Advertisement

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

  • Mayoor Patel
  • G. Gary Demerjian
  • Anthony B. Sims
Chapter

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).

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

References

  1. 1.
    Sateia MJ. International classification of sleep disorders: highlights and modifications. Chest J. 2014;146(5):1387–94.CrossRefGoogle Scholar
  2. 2.
    Bixler EO, Vgontzas AN, Lin HM, et al. Sleep disordered breathing in children in a general population sample: prevalence and risk factors. Sleep. 2009;32:731–6.CrossRefGoogle Scholar
  3. 3.
    Shah N, Roux F. The relationship of obesity and obstructive sleep apnea. Clin Chest Med. 2009;30:455–65.CrossRefGoogle Scholar
  4. 4.
    Katz ES, D’Ambrosio CM. Pathophysiology of pediatric obstructive sleep apnea. Proc Am Thorac Soc. 2008;12:253–62.CrossRefGoogle Scholar
  5. 5.
    Bentley A, Newton S, Zio C. Sensitivity of sleep stages to painful thermal stimuli. J Sleep Res. 2003;12:143–7.CrossRefGoogle Scholar
  6. 6.
    Drews A, Nielson K, ArendtNielsen L, BriketSmith L, Hansen L. The effect of cutaneous and deep pain on the electroencephalogram during sleep: an experimental study. Sleep. 1997;20:6326403.Google Scholar
  7. 7.
    Lavigne G, Zucconi M, Castronovo C, et al. Sleep arousal response to experimental thermal stimulation during sleep in human subjects free of pain and sleep problems. Pain. 2000;84:283–90.CrossRefGoogle Scholar
  8. 8.
    Lavigne G, Zucconi M, Castronovo C, et al. Heart rate changes during sleep in response to experimental thermal (nociceptive) stimulations in healthy subjects. Slin Neurophysiol. 2001;112:532–5.CrossRefGoogle Scholar
  9. 9.
    Lavigne G, Brousseau M, Kato T, et al. Experimental pain perception remains equally active over all sleep stages. Pain. 2004;110:646–55.CrossRefGoogle Scholar
  10. 10.
    Wang J, O’Reilly B, Venkataraman R, Mysliwiec V, Mysliwiec A. Efficacy of oral iron in patients with restless legs syndrome and a low-normal ferritin: a randomized, double-blind, placebo-controlled study. Sleep Med. 2009;10:973–5.CrossRefGoogle Scholar
  11. 11.
    Mahowald MW, Mahowald ML, Bundlie SR, Ytterberg SR. Sleep fragmentation in rheumatoid arthritis. Arthritis Rheum. 1989;32:974–83.CrossRefGoogle Scholar
  12. 12.
    Finkel AG. Epidemiology of cluster headache. Curr Pain Headache Rep. 2003;7(2):144–9.CrossRefGoogle Scholar
  13. 13.
    Dodick DW, Eross EJ, Parish JM. Clinical, anatomical, and physiologic relationship between sleep and headache. Headache. 2003;43:282–92.CrossRefGoogle Scholar
  14. 14.
    Straube A, Förderreuther S. Sleeping behaviour and headache attacks in cases of primary headache. Possible pathological mechanisms. Schmerz. 2004;18:300–5.PubMedGoogle Scholar
  15. 15.
    Smith MT, Wickwire EM, Grace EG, Edwards RR, Buenaver LF, Peterson S, Klick B, Haythornthwaite FA, et al. Sleep disorders and their association with laboratory pain sensitivity in temporomandibular joint disorders. Sleep. 2009;32(6):779–90.CrossRefGoogle Scholar
  16. 16.
    Roehrs TA, Hyde M, Blaisdell MS, Greenwald M, Roth T. Sleep loss and REM sleep loss are hyperalegic. Sleep. 2006;29:145–51.CrossRefGoogle Scholar
  17. 17.
    Kundermann B, Spernal J, Huber MT, Krieg JC, Lautenbacher S. Sleep deprivation affects thermal pain thresholds but not somatosensory thresholds in healthy volunteers. Psychosom Med. 2004;66:932–7.CrossRefGoogle Scholar
  18. 18.
    Onen SH, Alloui A, Gross A, Eschallier A, Dubray C. The effects of total sleep deprivation, selective sleep interruption and sleep recovery on pain tolerance thresholds in healthy subjects. J Sleep Res. 2001;10:35–42.CrossRefGoogle Scholar
  19. 19.
    Mitsikostas DD, Vikelis M, Viskos A. Refractory chronic headache associated with obstructive sleep apnea syndrome. Cephalalgia. 2008;28:139–43.PubMedGoogle Scholar
  20. 20.
    Vendrame M, Kaleyias J, Valencia I, Legido A, Kothare SV. Polysomnographic findings in children with headaches. Pediatr Neurol. 2008;39:6–11.CrossRefGoogle Scholar
  21. 21.
    Bellini B, Arruda M, Cescut A, Saule C, Persico A, Carotenuto M, Gatta M, Nacinovich R, Piazza FP, Termine C, Tozzi E, Lucchese F, Guidetti V. Headache and comorbidity in children and adolescents. J Headache Pain. 2013;14:79.CrossRefGoogle Scholar
  22. 22.
    Wahner-Roedler DL, Olson EJ, Narayanan S, et al. Gender-specific differences in a patient population with obstructive sleep apnea-hypopnea syndrome. Gend Med. 2007;4:329–38.CrossRefGoogle Scholar
  23. 23.
    Kudrow L, McGinty DJ, Phillips ER, Stevenson M. Sleep apnea in cluster headache. Cephalalgia. 1984;4:33–8.CrossRefGoogle Scholar
  24. 24.
    Chervin RD, Zallek SN, Lin X, Hall JM, Sharma N, Hedger KM. Sleep disordered breathing in patients with cluster headache. Neurology. 2000;54:2302–6.CrossRefGoogle Scholar
  25. 25.
    Nobre ME, Leal AJ, Filho PM. Investigation into sleep disturbance of patients suffering from cluster headache. Cephalalgia. 2005;25:488–92.CrossRefGoogle Scholar
  26. 26.
    Nobre ME, Filho PF, Dominici M. Cluster headache associated with sleep apnoea. Cephalalgia. 2003;23:276–9.CrossRefGoogle Scholar
  27. 27.
    Mitsikostas DD, Thomas AM. Comorbidity of headache and depressive disorders. Cephalalgia. 1999;19:211–7.CrossRefGoogle Scholar
  28. 28.
    Smith MT, Perlis ML, Smith MS, Giles DE, Carmody TP. Sleep quality and presleep arousal in chronic pain. J Behav Med. 2000;23:1–13.CrossRefGoogle Scholar
  29. 29.
    Ohayon MM. Prevalence and comorbidity of sleep disorders in general population. Rev Prat. 2007;57:1521–8.PubMedGoogle Scholar
  30. 30.
    Vgontzas AN, Chrousos GP. Sleep, the hypothalamic-pituitary-adrenal axis, and cytokines: multiple interactions and disturbances in sleep disorders. Endocrinol Metab Clin N Am. 2002;31:15–36.CrossRefGoogle Scholar
  31. 31.
    McCarley RW. Neurobiology of REM and NREM sleep. Sleep Med. 2007;8:302–30.CrossRefGoogle Scholar
  32. 32.
    Strine TW, Chapman DP, Balluz LS. Population-based U.S. study of severe headaches in adults: psychological distress and comorbidities. Headache. 2006;46:223–32.CrossRefGoogle Scholar
  33. 33.
    Bruni O, Fabrizi P, Ottaviano S, Cortesi F, Giannotti F, Guidetti V. Prevalence of sleep disorders in childhood and adolescence with headache: a case-control study. Cephalalgia. 1997;17:492–8.CrossRefGoogle Scholar
  34. 34.
    Lyngberg AC, Rasmussen BK, Jørgensen T, Jensen R. Prognosis of migraine and tension-type headache: a population-based follow-up study. Neurology. 2005;65:580–5.CrossRefGoogle Scholar
  35. 35.
    Schmidt-Wilcke T, Leinisch E, Straube A, et al. Gray matter decrease in patients with chronic tension type headache. Neurology. 2005;65:1483–6.CrossRefGoogle Scholar
  36. 36.
    Seidel S, Hartl T, Weber M, et al. Quality of sleep, fatigue and daytime sleepiness in migraine—a controlled study. Cephalalgia. 2009;29:662–9.CrossRefGoogle Scholar
  37. 37.
    Vgontzas A, Cui L, Merikangas KR. Are sleep difficulties associated with migraine attributable to anxiety and depression? Headache. 2008;48:1451–9.CrossRefGoogle Scholar
  38. 38.
    Calhoun AH, Ford S. Behavioral sleep modification may revert transformed migraine to episodic migraine. Headache. 2007;47:1178–83.CrossRefGoogle Scholar
  39. 39.
    Eli R, Fasciano JA. A chronopharmacological preventive treatment for sleep-related migraine headaches and chronic morning headaches: nitric oxide supersensitivity can cause sleep-related headaches in a subset of patients. Med Hypotheses. 2006;66:461–5.CrossRefGoogle Scholar
  40. 40.
    Ekbom KA. Restless legs. A clinical study. Acta Med Scand. 1945;158:1–123.Google Scholar
  41. 41.
    Desai AV, Cherkas LF, Spector TD, Williams AJ. Genetic influences in self-reported symptoms of obstructive sleep apnoea and restless legs: a twin study. Twin Res. 2004;7:589–95.CrossRefGoogle Scholar
  42. 42.
    Ondo W. Secondary restless legs syndrome. In: Ray Chaudhuri K, Odin P, Olanow CW, editors. Restless legs syndrome. London: Taylor & Francis; 2004. p. 57.Google Scholar
  43. 43.
    Weinstock LB, Walters AS, Mullin GE, Duntley SP. Celiac disease is associated with restless legs syndrome. Dig Dis Sci. 2010;55(6):1667–73.CrossRefGoogle Scholar
  44. 44.
    Allen RP, Picchietti D, Hening WA, et al. Restless legs syndrome: diagnostic criteria, special considerations, and epidemiology. A report from the restless legs syndrome diagnosis and epidemiology workshop at the National Institutes of Health. Sleep Med. 2003;4:101–19.CrossRefGoogle Scholar
  45. 45.
    Tison F, Crochard A, Léger D, et al. Epidemiology of restless legs syndrome in French adults: a nationwide survey: the INSTANT Study. Neurology. 2005;65:239–46.CrossRefGoogle Scholar
  46. 46.
    Rhode AM, Hösing VG, Happe S, et al. Comorbidity of migraine and restless legs syndrome—a case-control study. Cephalalgia. 2007;27:1255–60.CrossRefGoogle Scholar
  47. 47.
    Young WB, Piovesan EJ, Biglan KM. Restless legs syndrome and drug-induced akathisia in headache patients. CNS Spectr. 2003;8:450–6.CrossRefGoogle Scholar
  48. 48.
    Chen PK, Fuh JL, Chen SP, Wang SJ. Association between restless legs syndrome and migraine. J Neurol Neurosurg Psychiatry. 2010;81:524–8.CrossRefGoogle Scholar
  49. 49.
    Conti CF, de Oliveira MM, Andriolo RB, et al. Levodopa for idiopathic restless legs syndrome: evidence-based review. Mov Disord. 2007;22:1943–51.CrossRefGoogle Scholar
  50. 50.
    Cervenka S, Pålhagen SE, Comley RA, et al. Support for dopaminergic hypoactivity in restless legs syndrome: a PET study on D2-receptor binding. Brain. 2006;129:2017–28.CrossRefGoogle Scholar
  51. 51.
    Ondo WG, He Y, Rajasekaran S, Le WD. Clinical correlates of 6-hydroxydopamine injections into A11 dopaminergic neurons in rats: a possible model for restless legs syndrome. Mov Disord. 2000;15:154–8.CrossRefGoogle Scholar
  52. 52.
    Charbit A, Holland PR, Goadsby PJ. Stimulation or lesioning of dopaminergic A11 cell group affects neuronal firing in the trigeminal nucleus caudalis. Cephalalgia. 2007;27:605.Google Scholar
  53. 53.
    Kruit M, van Buchem M, Launer L, Terwindt G, Ferrari M. Migraine is associated with an increased risk of deep white matter lesions, subclinical posterior circulation infarcts and brain iron accumulation: the population-based MRI CAMERA study. Cephalalgia. 2010;30(2):129–36.CrossRefGoogle Scholar
  54. 54.
    Walters AS. Review of receptor agonist and antagonist studies relevant to the opiate system in restless legs syndrome. Sleep Med. 2002;3:301–4.CrossRefGoogle Scholar
  55. 55.
    Williamson DJ, Shepheard SL, Cook DA, Hargreaves RJ, Hill RG, Cumberbatch MJ. Role of opioid receptors in neurogenic dural vasodilation and sensitization of trigeminal neurones in anaesthetized rats. Br J Pharmacol. 2001;133:807–14.CrossRefGoogle Scholar
  56. 56.
    Lavigne GJ, Manzini C. Sleep bruxism and concomitant motor activity. In: Kryger MH, Roth T, Dement WC, editors. Principles and practice of sleep medicine. Philadelphia, PA: WB Saunders; 2000. p. 773–85.Google Scholar
  57. 57.
    Lobbezoo F, Van Der Zaag J, Naeije M. Bruxism: its multiple causes and its effects on dental implants—an updated review. J Oral Rehabil. 2006;33:293–300.CrossRefGoogle Scholar
  58. 58.
    Camparis CM, Siqueira JT. Sleep bruxism: clinical aspects and characteristics in patients with and without chronic orofacial pain. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2006;101:188–93.CrossRefGoogle Scholar
  59. 59.
    Gerstner GE, Clark GT, Goulet JP. Validity of a brief questionnaire in screening asymptomatic subjects from subjects with tension-type headaches or temporomandibular disorders. Community Dent Oral Epidemiol. 1994;22:235–42.CrossRefGoogle Scholar
  60. 60.
    Jensen R, Olesen J. Initiating mechanisms of experimentally induced tension-type headache. Cephalalgia. 1996;16:175–82.CrossRefGoogle Scholar
  61. 61.
    Neufeld JD, Holroyd KA, Lipchik GL. Dynamic assessment of abnormalities in central pain transmission and modulation in tension-type headache sufferers. Headache. 2000;40:142–51.CrossRefGoogle Scholar
  62. 62.
    Miller VA, Palermo TM, Powers SW, Scher MS, Hershey AD. Migraine headaches and sleep disturbances in children. Headache. 2003;43:362–8.CrossRefGoogle Scholar
  63. 63.
    Moldofsky H. Sleep and pain. Sleep Med Rev. 2001;5(5):387–98.CrossRefGoogle Scholar
  64. 64.
    Yatani H, Studts J, Cordova M, Carlson CR, Okeson JP. Comparison of sleep quality and clinical psychologist characteristics in patients with temporomandibular disorders. J Orofac Pain. 2002;16:221–8.PubMedGoogle Scholar
  65. 65.
    Cunali PA, Almeida FR, Santos CD, Valdrighi NY, Nascimento LS, Dal’Fabbro C, et al. Prevalence of temporomandibular disorders in obstructive sleep apnea patients referred for oral appliance therapy. J Orofac Pain. 2009;23(4):339.PubMedGoogle Scholar
  66. 66.
    Von Korff MR, Ormel J, Keefe FJ, Dworkin SF. Grading the severity of chronic pain. Pain. 1992;50:133–49.CrossRefGoogle Scholar
  67. 67.
    Yap AU, Dworkin SF, Chua EK, List L, Tan KB, Tan HH. Prevalence of temporomandibular disorder subtypes, psychologic distress, and psychosocial dysfunction in Asian patients. J Orofac Pain. 2003;17:21–8.PubMedGoogle Scholar
  68. 68.
    Collesano V, Segu M, Masseroli C, Manni R. Temporomandibular disorders and sleep disorders: which relationship? Minerva Stomatol. 2004;53:661–8.PubMedGoogle Scholar
  69. 69.
    Selaimen CM, Jeronymo JC, Brilhante DP, Grossi ML. Sleep and depression as risk indicators for temporomandibular disorders in a cross-cultural perspective: a case-control study. Int J Prosthodont. 2006;19:154–61.PubMedGoogle Scholar
  70. 70.
    Nicassio PM, Wallston KA. Longitudinal relationships among pain, sleep problems, and depression in rheumatoid arthritis. J Abnorm Psychol. 1992;3:514–20.CrossRefGoogle Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  • Mayoor Patel
    • 1
  • G. Gary Demerjian
    • 2
  • Anthony B. Sims
    • 3
  1. 1.Craniofacial Pain and Dental Sleep Center of GeorgiaAtlantaUSA
  2. 2.Center for TMJ & Sleep TherapyGlendoraUSA
  3. 3.Maryland Center for Craniofacial, TMJ and Dental Sleep DisordersColumbiaUSA

Personalised recommendations