Clinical phenotype of South–East Asian Temporomandibular Disorder patients with Upper Airway Resistance Syndrome

Abstract

Objective

To document the clinical phenotype of temporomandibular disorder (TMD) patients with concomitant upper airway resistance syndrome (UARS) in a South East Asian population.

Study Design

A multi-center prospective series of 86 TMD patients (26 men and 60 women / mean age 35.7 years) with UARS. All had excessive daytime sleepiness, high arousal index and apnea-hypopnea index (AHI)<5

Results

The mean body mass index was 20.1, mean arousal index 16.2, mean respiratory disturbance index 19.6, mean AHI 3.9 while the mean Epworth Sleepiness Scale was 14.8. Many had functional somatic complaints; 66.3% headaches, 41.9% neck aches, 53.5% masticatory muscle myalgia, 68.6% temporomandibular joint (TMJ) arthralgia while 90.7% reported sleep bruxism (SB). Unlike patients with obstructive sleep apnea (OSA), hypertension was uncommon (4.7%) whilst depression was prevalent at 68.6% with short REM latency of <90mins and an increased REM composition >25% documented in 79.6% and 57.6% of these depressed patients, respectively. 65.1% displayed a posteriorly displaced condyle at maximum intercuspation with or without TMJ clicking. Most exhibited a forward head posture (FHP) characterized by loss of normal cervical lordosis (80.2%), C0-C1 narrowing (38.4%) or an elevated hyoid position (50%), and 91.9% had nasal congestion.

Conclusion

The TMD-UARS phenotype may have originally developed as an adaptive response to 'awake' disordered breathing during growth. Patients with persistent TMD and/or reporting SB should be screened for UARS and chronic nasal obstruction, especially when they also present with FHP. The lateral cephalogram is a useful tool in the differentiation of UARS from other OSA phenotypes.

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