Sleep Disorders in Tempororomandiular Disorders: Unraveling the Impact of Obstructive Sleep Apnea, Insomnia, and Their Comorbidity on Pain and Psychosocial Well-Being

Keywords

sleep apnea - insomnia - anxiety - catastrophizing - pain - temporomandibular disorder

Introduction: Sleep disorders are prevalent in Temporomandibular Disorders (TMD), and they may precede its onset or worsen symptoms and treatment responses

Objective: The aim is to assess the correlation and impact of Obstructive Sleep Apnea (OSA), Insomnia (I), and Comorbidity Insomnia and Obstructive Sleep Apnea (COMISA) in TMD patients, focusing on pain characteristics, anxiety, catastrophizing, and quality of sleep.

Methods: A cross-sectional study was conducted from October 2023 to July 2024, involving sixty-six painful Temporomandibular Disorder patients (diagnosed using the Diagnostic Criteria for TMD). OSA was diagnosed through the Biologix Sleep Test (two nights), Insomnia through the Insomnia Severity Index (ISI), and the other variables were verified by validated questionnaires and scales. Pain duration was recorded in months. TMD patients were categorized into four groups: those without sleep disorders (TMD only - control group - C) and those with TMD and Obstructive Sleep Apnea and/or Insomnia (TMD + OSA, TMD + I, and TMD + COMISA). Distribution among variables was checked using the Shapiro-Wilk test. Pearson or Spearman tests were used for correlations, significant differences were identified using ANOVA or the Kruskal-Wallis rank sum test (Jamovi software).

Results: Most of the study population were women (86.4%) with a mean age of 43.1 ± 14.7 years. Overall, 84.6% suffered from pain for more than 3 months. In terms of sleep disorders, 69.7% had Insomnia, 4.5% had OSA, 16.7% had COMISA, and 9.1% had none of these conditions. Regarding correlation analysis, Insomnia was correlated with pain duration (rho = 0.415, p = < 0.001), Anxiety symptoms (rho = -0.305, p = < 0.013), Body Mass Index (BMI) (rho = -0.289, p = 0.018), and IDO (rho = 0.274, p = < 0.026). OSA was correlated with BMI (rho = 0.482, p = < 0.001) and Sat O2 < 90% (rho = 0.429, p= < 0.001). Statistical differences were only found in anxiety symptoms (p = 0.020; C-I p = 0.023).

Conclusion: Although the study identified significant links between sleep disorders and anxiety, no direct correlation could be found between them and aspects such as pain characteristics, catastrophizing, and sleep quality. This indicates that although these sleep disturbances are common in TMD patients, their direct effect on pain perception and psychological conditions is complex and requires further investigation.

No conflict of interest has been declared by the author(s).

Publication History

Article published online:
16 September 2025