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The Relationship of Temporomandibular Joint, Orofacial Pain, and Sleep Apnea

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Abstract

Temporomandibular disorder (TMD) is a heterogeneous family of musculoskeletal disorders that represent the most common chronic orofacial pain condition. It has been described as a prototypic idiopathic pain syndrome, characterized by episodic, masticatory muscle and/or joint pain. Patients often present with overlapping symptoms including psychological distress, neuroendocrine abnormalities, and chronic insomnia. Characteristics of this condition include persistent pain in the TMJ, periauricular region, and muscles of the head and neck. Prevalence in the adult population is estimated from 5 to 12% with a higher prevalence in females. What makes sleep disorders and headaches/orofacial pain highly relevant is the fact that both conditions highly increase the risk for each other. Pain is a complex experience that encompasses cognitive, emotional, motivational, and discriminating sensorial dimensions and is reported by approximately 15% of the general population and 50% of the elderly.

The co-occurrence of sleep and headache disorders not only results in overlapping clinical manifestations but also largely determines their natural history and prognosis and often promotes their transformation into a chronic, compound, persistent, and intractable condition as seen in many clinical settings. In terms of their pathogenesis, anatomical structures such as the thalamus, hypothalamus, and some brainstem nuclei play a pivotal role in the development of both conditions. Other considerations are the powerful influence exerted on them by psychological, environmental, and hormonal factors. Specific headache disorders, like paroxysmal hemicrania (PH), cluster headache (CH), and hypnic headache (HH) are related to rapid eye movement (REM) sleep or to obstructive sleep apnea syndrome (OSAS).

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Abbreviations

AHI:

Apnea hypopnea index

BMI:

Body mass index

CH:

Cluster headache

HH:

Hypnic headache

ICSD:

International Classification of Sleep Disorders

OSA:

Obstructive sleep apnea

OSAS:

Obstructive sleep apnea syndrome

PH:

Paroxysmal hemicrania

PSG:

Polysomnography

RDC:

Research diagnostic criteria

REM:

Rapid eye movement

RLS:

Restless legs syndrome

SB:

Sleep-related bruxism

SRBD:

Sleep-related breathing disorders

TMD:

Temporomandibular joint disorder

TMJ:

Temporomandibular joint

TTH:

Tension-type headaches

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Author information

Authors and Affiliations

  1. Craniofacial Pain and Dental Sleep Center of Georgia, Atlanta, GA, USA

    Mayoor Patel

  2. Center for TMJ & Sleep Therapy, 175 N. Pennsylvania Ave. #4, Glendora, 91741, CA, USA

    G. Gary Demerjian

  3. Maryland Center for Craniofacial, TMJ and Dental Sleep Disorders, Columbia, MD, USA

    Anthony B. Sims

Authors
  1. Mayoor Patel
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  2. G. Gary Demerjian
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  3. Anthony B. Sims
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Editor information

Editors and Affiliations

  1. Center for TMJ & Sleep Therapy, Glendora, CA, USA

    G. Gary Demerjian

  2. Oral Biology and Medicine, UCLA School of Dentistry, Los Angeles, CA, USA

    André Barkhordarian

  3. CHS 63-090, UCLA School of Dentistry, Los Angeles, CA, USA

    Francesco Chiappelli

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Patel, M., Demerjian, G.G., Sims, A.B. (2018). The Relationship of Temporomandibular Joint, Orofacial Pain, and Sleep Apnea. In: Demerjian, G., Barkhordarian, A., Chiappelli, F. (eds) Temporomandibular Joint and Airway Disorders. Springer, Cham. https://doi.org/10.1007/978-3-319-76367-5_7

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  • DOI: https://doi.org/10.1007/978-3-319-76367-5_7

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