Evaluation of Prevalence of Temporomandibular Joint Disorders in Patients with OSAS

Öz

Background: The aim of our study was to investigate the prevalence of Temporomandibular Joint (TMJ) disorder in 54 patients diagnosed with Obstructive Sleep Apnea syndrome (OSAS) by polysomnography (PSG) and to invetigate age and sex relationship.
Materials and Methods: 54 patients who were diagnosed with OSAS Between January 2018 and June 2018, in the Department of Pulmonology, Faculty of Medicine, Harran University were included in this study. Patients diagnosed with OSAS were referred to the Oral, Dental and Maxillofacial Surgery Clinic of the Faculty of Dentistry at Harran University. TME examination of these patients was performed bilaterally by the same physician. TME was examined during the examination. The diagnosed ailments were classed according to the RDC/TMD Axis 1 classification. The age and sex of the patients were also recorded.
Results: According to the results, 75.9% of the patients were male and 24.1% were female. 24.1% have bruxism and 9.3% have reduced disc displacement. According to the ahi index, 70.4% of patients had severe, 20.4% had moderate, 9.3% had mild OSAS. The mean age of the patients was approximately 50, the mean age of the mild Osas group was 33.4, the mean age of the moderate OSAS group was 49.3 and the mean age of the severe OSAS group was 51.8. According to the significance values of the test statistics, there was a statistically significant relationship between the degree of disease and age groups only (p<0.05). The average age of patients diagnosed with severe OSAS is significantly higher than those diagnosed with mild OSAS, according to the findings of the multiple comparison test. There was no statistically significant association between all other factors and the degree of disease (p>0.05).
Conclusions: OSAS is more common in men and in later ages, and the severity of the disease increases as age progresses. In our study, TME disorder was observed in one third of patients with OSAS and bruxism was recorded as the most common TME disorder group. The authors consider this to be due to impaired sleep quality leading to psychological stress in patients and consequently triggering bruxism. However, the study needs to be carried out on the wider patient population and further studies comparing the findings of TME disease before and after treatment of patients with OSAS are needed.

OSAS'lı Hastalarda Temporomandibular Eklem Rahatsızlıklarının Prevelansının Değerlendirilmesi

Öz

Amaç: Çalışmamızın amacı polisomnografi (PSG) ile Obstrüktif Uyku Apne sendromu (OSAS) teşhisi konmuş 54 hastada Temporomandibular eklem (TME) rahatsızlığı prevelansını, ve OSAS’ın yaş ve cinsiyet ile ilişkisini araştırmaktır.
Materyal ve Metod: Çalışmamıza Ocak 2018 – Haziran 2018 tarihleri arasında Harran Üniversitesi Tıp Fakültesi Göğüs Hastalıkları Anabilim Dalında OSAS teşhisi konmuş fakat OSAS tedavisine başlanmamış 54 hasta dâhil edildi. OSAS teşhisi konmuş hastalar Harran Üniversitesi Diş Hekimliği Fakültesi Ağız, Diş ve Çene Cerrahisi kliniğine yönlendirildi. Bu hastaların TME muayenesi tek hekim tarafından bilateral olarak yapıldı. Muayene esnasında TME rahatsızlığına bakıldı. Teşhis edilen rahatsızlıklar TME rahatsızlığı/eksen 1 (RDC/TMD Axis 1) sınıflandırmasına göre klasifiye edildi. Ayrıca hastaların yaş ve cinsiyetleri de kayıt edildi.
Bulgular: Elde edilen sonuçlara göre hastaların % 75,9’u erkek, % 24,1’i kadındır. % 24,1’inde bruksizm, % 9,3’ünde redüksiyonlu disk deplasmanı vardır. Apne/Hipopne indeksi (AHİ) indeksine göre hastaların % 70,4’ünde ağır derecede, % 20,4’ünde orta derece, % 9,3’ünde hafif derecede OSAS bulunmaktaydı. Hastaların yaş ortalaması yaklaşık 50, hafif derecede OSAS grubunun yaş ortalaması 33,4, orta derecede OSAS grubunun yaş ortalaması 49,3 ve ağır derecede OSAS grubunun yaş ortalaması ise 51,8'dır. Test istatistiğinin anlamlılık değerlerine göre, hastalık derecesi ile yalnızca yaş grupları arasında istatistiksel olarak anlamlı ilişki bulunmuştur (p<0.05). Çoklu karşılaştırma testi bulgularına göre ağır derecede OSAS teşhisi konulan hastaların yaş ortalamaları, hafif derecede OSAS teşhisi konulan hastalara göre anlamlı ölçüde yüksektir. Diğer tüm faktörlerle hastalık derecesi arasında istatistiksel olarak anlamlı ilişki bulunamamıştır (p>0.05).
Sonuç: OSAS erkelerde ve ilerleyen yaşlarda daha yüksek oranda görülmektedir ve yaş ilerledikçe hastalığın şiddeti de artmaktadır. Çalışmamızda OSAS’lı hastalarda üçte birinde TME rahatsızlığının eşlik ettiği görülmüş olup en sık gözlenen TME rahatsızlığı bruksizm olarak kaydedilmiştir. Yazarlar bunun nedeni olarak uyku kalitesinin bozulmasının hastalarda psikolojik strese yol açtığını ve sonuç olarak bruksizmi tetiklediğini düşünmektedir. Bununla birlikte çalışmanın daha geniş hasta popülasyonları üzerinde yapılmasına ve ayrıca OSAS’lı hastaların tedavi öncesi ve sonrası TME rahatsızlığı bulgularını karşılaştıran ileri çalışmalara ihtiyaç bulunmaktadır.  

Anahtar Kelimeler

• Temporomandibular eklem rahatsızlığı,OSAS,YAŞ,CİNSİYET

Kaynakça

1. Referanslar 1. Odabaş B, Gündüz Arslan S. Temporomandibular eklem anatomisi ve rahatsızlıkları. Dicle Tıp Dergisi. 2008;35:77-85
2. 2. American Academy of Pediatric Dentistry. Clinical guideline on acquired temporomandibular disorders in infants, children and adolescents. Pediatric Dentistry. 2015; 37: 272–8.
3. 3. Liu F, Steinkeler A. Epidemiology, diagnosis, and treatment of temporomandibular disorders. Dent Clin North Am. 2013;57:465-79 4. List T, Dworkin SF. Comparing TMD diagnoses and clinical findings at Swedish and US TMD center using Research Diag-nostic Criteria for Temporomandibular Disorders. J Orofac Pain. 1996;10:240–53
4. 5. Ahmad M, Hollender L, Anderson Q, Kartha K, Ohrbach R, True-love EL, et all. Research diagnostic criteria for temporomandibular disorders (RDC/TMD): development of image analysis criteria and examiner reliability for image analy-sis. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2009;107:844-60
5. 6. Azagra-Calero E, Espinar-Escalona E, BarreraMora JM, Llamas-Carreras JM, Solano-Reina E. Obstructive Sleep Apnea Syndrome (OSAS). Review of the literature. Med Oral Patol Oral Cir Bucal. 2012;17(6):925-9.
6. 7. Guilleminault C, Tilkian A, Dement WC. The sleep apnea syndromes. Annu Rev Med. 1976;27:465–84.
7. 8. Peppard P E, Young T, Barnet JH, Palta M, Hagen EW, Hla KM. Increased Prevalence of Sleep-Disordered Breathing in Adults. Am J Epidemiol. 2013;177(9):1006-14.
8. 9. Strauss RS, Browner WS. Risk for obstructive sleep apnea. Ann Intern Med. 2000;132(9):758-9.

9. 10. Stansbury RC, Strollo PJ. Clinical manifestations of sleep apnea. J Thorac Dis. 2015;7(9):298-310.
10. 11. Kushida CA, Littner MR, Morgenthaler T, Alessi CA, Bailey D, Coleman J J, et al. Practice parameters for the indications for polysomnography and related procedures: an update for 2005. Sleep. 2005;28(4):499-521.
11. 12. Z Alaçam, S Pekcan, B Akdağ. Obstrüktif Uyku Apne Sendromu Tanılı Hastalarda; Hemogram Parametreleri ile Gece Desatürasyonu İlişkisi. Journal of Turkish Sleep Medicine 2018;5:62-6.
12. 13. Jordan AS, McSharry DG, Malhotra A. Adult obstructive sleep apnoea. Lancet 2014;383:736–747.
13. 14. Okeson JP, de Leeuw R. Differential diagnosis of temporomandibu- lar disorders and other orofacial pain disorders. Dent Clin North Am 2011;55(1):105-120.
14. 15. Cooper BC, Kleinberg I. Examination of a large patient population for the presence of symptoms and signs of temporomandibular disorders. Cranio 2007;25(2):114-126.
15. 16. Cunali PA, Almeida FR, Santos CD, Valdrighi NY, Nascimento LS, Dal’Fabbro C, et al. Prevalence of temporomandibular disorders in ob- structive sleep apnea patients referred for oral appliance therapy. J Orofac Pain 2009;23(4):339-344.
16. 17. Smith MT, Wickwire EM, Grace EG, Edwards RR, Buenaver LF, Peterson S, et al. Sleep disorders and their association with laboratory pain sensitivity in temporomandibular joint disorder. Sleep 2009;32(6):779-790.
17. 18. Sanders AE, Essick GK, Fillingim R, Knott C, Ohrbach R, Greenspan JD, Diatchenko L, Maixner W, Dubner R, Bair E,. Miller VE, Slade GD. Sleep Apnea Symptoms and Risk of Temporomandibular Disorder: OPPERA Cohort. J Dent Res 2013; Jul;92(7Suppl):70-77.
18. 19. Togeiro SMGP, Smith AK. Diagnostics methods for sleep disorders. Rev Bras Psiquiatr 2005;27(Supl I):8-15.
19. 20. Veiga DM, Cunali R, Bonotto D, Cunali PA. Sleep quality in patients with temporomandibular disorder: a systematic review. Sleep Sci 2013;6(3):120-124.
20. 21. Pişkin B, Akın H, Şentut F. Obstrüktif uyku apnesinde oral aparey kullanımı. Cumhuriyet Dent J 2012;15(3):264-278.
21. 22. Stradling JR, Davies RJO. Obstructive sleep apnea/hypopnea syndrome: definitions, epidemiology and natural history. Thorax 2004;59(1):73-78.
22. 23. A Arısoy, H Günbatar, S Ekin. OSAS'lı Hastalarımızın Değerlendirilmesi. Van Tıp Dergisi, 21(4): 203-205, 2014.
23. 24. D Doğan, N Öcal. Obstruktif Uyku Apne Ön Tanısında Tiroid Fonksiyon Testlerinin Önemi ve Gerekliliği. Konuralp Tıp Dergisi 2019;11(1): 36-40.
24. 25. Santos-Silva R, Castro LS, Taddei JA, Tufik S, Bittencourt LR. Sleep dis- orders and demand for medical services: evidence from a population- based longitudinal study. PLoS One. 2012;7(2):e30085.
25. 26. Gislason T, Sunnergren O. Obstructive sleep apnoea in adults. In: Annesi-Maesano I, Lundbäck B and Viegi G, eds. Respiratory Epidemiology (ERS Monograph). Sheffield, European Respiratory Society, 2014;88–105.
26. 27. Heinzer R, Vat S, Marques-Vidal P, et al. Prevalence of sleep-disordered breathing in the general population: the HypnoLaus study. Lancet Respir Med 2015; 3: 310–318.
27. 28. Berry R, Brooks R, Gamaldo C, et al. The AASM Manual for the Scoring of Sleep and Associated Events: Rules, Terminology, and Technical Specifications, Version 2.1. Darien, American Academy of Sleep, 2014.
28. 29. Arnardottir ES, Bjornsdottir E, Olafsdottir KA, Benediktsdottir B, Gislason T. Obstructive sleep apnoea in the general population: highly prevalent but minimal symptoms. Eur Respir J 2016; 47: 194–202.
29. 30. Franklin KA, Lindberg E. Obstructive sleep apnea is a common disorder in the population a review on the epidemiology of sleep apnea. J Thorac Dis 2015;7(8):1311-1322.
30. 31. American Academy of Sleep Medicine (2005).The International Classification of Sleep Disorders. Diagnostic and Coding Manual. 2nd ed. Westchester, IL: American Academy of Sleep Medicine.
31. 32. Maluly M, Andersen ML, Dal-Fabbro C, Garbuio S, Bittencourt L, de Siqueira JTT, and Tufik S. Polysomnographic Study of the Prevalence of Sleep Bruxism in a Population Sample. J Dent Res. 2013 Jul;92(7 Suppl):97-103.
32. 33. Lavigne GJ, Montplaisir JY. Restless legs syndrome and sleep bruxism: prevalence and association among Canadians. Sleep 1994;(17):739-743.
33. 34. Ohayon MM, Li KK, Guilleminault C. Risk factors for sleep bruxism in the general population. Chest 2001, 119:53-61.
34. 35. Kato T, Velly AM, Nakane T, Masuda Y, Maki S. Age is associated with self-reported sleep bruxism, independently of tooth loss. Sleep Breath 2012,16:1159-1165.
35. 36. Abekura H, Tsuboi M, Okura T, Kagawa K, Sadamori S, Akagawa Y (2011). Association between sleep bruxism and stress sensitivity in an experimental psychological stress task. Biomed Res 32:395-399.
36. 37. Bonnet MH, Arand DL (2010). Hyperarousal and insomnia: state of the science. Sleep Med Rev 14:9-15.