Interactions between sleep parameters and heart rate variability in temporomandibular disorders

Q: What is the clinical evidence from this study?

Study design: Cross-Sectional. Population: Temporomandibular disorders (TMD) (n=93). Intervention: High TMD-related pain intensity (NRS > 5) vs. Low TMD-related pain intensity (NRS ≤ 5). Primary outcome: Sleep efficiency (%) (p=0.022).

Q: What does this research mean for the field?

High pain intensity in temporomandibular disorders is associated with significantly reduced sleep efficiency and lower nocturnal oxygen saturation, but does not alter 24-hour heart rate variability parameters. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

Helena Martynowicz; Małgorzata Trocha; Karol Marschollek; Piotr Macek; Wiktor Trzepietowski; Jakub Przegrałek; Katarzyna Madziarska; Mieszko Adam Wieckiewicz

doi:10.17219/dmp/217119

October 28, 2026Dental and Medical ProblemsOpen Access

Interactions between sleep parameters and heart rate variability in temporomandibular disorders

View Full Paper

Ask AI

Bookmark

Share

Key result

High TMD-related pain is linked to ~3-point lower sleep efficiency.

P=0.022
n=93

Why the study?

Temporomandibular disorder-related pain is associated with sleep disorders and affects heart rate parameters, but data from polysomnographic studies remain inconclusive.

Does high temporomandibular disorder-related pain intensity affect objective sleep parameters on video-polysomnography and 24-hour heart rate variability compared to low pain intensity in adults with temporomandibular disorders?

Key Points

To evaluate the impact of temporomandibular disorders on sleep architecture recorded by video-polysomnography and heart rate variability assessed via 24-hour electrocardiogram monitoring.
Cross-sectional study of 93 patients with temporomandibular disorders diagnosed according to the Diagnostic Criteria for Temporomandibular Disorders (DC/TMD).
Participants underwent overnight video-polysomnography and 24-hour electrocardiogram monitoring.
Pain intensity was assessed using the numeric rating scale (0–10) to categorize participants into low pain intensity (≤5, n = 66) and high pain intensity (>5, n = 27) groups.
Patients with high pain intensity exhibited lower sleep efficiency (87.7% vs. 90.8%, p = 0.022) and lower mean oxygen saturation (94.7% vs. 95.2%, p = 0.036) compared to those with low pain intensity, while heart rate variability parameters showed no significant differences between pain groups.
Women reported higher total pain scores than men (20 vs. 10, p = 0.007) and demonstrated higher 24-hour pNN50 (22.5% vs. 14.2%, p = 0.013), daytime pNN50 (18.0% vs. 9.8%, p = 0.002), daytime RMSSD (41.7 vs. 34.8, p = 0.026), and nighttime HR (63.8 vs. 60.5, p = 0.047).
Women had significantly lower 24-hour very low frequency power (1,402.4 vs. 2,214.5, p = 0.010), low frequency power (1,415.5 vs. 2,494.5, p = 0.028), and LF/HF ratio (1.3 vs. 2.5, p < 0.001) compared with men.

Study Design

Type

Cross-Sectional (n=93)

Blinding

Assessor-blinded

Multicenter

No

Structured PICO

Does high temporomandibular disorder-related pain intensity affect objective sleep parameters on video-polysomnography and 24-hour heart rate variability compared to low pain intensity in adults with temporomandibular disorders?

P

Population

93 adults (61.3% female, aged ≥18 years) with diagnosed temporomandibular disorders free of neurological, respiratory, or severe psychiatric comorbidities, evaluated via overnight video-polysomnography and 24-hour ECG monitoring.

E

Exposure

High TMD-related pain intensity (numeric rating scale [NRS] > 5, n=27) evaluated with overnight video-polysomnography (vPSG, 10 pm to 6 am) and concurrent 24-hour 12-channel Holter ECG monitoring.

C

Comparator

Low TMD-related pain intensity (numeric rating scale [NRS] ≤ 5, n=66); secondary comparison between women (n=57) and men (n=36).

O

Outcome

Video-polysomnography (vPSG) sleep parameters (including total sleep time, sleep efficiency, sleep stages, apnea-hypopnea index, and oxygen saturation) and 24-hour ECG heart rate variability (HRV) parameters (time-domain and frequency-domain parameters over 24 hours, daytime, and nighttime).surrogate

Main Result

Absolute Event Rate: 87.7% vs 90.8%

p-value: p=0.022

In patients with temporomandibular disorders, severe pain intensity is associated with modestly reduced sleep efficiency and nocturnal oxygen saturation without altering 24-hour heart rate variability, whereas female sex is associated with higher pain scores alongside greater parasympathetic/lower sympathetic HRV indices.

Limitations

Polysomnography was performed without an adaptation night, potentially inducing a first-night effect
Lifestyle-related factors affecting autonomic nervous system activity and HRV (e.g., stress, caffeine, noise) were not fully controlled
Patients with hypertension and those taking medications that could affect HRV were not excluded
Exploratory study design without prespecified primary endpoints, a priori power calculation, or multivariable adjustment for confounders
Cross-sectional design precludes establishing temporal relationships and causality
Formal inter-rater reliability of pain assessment was not re-evaluated, and detailed clinical phenotyping (pain duration, TMD subtypes) was unavailable
Phase of the menstrual cycle in women and use of hormone therapy were not accounted for
Differences in sleep efficiency and mean oxygen saturation between pain groups were small in magnitude and of uncertain clinical relevance

Implication

High TMD pain may prompt sleep evaluation; extends cross-sectional associations but leaves open causality and intervention effects.

Abstract

Background.Temporomandibular disorders (TMD) cause pain and dysfunction in the temporomandibular joints (TMJs) and masticatory muscles and significantly impact quality of life.Temporomandibular disorderrelated pain is associated with sleep disorders and affects heart rate (HR) parameters; however, data from polysomnographic studies remains inconclusive.Objectives.The aim of the study was to evaluate the impact of TMD on sleep parameters recorded using video-polysomnography (vPSG) and heart rate variability (HRV) monitored with the use of a 24-hour electrocardiogram (ECG). Material and methods.A cross-sectional study included 93 patients with TMD diagnosed according to the Diagnostic Criteria for Temporomandibular Disorders (DC/TMD).Video-polysomnography and 24-hour ECG monitoring were conducted.Pain was assessed using the numeric rating scale (NRS) (0-10) and categorized as mild (≤5) or severe (>5).Results.The study included 93 patients with TMD, divided into groups of low pain intensity (n = 66) and high pain intensity (n = 27).The group with high pain intensity demonstrated lower sleep efficiency (87.7% vs. 90.8%,p = 0.022) and lower oxygen saturation (94.7% vs. 95.2%,p = 0.036).Heart rate variability parameters were similar in both groups.Women reported a higher total pain score (20 vs. 10, p = 0.007) and had a higher percentage of normal-to-normal (NN) intervals differing by more than 50 ms (pNN50) (24 h: 22.5% vs. 14.2%, p = 0.013; daytime: 18.0% vs. 9.8%, p = 0.002), higher daytime root mean square of successive differences (RMSSD) (41.7 vs. 34.8,p = 0.026), and a higher nighttime HR (63.8 vs. 60.5, p = 0.047).Additionally, women demonstrated lower values for very low frequency (VLF) power (1,402.4 vs. 2,214.5,p = 0.010), low frequency (LF) power (1,415.5 vs. 2,494.5,p = 0.028), and the low frequency/high frequency (LF/HF) ratio (1.3 vs. 2.5, p < 0.001). Conclusions.High TMD-related pain intensity is associated with reduced sleep efficiency and lower mean oxygen saturation during sleep.Women experience higher pain intensity but lower sympathetic activation than men.

Discussion

No takes yet. Share an insight, caveat, or question.

Cite This Study

Martynowicz et al. (2026) conducted a cross-sectional in Temporomandibular disorders (TMD) (n=93). High TMD-related pain intensity (NRS > 5) vs. Low TMD-related pain intensity (NRS ≤ 5) was evaluated on Sleep efficiency (%) (p=0.022). High TMD-related pain intensity was associated with lower sleep efficiency (87.7% vs. 90.8%, p=0.022) and oxygen saturation (94.7% vs. 95.2%, p=0.036) compared to low pain intensity.

synapsesocial.com/papers/6ae584814c46c197bbab25e7 https://doi.org/10.17219/dmp/217119

View Full Paper

Ask AI

Bookmark

Share

Interactions between sleep parameters and heart rate variability in temporomandibular disorders

Key Points

Study Design

Structured PICO

Main Result

Limitations

Implication

Abstract

Discussion

Cite This Study

Interactions between sleep parameters and heart rate variability in temporomandibular disorders

Key Points

Study Design

Structured PICO

Main Result

Limitations

Implication

Abstract

Discussion

Cite This Study

Keep reading

Keep reading