Dr. Anne Sanders was kind enough to write the following synopsis of a recent study on sleep and TMD.
A recent study of the OPPERA group reported in The Journal of Pain, sheds new light on the understanding of poor sleep in relation to painful Temporomandibular Disorders (TMD). OPPERA, an acronym for "Orofacial Pain: Prospective Evaluation and Risk Assessment," is an NIDCR-sponsored community-based, multi-site project that for the past 10 years has been investigating risk factors for the onset and persistence of painful TMD. Although scientists have long known that pain and poor sleep often coexist, only recently has science combined evidence from experimental and longitudinal studies to determine which direction matters most: does pain lead to poor sleep; or is poor sleep a stronger predictor of pain? Those reviews concluded the latter--that poor sleep is a stronger and more reliable predictor of pain onset.
This finding is consistent with OPPERA findings from 2013. In its prospective cohort study, OPPERA enrolled 2,722 men and women who were clinically free of painful TMD and who had no lifetime experience of TMD. At enrollment, these study participants completed the Pittsburgh Sleep Quality Index--a questionnaire that evaluated their sleep quality. The OPPERA investigators then followed them for a median 2.8 years to observe who developed TMD and who did not. Dr. Sanders and colleagues found that the rate of first-onset TMD was 50% higher in participants whose sleep quality at enrollment was poor compared to those with good sleep quality.
The 2013 findings were informative, but still fell short in providing a full picture of what happens to sleep quality in the window between enrollment and TMD development, which often occurs many months or years later. By analyzing participants' questionnaire responses (sent every three months throughout the entire study), OPPERA investigators found no change in sleep quality in those who did not develop TMD; however, in participants who developed painful TMD, sleep quality worsened progressively over time. Not only did those who went on to develop TMD have worse sleep quality at enrollment, but their sleep quality continued to worsen. Most intriguing was that sleep quality deteriorated before these participants developed symptoms that alerted OPPERA investigators to recall them for a follow-up clinical examination. Furthermore, the statistical analytic approach determined that worsening sleep quality was independent of psychological stress, somatic awareness and other major predictors of TMD found in the OPPERA study.
The OPPERA team recognizes the importance of these findings in the comprehensive management of TMD pain and related symptoms, and is now planning a six-to-eight week pilot study to determine the feasibility of monitoring sleep duration and staging while chronic TMD patients receive treatment. Promising findings may lead to a more definitive study to identify new treatment for painful TMD.
Source: Sanders AE, Akinkugbe AA, Bair E, Fillingim RB, Greenspan JD, Ohrbach R, Dubner R, Maixner W, Slade GD. Subjective Sleep Quality Deteriorates Prior to Development of Painful Temporomandibular Disorder. J Pain. 2016 Feb 19. pii: S1526-5900(16)00521-6. doi: 10.1016/j.jpain.2016.02.004. PubMed PMID: 26902644.
Sanders AE, Slade GD, Bair E, Fillingim RB, Knott C, Dubner R, Greenspan JD, Maixner W, Ohrbach R. General health status and incidence of first-onset temporomandibular disorder: the OPPERA prospective cohort study. J Pain. 2013 Dec;14(12 Suppl):T51-62.