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<p>This cross-sectional observational study aimed to identify the predictors of sleep bruxism (SB) in patients with temporomandibular disorder (TMD) and to comprehensively investigate its association with clinical, sleep-related, psychological, and hematological factors. Seventy-nine patients with TMD (69 females and 10 males; mean age 45.46 ± 14.46 years) were divided into two groups based on the presence or absence of SB: TMD_nonbruxer and TMD_bruxer. Descriptive statistics, correlation analyses, and multivariate stepwise logistic regression were conducted; <i>p</i> &lt; 0.05 was considered statistically significant. In Cramer’s V, SB was correlated with several clinical and sleep-related factors, including TMJ noise (<i>r</i> = 0.52), TMD pain (<i>r</i> = 0.48), craniomandibular index (<i>r</i> = 0.32), limited mouth opening (<i>r</i> = 0.29), tinnitus (<i>r</i> = 0.29), an increase in the Pittsburgh sleep quality index (PSQI) global score (<i>r</i> = 0.24), and poor sleep quality, defined as a PSQI global score ≥ 5 (<i>r</i> = 0.19) (all <i>p</i> &lt; 0.05). SB was also associated with psychological distress. Regarding hematological factors, elevated levels of cortisol (<i>r</i> = 0.30), adrenocorticotropic hormone (ACTH) (<i>r</i> = 0.34), and cortisol/ACTH ratio (<i>r</i> = 0.35) were also associated with SB (all <i>p</i> &lt; 0.05). The factors associated with an increased likelihood of SB ranked in terms of the odds ratio (OR) were: craniomandibular index (OR = 18.400, <i>p</i> = 0.006), poor sleep quality with a PSQI global score ≥ 5 (OR = 11.425, <i>p</i> = 0.027), depression (OR = 1.189, <i>p</i> = 0.014), cortisol/ACTH ratio (OR = 1.151, <i>p</i> = 0.007), anxiety (OR = 1.081, <i>p</i> = 0.040), and adrenocorticotropic hormone (OR = 1.073, <i>p</i> = 0.019). Notably, an increase in age was associated with a decreased likelihood of SB (OR = 0.905, <i>p</i> = 0.006), with a cut-off value of 50 years (AUC = 0.259, 95% CI: 0.149–0.368, <i>p</i> = 0.024), indicating a significant decrease in bruxism occurrence in individuals aged ≥ 50 years. Further analysis revealed complex interconnections between SB and its predictors. In conclusion, SB in TMD patients was associated with age &lt; 50 years, various clinical factors, such as TMD pain and TMJ noise, poor sleep quality, psychological deterioration, and elevated cortisol and ACTH levels.</p>

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Clinical, psychological, and hematological factors predicting sleep bruxism in patients with temporomandibular disorders

  • 期刊论文

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  • 发表日期：

    2025年5月31日

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  • Yeon-Hee Lee,
  • Suk Chon,
  • Q-Schick Auh,
  • Merel Charlotte Verhoeff,
  • Frank Lobbezoo

摘要

This cross-sectional observational study aimed to identify the predictors of sleep bruxism (SB) in patients with temporomandibular disorder (TMD) and to comprehensively investigate its association with clinical, sleep-related, psychological, and hematological factors. Seventy-nine patients with TMD (69 females and 10 males; mean age 45.46 ± 14.46 years) were divided into two groups based on the presence or absence of SB: TMD_nonbruxer and TMD_bruxer. Descriptive statistics, correlation analyses, and multivariate stepwise logistic regression were conducted; p < 0.05 was considered statistically significant. In Cramer’s V, SB was correlated with several clinical and sleep-related factors, including TMJ noise (r = 0.52), TMD pain (r = 0.48), craniomandibular index (r = 0.32), limited mouth opening (r = 0.29), tinnitus (r = 0.29), an increase in the Pittsburgh sleep quality index (PSQI) global score (r = 0.24), and poor sleep quality, defined as a PSQI global score ≥ 5 (r = 0.19) (all p < 0.05). SB was also associated with psychological distress. Regarding hematological factors, elevated levels of cortisol (r = 0.30), adrenocorticotropic hormone (ACTH) (r = 0.34), and cortisol/ACTH ratio (r = 0.35) were also associated with SB (all p < 0.05). The factors associated with an increased likelihood of SB ranked in terms of the odds ratio (OR) were: craniomandibular index (OR = 18.400, p = 0.006), poor sleep quality with a PSQI global score ≥ 5 (OR = 11.425, p = 0.027), depression (OR = 1.189, p = 0.014), cortisol/ACTH ratio (OR = 1.151, p = 0.007), anxiety (OR = 1.081, p = 0.040), and adrenocorticotropic hormone (OR = 1.073, p = 0.019). Notably, an increase in age was associated with a decreased likelihood of SB (OR = 0.905, p = 0.006), with a cut-off value of 50 years (AUC = 0.259, 95% CI: 0.149–0.368, p = 0.024), indicating a significant decrease in bruxism occurrence in individuals aged ≥ 50 years. Further analysis revealed complex interconnections between SB and its predictors. In conclusion, SB in TMD patients was associated with age < 50 years, various clinical factors, such as TMD pain and TMJ noise, poor sleep quality, psychological deterioration, and elevated cortisol and ACTH levels.