Depressive symptoms account for differences between self-reported versus polysomnographic assessment of sleep quality in women with myofascial TMD.

TitreDepressive symptoms account for differences between self-reported versus polysomnographic assessment of sleep quality in women with myofascial TMD.
Publication TypeJournal Article
Year of Publication2017
AuthorsDubrovsky B, Janal MN, Lavigne GJ, Sirois DA, Wigren PE, Nemelivsky L, Krieger AC, Raphael KG
JournalJ Oral Rehabil
Date Published2017 Aug 29
ISSN1365-2842
Abstract

Patients with temporomandibular disorder (TMD) report poor sleep quality on the Pittsburgh Sleep Quality Index (PSQI). However, polysomnographic (PSG) studies show meagre evidence of sleep disturbance on standard physiological measures. The present aim was to analyse self-reported sleep quality in TMD as a function of myofascial pain, PSG parameters and depressive symptomatology. PSQI scores from 124 women with myofascial TMD and 46 matched controls were hierarchically regressed onto TMD presence, ratings of pain intensity and pain-related disability, in-laboratory PSG variables and depressive symptoms (Symptoms Checklist-90). Relative to controls, TMD cases had higher PSQI scores, representing poorer subjective sleep and more depressive symptoms (both P < 0·001). Higher PSQI scores were strongly predicted by more depressive symptoms (P < 0·001, R(2) = 26%). Of 19 PSG variables, two had modest contributions to higher PSQI scores: longer rapid eye movement latency in TMD cases (P = 0·01, R(2) = 3%) and more awakenings in all participants (P = 0·03, R(2) = 2%). After accounting for these factors, TMD presence and pain ratings were not significantly related to PSQI scores. These results show that reported poor sleep quality in TMD is better explained by depressive symptoms than by PSG-assessed sleep disturbances or myofascial pain. As TMD cases lacked typical PSG features of clinical depression, the results suggest a negative cognitive bias in TMD and caution against interpreting self-report sleep measures as accurate indicators of PSG sleep disturbance. Future investigations should take account of depressive symptomatology when interpreting reports of poor sleep.

DOI10.1111/joor.12552
Alternate JournalJ Oral Rehabil
PubMed ID28853162
Grant ListR01 DE018569 / DE / NIDCR NIH HHS / United States