483: Painful TMD in OSA: Roles of Insomnia, Distress, and Sleep Bruxism

Topic: Clinical Science
Subtopic: Pain category (ICD-11), Chronic primary orofacial pain, Epidemiology

Background and Aims: Temporomandibular disorders (TMD), insomnia, psychological distress, and sleep bruxism
frequently coexist in obstructive sleep apnea (OSA), yet phenotype-specific relationships remain unclear. Objective assessment of sleep bruxism using polysomnography in OSA populations is limited. This study determined the prevalence of painful TMD among OSA patients with TMD, and examined its associations with insomnia, anxiety, depression, and polysomnography-derived bruxism. We hypothesized that painful TMD would be associated with greater psychological distress, higher insomnia prevalence, and increased sleep bruxism activity.

Methods: This preliminary cross-sectional study investigated adult patients diagnosed with OSA in the Sleep Laboratory, Srinagarind Hospital, Thailand. TMD was classified using brief DC/TMD. Anxiety and depressive symptoms were assessed using HADS. Insomnia was defined according to DSM-5 criteria. Bruxism was diagnosed with polysomnography based on the Bruxism Episode Index (BEI≥2 episodes/hour). Group comparisons employed Chi-square, independent t-tests, or Mann–Whitney U tests.

Results: Among 54 adults with OSA, 35 were diagnosed with TMD, including 18 (51.4%) with painful and 17 (48.6%) with non-painful TMD. Patients with painful TMD were younger than those with non-painful TMD (41.5±10.6 vs 49.7±15.0 years), although this difference was marginal (p=0.07). No significant differences were found in sex distribution (p=0.89), insomnia prevalence (77.8% vs 82.4%, p=0.74), or sleep bruxism prevalence (77.8% vs 58.8%, p=0.23). HADS-A and HADS-D scores were similar between groups. Total BEI did not differ, while phasic BEI was slightly higher in painful TMD (1.1 vs 0.9 episodes/hour, p=0.14).

Conclusions: In adults with OSA, painful and non-painful TMD subgroups share a comparably high burden of insomnia and psychological distress. Younger age shows a marginal trend toward the painful phenotype. A future study with a larger sample size is needed to clarify the potential sleep–pain interactions.

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Presenting Author: Kanokrat Sitthikaew
Submitting Author: Kanokrat Sitthikaew

Senior Author: Jarin Paphangkorakit

IASP 2026 Global Year theme of Neuropathic Pain: No

• Tanaporn Amnuayrungrueng: DDS. - Faculty of Dentistry, Khon Kaen University, Thailand
• Waranuch Pitiphat: DDS, MPHM, MS, ScD (Epidemiology), FRCDS (Dental Public Health) - Faculty of Dentistry, Khon Kaen University, Thailand
• Apichart So-ngern: M.D, Ph.D. - Faculty of Medicine, Khon Kaen University, Thailand
• Supanigar Ruangsri: DDS., M.Sc. (Occlusion), Ph.D. (Oral Biology) - Faculty of Dentistry, Khon Kaen University, Thailand
• Sawita Khimsuksri: DDS., M.Sc. (Neuroscience), Ph.D. (Oral Sciences) - Faculty of Dentistry, Khon Kaen University, Thailand
• Teekayu Plangkoon Jorns: DDS., M.D.Sc. (Oral Biology), Ph.D. (Orofacial Pain) - Faculty of Dentistry, Khon Kaen University, Thailand
• Jarin Paphangkorakit: DDS., Ph.D. (Oral Biology) - Faculty of Dentistry, Khon Kaen University, Thailand