Sleep disturbance in temporomandibular disorders: Psychological distress outweighs pain severity

This study aimed to determine the prevalence of sleep disturbance among patients with temporomandibular disorders (TMDs) and to identify clinical and psychological predictors associated with its presence.

This retrospective cross-sectional study analyzed clinical records of 299 adult patients diagnosed with TMDs at a tertiary orofacial pain clinic between 2016 and 2021. Sleep disturbance was defined as the presence of pain-related sleep interference based on the Thai Brief Pain Inventory and clinical documentation. Variables included TMDs subtypes, pain intensity, number of facial pain sites, presence of widespread pain, fibromyalgia risk, bruxism, and psychological distress. Multivariable logistic regression then was performed to identify independent predictors.

Sleep disturbance was reported by 62.2% (113/299) of patients. Univariable analyses showed significant associations with muscle pain - related TMDs (OR = 2.08, p < .001), widespread pain (OR = 1.70, p = .001), and anxiety/depression (OR = 2.23, p < .001). TMJ disorders were inversely associated with sleep disturbance (OR = 0.64, p = .002). Patients with sleep disturbance also demonstrated higher pain intensity and a more facial pain sites (p < .001for both comparisons). In multivariable analysis, anxiety/depression remained the only independent predictor (OR = 2.55, 95%, p = .023).

Sleep disturbance was common among patients with TMDs. Psychological distress was strongly associated with sleep disturbance. These findings suggest that routine assessment of sleep and psychological factors may be useful in the management of TMDs.