Effect of insomnia in the association between temporomandibular disorder pain and central sensitization

Author(s)

Fernanda Gruninger Mercante

• Document type: Master's Dissertation
• Press: Araraquara. 2019-04-05.
• Institution: Universidade Estadual Paulista (Unesp). Faculdade de Odontologia. Araraquara
• Defense date: 2019-02-26
• Advisor: Daniela Aparecida Godoi Gonçalves

Abstract

Previous studies have shown an association between temporomandibular disorders (TMD) and central sensitization(CS). The presence of CS includes hypofunction of the pain inhibitory system, affecting the modulation of the nociceptive function. There is evidence of the association between insomnia and CS in individuals with chronic pain. However, there are no studies about this association in patients with TMD. Aim: To estimate the association between CS, TMD pain and insomnia and to assess sleep quality, duration, latency and efficiency in individuals with and without CS. Methods: This cross-sectional study was conducted in a sample of 104 individuals, aged between 20-65 years, stratified into two groups: 1) TMD; and 2) TMD and insomnia. TMD were classified according to Research Diagnosis Criteria for Temporomandibular Disorders (RDC/TMD). Insomnia was assessed according to the criteria of the 3rd International Classification of Sleep Disorders, and quantified by the Insomnia Severity Index questionnaire. The presence of SC was evaluated through quantitative sensorial testing (QST), which were pressure pain threshold (PPT) and temporal summation (TS) and the conditioned pain modulation test (CPM). The QST parameters (LDP and ST) were transformed into z-score profiles. The 2-factor ANCOVA was used to test the difference between groups. To test the CPM effect, we used a 2-factor ANCOVA for repeated measures. The level of significance adopted was 5%. Results: There were no associations between groups for TS in the trigeminal (F=0,242; p=0,624) and extratrigeminal (F=0,006; p=0,939) areas. Also, there were no associations between groups for the PPT in the trigeminal (F=0,023; p=0,880) and extratrigeminal (F=0,127; p=0,722) area and no significant difference between groups for the CPM test in the trigeminal (F=0,019; p=0,890) and extratrigeminal (F=0,809; p=0,371) areas. Furthermore, no difference was found for total sleep duration (F=0,130, p=0,643; F=1,590, p=0,211), sleep latency (F=0,521, p=0,473; F=0,013, p=0,910), sleep efficiency (F=0,687, p=0,410; F-1,075; p=0,310) and sleep quality (p=0,864; p=0,695) for the trigeminal and extratrigeminal áreas, in this order. Conclusion: Insomnia did not influence the association between TMD and CS. Also, CS did not influence subjective sleep parameters. (AU)

• FAPESP's process: 17/14266-3 - Effect of insomnia in the association between temporomandibular disorder pain and central sensitization
• Grantee: Fernanda Gruninger Mercante
• Support Opportunities: Scholarships in Brazil - Master