Causal Mediation in the Development of Painful Temporomandibular Disorder
Causal Mediation in the Development of Painful Temporomandibular Disorder
复制标题
DOI：
10.1016/j.jpain.2016.12.003
复制
发表时间：
2017-04-01
期刊：
影响因子：
4
通讯作者：
Slade, Gary D.
中科院分区：
文献类型：
--
作者：
Sanders, Anne E.;Akinkugbe, Aderonke A.;Slade, Gary D.
我们探讨了睡眠质量和知觉压力在疼痛性颞下颌关节紊乱病（TMD）发展中的因果调节作用。在口面部疼痛前瞻性评价和风险评估研究（OPPERA）前瞻性队列研究中，对2,737名最初无TMD的成年人进行了基线和季度间隔的睡眠质量和感知压力评估。在随访期间，使用研究诊断标准对事件TMD病例进行分类。中介分析采用加权考克斯比例风险回归模型，估计风险比（HR）和95%置信限（CL）的首次发作TMD。模型确定是否：1）随访期间的睡眠质量差介导了基线感知压力对首发TMD的影响; 2）随访期间的感知压力介导了基线睡眠质量差对首发TMD的影响。在这两种分析中，总效应被分解为自然直接效应和间接效应。睡眠质量差的基线会导致感知压力的增加，从而导致TMD的发展。当分解睡眠质量差的总效应（HR = 2.10，CL = 1.76，2.50）时，其效应的34%是由感知压力介导的（间接效应HR = 1.29，CL = 1.06，1.58）。知觉压力对首发TMD的影响不受睡眠质量的影响。改善睡眠可能会避免升级的压力，限制这两个因素对TMD development.Perspective的影响：因果调解分析突出机制，睡眠质量差，促进发展的TMD。首先，睡眠质量差对疼痛有直接影响。其次，它会引发对压力的高度感知，这是睡眠质量差和首次发作TMD疼痛之间因果关系的中间因素。(C)2016年美国疼痛协会American Pain Society
We explored causal mediation of sleep quality and perceived stress in development of painful temporomandibular disorder (TMD). Sleep quality and perceived stress were assessed at baseline and quarterly intervals thereafter in 2,737 initially TMD-free adults in the Orofacial Pain Prospective Evaluation and Risk Assessment study (OPPERA) prospective cohort study. During follow-up, incident TMD cases were classified using research diagnostic criteria. Mediation analysis was conducted using a weighted Cox proportional hazards regression model that estimated hazard ratios (HRs) and 95% confidence limits (CL) of first-onset TMD. Models determined whether: 1) poor sleep quality during follow-up mediated the effect of baseline perceived stress on first-onset TMD, and 2) perceived stress during follow-up mediated the effect of baseline poor sleep quality on first-onset TMD. In both analyses, the total effect was decomposed into natural direct and indirect effects. Poor baseline sleep quality led to heightened perceived stress that then contributed to TMD development. When the total effect of poor sleep quality (HR = 2.10, CL = 1.76, 2.50) was decomposed, 34% of its effect was mediated by perceived stress (indirect effect HR = 1.29, CL = 1.06, 1.58). The effect of perceived stress on first-onset TMD was not mediated by sleep quality. Improving sleep may avert escalation of stress, limiting effects of both factors on TMD development.Perspective: Causal mediation analysis highlights mechanisms by which poor sleep quality promotes development of TMD. First, poor sleep quality exerts a direct effect on pain. Second, it triggers a heightened perception of stress, which acts as an intermediate factor in the causal pathway between poor sleep quality and first-onset TMD pain. (C) 2016 by the American Pain Society