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Published on: September 13, 2024
Sleep-Severity Profiles in Temporomandibular Disorder: A Cluster-Analytic Approach to Identifying Biopsychosocial
S Montesino-Goicolea1,2, R B Fillingim1,2, M Ribeiro Dasilva1,3
1Pain Research & Intervention Center of Excellence (PRICE), University of Florida, Gainesville, Florida, USA.
Background:
Painful temporomandibular disorders (TMDs) are frequently comorbid with sleep disturbance, yet heterogeneity in sleep profiles remains poorly characterized.
Objectives:
To identify sleep-severity profiles in adults with and without TMD and examine their psychological correlates.
Methods:
Eighty-four adults (32 TMD, 52 controls) completed the Pittsburgh Sleep Quality Index (PSQI) and measures of psychological symptoms (SCL-90-R), body vigilance (BVS), positive and negative affect (PANAS), and trait anxiety (STAI). Sleep-severity profiles were derived by principal component analysis of the PSQI components and hierarchical clustering, and their diagnostic composition was compared by chi-squared test. Psychological outcomes were reduced based on their intercorrelation structure and analysed by two-way MANCOVA (Profile × TMD status), covarying age and sex.
Results:
Two profiles emerged: Mild-Moderate (n = 59; PSQI M = 5.25) and Severe Poor Sleepers (n = 21; PSQI M = 9.19), TMD being concentrated in the Severe profile (χ2(1) = 9.35, p = 0.002). The outcomes reflected a single general-distress dimension indexed by the SCL-90-R Global Severity Index (GSI). GSI therefore served as the primary outcome, with body vigilance and affect tested with that dimension partialled out. Profile and Profile × TMD effects were significant (TMD main effect, n.s.), both carried by general distress: distress was elevated in the Severe profile (η2p = 0.17), and the interaction (η2p = 0.16) reflected distress rising with sleep severity in controls but uniformly elevated in TMD. No effect was specific to body vigilance or affect.
Conclusion:
Severe self-reported sleep disturbance was associated with psychological distress comparable to that of TMD; these exploratory findings require replication with objective sleep and pain measures.
