Comorbid Insomnia and Sleep-Disordered Breathing in Painful Temporomandibular Disorders: Association With Pain Intensity

J Oral Rehabil. 2026 Mar 7. doi: 10.1111/joor.70185. Online ahead of print.

ABSTRACT

PURPOSE: Sleep disturbances are common in temporomandibular disorders (TMD), yet insomnia-related complaints are often treated as homogeneous despite frequent co-occurrence with sleep-disordered breathing. This study examined whether sleep-pain relationships differ between insomnia alone and comorbid insomnia and sleep-disordered breathing (COMISA) in patients with chronic TMD-related orofacial pain.

METHODS: In this cross-sectional study, 50 adults with chronic TMD pain were classified as having insomnia alone (n = 20) or COMISA (n = 30) using validated questionnaires and overnight pulse oximetry. Pain intensity (VAS), pain frequency (days/week), circadian pain patterns, subjective sleep quality (PSQI) and objective nocturnal respiratory and autonomic parameters were assessed. Group comparisons and within-group linear regression analyses were performed.

RESULTS: Pain intensity did not differ between groups (7.45 ± 1.67 vs. 7.33 ± 1.90; p = 0.95). Patients with COMISA reported more frequent pain (3.37 ± 1.35 vs. 2.55 ± 1.19 days/week; p = 0.04) and more frequent morning pain (93.3% vs. 50.0%; p < 0.001). Subjective sleep quality was associated with pain intensity in COMISA (B = 0.200, r = 0.417, p = 0.022) but not in insomnia alone (p = 0.353). In COMISA, lower minimum nocturnal oxygen saturation (p = 0.043) and maximum nocturnal heart rate (p = 0.021) were associated with pain intensity; no such associations were observed in insomnia alone.

CONCLUSIONS: Sleep-pain relationships in chronic TMD vary by sleep phenotype. These findings support the need for further investigation of COMISA in relation to pain, particularly in orofacial pain and TMD populations.

PMID:41793288 | DOI:10.1111/joor.70185