Sleep misperception in women with myofascial temporomandibular disorder.

Abstract

Study objectives: Temporomandibular disorders (TMD) were linked to poor sleep on the Pittsburgh Sleep Quality Index (PSQI), whereas polysomnography (PSG) revealed no major sleep disturbances, implying sleep state misperception (SSM). This study investigates SSM in TMD and control participants; correlates SSM with objective short sleep duration (SSD), depression symptoms, daytime sleepiness, and orofacial pain; and compares objective SSD between the groups.

Methods: General linear models were used to compare second-night PSG total sleep time (TST), sleep latency (SL), sleep efficiency (SE) and wake after sleep onset (WASO) with homologous PSQI-derived variables in 124 women with myofascial TMD and 46 age and BMI matched controls. PSQI variables were regressed onto objective SSD, depression symptoms, daytime sleepiness, and pain. Lastly, objective SSD was related to TMD presence.

Results: Compared to controls, TMD cases misperceived SE (p = 0.02); depression symptoms explained PSQI-derived SE (p = 0.002) and mediated the effect of pain (p <.001). PSQI variables were unrelated to respective PSG measures or objective SSD, except a significant subjective-objective correlation in SE among controls only (p = 0.002). Objective SSD was more frequent in TMD cases (p = 0.02, OR = 2.95), but it was unrelated to depression symptoms, daytime sleepiness or pre-PSG pain.

Conclusions: The study demonstrates misperception of SE among TMD cases, which was accounted for by depression symptoms. Objective SSD nearly tripled in TMD cases; however, it was unrelated to PSQI variables, depression, daytime sleepiness, or pain, suggesting that SSM and objective SSD are two independent sleep features in TMD.