title: Subjective Sleep Quality Deteriorates Before Development of Painful Temporomandibular Disorder.
abstract: There is good evidence that poor sleep quality increases risk of painful temporomandibular disorder (TMD). However, little is known about the course of sleep quality in the months preceding TMD onset, and whether the relationship is mediated by heightened sensitivity to pain. The Pittsburgh Sleep Quality Index was administered at enrollment into the Orofacial Pain: Prospective Evaluation and Risk Assessment (OPPERA) prospective cohort study. Thereafter the Sleep Quality Numeric Rating Scale was administered every 3 months to 2,453 participants. Sensitivity to experimental pressure pain and pinprick pain stimuli was measured at baseline and repeated during follow-up of incident TMD cases (n = 220) and matched TMD-free controls (n = 193). Subjective sleep quality deteriorated progressively, but only in those who subsequently developed TMD. A Cox proportional hazards model showed that risk of TMD was greater among participants whose sleep quality worsened during follow-up (adjusted hazard ratio = 1.73, 95% confidence limits = 1.29, 2.32). This association was independent of baseline measures of sleep quality, psychological stress, somatic awareness, comorbid conditions, nonpain facial symptoms, and demographic characteristics. Poor baseline sleep quality was not significantly associated with baseline pain sensitivity or with subsequent change in pain sensitivity. Furthermore the relationship between sleep quality and TMD incidence was not mediated via baseline pain sensitivity or change in pain sensitivity.
  
  
  
  Subjective sleep quality deteriorates progressively before the onset of painful TMD, but sensitivity to experimental pain does not mediate this relationship. Furthermore, the relationship is independent of potential confounders such as psychological stress, somatic awareness, comorbid conditions, nonpain facial symptoms, and various demographic factors.
authors.affiliation: Department of Dental Ecology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina. Electronic address: anne_sanders@unc.edu.
authors.forename: Anne E
authors.initials: AE
authors.lastname: Sanders
authors.affiliation: Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.
authors.forename: Aderonke A
authors.initials: AA
authors.lastname: Akinkugbe
authors.affiliation: Department of Biostatistics, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina; Department of Endodontics, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina; Center for Pain Research and Innovation, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.
authors.forename: Eric
authors.initials: E
authors.lastname: Bair
authors.affiliation: Pain Research & Intervention Center of Excellence, University of Florida, Gainesville, Florida.
authors.forename: Roger B
authors.initials: RB
authors.lastname: Fillingim
authors.affiliation: Department of Neural and Pain Sciences, University of Maryland School of Dentistry, Baltimore, Maryland; Brotman Facial Pain Clinic, University of Maryland School of Dentistry, Baltimore, Maryland.
authors.forename: Joel D
authors.initials: JD
authors.lastname: Greenspan
authors.affiliation: Department of Oral Diagnostic Sciences, University at Buffalo, Buffalo, New York.
authors.forename: Richard
authors.initials: R
authors.lastname: Ohrbach
authors.affiliation: Department of Neural and Pain Sciences, University of Maryland School of Dentistry, Baltimore, Maryland.
authors.forename: Ronald
authors.initials: R
authors.lastname: Dubner
authors.affiliation: Department of Endodontics, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina; Center for Pain Research and Innovation, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.
authors.forename: William
authors.initials: W
authors.lastname: Maixner
authors.affiliation: Department of Dental Ecology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina; Center for Pain Research and Innovation, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.
authors.forename: Gary D
authors.initials: GD
authors.lastname: Slade
mesh_terms: D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D015331:Cohort Studies; D005260:Female; D006801:Humans; D008297:Male; D016016:Proportional Hazards Models; D012893:Sleep Wake Disorders / Q000209:etiology*; D013705:Temporomandibular Joint Disorders / Q000150:complications* / Q000453:epidemiology*; D055815:Young Adult
keywords: Epidemiology; musculoskeletal pain; pain perception; psychological stress; sleep quality