Depressive Symptoms Account for Differences between Self-reported Versus Polysomnographic Assessment of Sleep Quality in Women with Myofascial TMD

Abstract

Background

Temporomandibular disorder (TMD) patients report poor sleep quality on the Pittsburgh Sleep Quality Index (PSQI). However, polysomnographic (PSG) studies show meager evidence of sleep disturbance on standard physiological measures.

Objective

The present aim was to analyze self-reported sleep quality in TMD as a function of myofascial pain, PSG parameters, and depressive symptomatology.

Methods

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-lab PSG variables, and depressive symptoms (Symptoms Checklist-90).

Results

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, R² = 26%). Of 19 PSG variables, two had modest contributions to higher PSQI scores: longer REM latency in TMD cases (P = 0.01, R² = 3%) and more awakenings in all participants (P = 0.03, R² = 2%). After accounting for these factors, TMD presence and pain ratings were not significantly related to PSQI scores.

Conclusion

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.

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