Catholic University of Sacred Heart, Rome, Italy

    Anna Alessandri-Bonetti, Massimo Cordaro & Patrizia Gallenzi

  2. Department of Otorhinolaryngology, Pia Fondazione di culto e religione cardinale G. Panico Hospital, Tricase, LE, Italy

    Emanuele Scarano

  3. Department of Otorhinolaryngology, A. Gemelli University Policlinic IRCCS, Catholic University of the Sacred Heart, Rome, Italy

    Antonella Fiorita

Authors
  1. Anna Alessandri-Bonetti
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Emanuele Scarano
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Antonella Fiorita
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Massimo Cordaro
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Patrizia Gallenzi
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

All authors contributed to the study conception and design. Material preparation, data collection, and analysis were performed by all authors. The first draft of the manuscript was written by Anna Alessandri-Bonetti and all authors commented on the previous versions of the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Anna Alessandri-Bonetti.

Ethics declarations

Ethics approval

All procedures in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. The study was approved by the ethical committee of the A. Gemelli Hospital with number 7372/18.

Consent to participate

Informed consent was obtained from all individual participants included in the study.

Conflict of interest

The authors have no conflict of interest to declare that are relevant to the content of this article.

Additional information

Publisher’s note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Alessandri-Bonetti, A., Scarano, E., Fiorita, A. et al. Prevalence of signs and symptoms of temporo-mandibular disorder in patients with sleep apnea . Sleep Breath 25, 2001–2006 (2021). https://doi.org/10.1007/s11325-021-02337-9

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11325-021-02337-9

Keywords

Search

Navigation