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Comparison of Sleep Quality Deterioration by Subgroup of Painful Temporomandibular Disorder Based on Diagnostic Criteria for Temporomandibular Disorders 


 This study investigated whether sleep deterioration in patients with painful temporomandibular disorder depends on the origin of pain, and also analyzed which clinical disease characteristics and whether psychological distress affected sleep quality. A total of 337 consecutive patients (215 women; mean age, 33.01 ± 13.01 years) with painful temporomandibular disorder (myalgia [n = 120], temporomandibular joint arthralgia [n = 62], mixed joint–muscle temporomandibular disorder pain [n = 155]) based on the diagnostic criteria for temporomandibular disorder were enrolled. They completed a battery of standardized reports on clinical sign and symptoms, and answered questions on sleep quality, excessive daytime sleepiness, and patients’ psychological status. The mean global Pittsburgh Sleep Quality Index scores were significantly higher in the mixed temporomandibular disorder pain group (6.97 ± 3.38) and myalgia group (6.40 ± 3.22) than in the arthralgia group (5.16 ± 2.94) (p = 0.001). Poor sleepers were significantly more prevalent in the mixed temporomandibular disorder pain group (76.8%) and myalgia group (71.7%) than in the arthralgia group (54.8%) (p = 0.006). The presence of psychological distress in the myalgia group (β = 1.236, p = 0.022), global severity index of the Symptom Checklist-90-Revised in the arthralgia group (β = 1.668, p = 0.008), and presence of headache (β = 1.631, p = 0.002) and self-reported sleep problems (β = 2.849, p < 0.001) in the mixed temporomandibular disorder pain group were associated with an increase in the Pittsburgh Sleep Quality Index score. Because there is a difference in sleep quality and influencing factors according to the pain source of painful temporomandibular disorder, and the complex interplay between sleep and pain can vary, sophisticated treatment is required for patients.