Sleep Disorders and their Association with Laboratory Pain Sensitivity in Temporomandibular Joint Disorder
Sleep Disorders and their Association with Laboratory Pain Sensitivity in Temporomandibular Joint Disorder
复制标题
DOI：
10.1093/sleep/32.6.779
复制
发表时间：
2009-06-01
期刊：
影响因子：
5.6
通讯作者：
Haythornthwaite, Jennifer A.
中科院分区：
文献类型：
--
作者：
Smith, Michael T.;Wickwire, Emerson M.;Haythornthwaite, Jennifer A.
研究目的：我们描述了颞下颌关节紊乱病（TMD）患者的睡眠障碍率，并评估了睡眠障碍与疼痛敏感性实验室指标之间可能的相关性。设计：进行了研究诊断检查，随后进行了两次连续的夜间多导睡眠图研究，并在早晨和晚上评估疼痛阈值。53例患者符合肌筋膜TMD的研究诊断标准。干预措施：N/A测量和结果：我们确定了睡眠障碍的诊断率，并进行了咬肌和前臂的压力疼痛阈值的测痛测量。在前臂上测量热痛阈值; 75%符合睡眠磨牙症的自我报告标准，但只有17%符合活动性睡眠磨牙症的PSG标准。43%的患者被诊断出有两种或两种以上的睡眠障碍。失眠症（36%）和睡眠呼吸暂停（28.4%）的发生率最高。原发性失眠（PI）（26%）是失眠的最大亚类。即使在控制了多种潜在的混淆后，PI与所有部位的机械和热痛阈值降低相关（P < 0.05）。相反，呼吸紊乱指数与前臂机械性疼痛阈值增加相关（P < 0.05）。结论：PI和睡眠呼吸暂停的高发生率突出了需要将主诉睡眠障碍的TMD患者转诊进行多导睡眠图评估。PI和痛觉过敏在非口面部位的关联表明，PI可能与中枢敏感性有关，并可能在特发性疼痛障碍中发挥病因作用。睡眠呼吸障碍和痛觉减退之间的联系需要进一步研究，并可能为睡眠和疼痛调节过程之间复杂的相互作用提供新的见解。
Study Objectives: We characterized sleep disorder rates in temporomandibular joint disorder (TMD) and evaluated possible associations between sleep disorders and laboratory measures of pain sensitivity.Design: Research diagnostic examinations were conducted, followed by two consecutive overnight polysomnographic studies with morning and evening assessments of pain threshold.Setting: Orofacial pain clinic and inpatient sleep research facilityParticipants: Fifty-three patients meeting research diagnostic criteria for myofascial TMD.Interventions: N/AMeasurements and Results: We determined sleep disorder diagnostic rates and conducted algometric measures of pressure pain threshold on the masseter and forearm. Heat pain threshold was measured on the forearm; 75% met self-report criteria for sleep bruxism, but only 17% met PSG criteria for active sleep bruxism. Two or more sleep disorders were diagnosed in 43% of patients. Insomnia disorder (36%) and sleep apnea (28.4%) demonstrated the highest frequencies. Primary insomnia (PI) (26%) comprised the largest subcategory of insomnia. Even after controlling for multiple potential confounds, PI was associated with reduced mechanical and thermal pain thresholds at all sites (P < 0.05). Conversely, the respiratory disturbance index was associated with increased mechanical pain thresholds on the forearm (P < 0.05).Conclusions: High rates of PI and sleep apnea highlight the need to refer TMD patients complaining of sleep disturbance for polysomnographic evaluation. The association of PI and hyperalgesia at a non-orofacial site suggests that PI may be linked with central sensitivity and could play an etiologic role in idiopathic pain disorders. The association between sleep disordered breathing and hypoalgesia requires further study and may provide novel insight into the complex interactions between sleep and pain-regulatory processes.