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

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


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).



Apnea hypopnea index


Body mass index


Cluster headache


Hypnic headache


International Classification of Sleep Disorders


Obstructive sleep apnea


Obstructive sleep apnea syndrome


Paroxysmal hemicrania




Research diagnostic criteria


Rapid eye movement


Restless legs syndrome


Sleep-related bruxism


Sleep-related breathing disorders


Temporomandibular joint disorder


Temporomandibular joint


Tension-type headaches


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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

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