睡眠问题、焦虑及压力是颞下颌关节紊乱病肌筋膜疼痛发病的风险指标

doi:10.3969/j.issn.1671-167X.2016.04.025

摘要/Abstract

摘要：

目的：调查睡眠及心理问题在颞下颌关节紊乱病（temporomandibular disorders, TMD）患者中的患病情况，并探讨其是否可能与TMD发病有关。方法：采用抑郁焦虑压力量表-21（depression, anxiety and stress scales-21, DASS-21）评估患者抑郁、焦虑、压力情况；采用匹兹堡睡眠质量指数量表（Pittsburgh sleep quality index,PSQI）评估患者睡眠质量；纳入连续就诊的755名TMD初诊患者（男性：172名，女性：583名），年龄11~82岁，平均年龄（29.99±13.60）岁。收集患者TMD临床检查各项数据及临床统计信息，根据颞下颌关节紊乱病研究诊断标准（Research Diagnostic Criteria for Temporomandibular Disorders, RDC/TMD）,755名TMD患者共分为7组，包括肌筋膜疼组、关节盘移位组、关节痛/骨关节炎（病）组、肌筋膜疼痛+关节盘移位组、肌筋膜疼痛+关节痛/骨关节炎（病）组、关节盘移位+关节痛/骨关节炎（病）组以及肌筋膜疼痛+关节盘移位+关节痛/骨关节炎（病）组，为进一步统计分析，将TMD患者又分为伴有（n=181）和不伴有肌筋膜疼痛（n=574）两组，采用SPSS 20.0对结果进行统计学分析。结果：伴有肌筋膜疼痛患者，其中度以上睡眠问题、抑郁、焦虑以及压力的患病率（27.1%、28.7%、60.8%及32.0%）显著高于不伴有肌筋膜疼痛（关节盘移位及关节痛/骨关节炎（病）的患者（11.1%、10.1%、27.4%及11.0%）， P<0.05。Logistic逐步回归分析表明，睡眠问题［（OR=1.74），具体包括主观睡眠质量（OR=1.69）和睡眠障碍（OR=1.63）两项睡眠因子］、焦虑（OR=3.14）及压力（OR=2.15）与TMD肌筋膜疼痛的发病有关，且差异具有统计学意义（P<0.05）。结论：TMD患者常常主诉有睡眠及心理问题，与关节盘移位或关节痛/骨关节炎（病）相比，肌筋膜疼痛患者更为严重;主观睡眠质量、睡眠障碍、焦虑及压力与TMD肌筋膜疼痛的发生有关。

关键词: 颞下颌关节障碍, 睡眠, 焦虑, 抑郁

Abstract:

Objective： To explore the relationship betweensleep/psychological distress and temporomandibular disorders (TMD) and to discuss the possibility of disturbed sleep and psychological distress as risk indicators in relation to TMD in a Chinese population. Methods: The standardized and validated selfreported Chinese version questionnaires including Pittsburgh sleep quality index (PSQI) and depression, anxietyandstress scales-21 (DASS-21) were used to measure sleep quality and psychological distress. A total of 755 TMD patients (172 males and 583 females)with a mean age (29.99 ± 13.60) years were included in the study. The patients were divided into 7 diagnostic groups based on the Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD), including Group Ⅰ(exclusively myofascial pain), Group Ⅱ(exclusively disc displacement), Group Ⅲ (exclusively arthralgia or degenerative joint disease), Group Ⅳ (myofascial pain plus disc displacement), Group Ⅴ (myofascial pain plus arthralgia or degenerative joint disease), Group Ⅵ (disc displacement plus arthralgia or dege-nerative joint disease) and Group Ⅶ (myofascial pain plus disc displacement plus arthralgia or degenerative joint disease). For statistical analysis, the patients were subsequently grouped into those with (181 patients) and without (574 patients) myofascial pain. Chisquare tests, independent-samples t test, partial correlation as well as stepwise Logistic regression analysis were used to analyze the data, using software SPSS 20.0 and P<0.05 was of significance. Results: The prevalence of moderate to (extremely) severe disturbed sleep and psychological distress was significantly higher in the myofascial pain group (27.1%, 28.7%, 60.8% and 32.0%) than in the non-myofascial pain group (disc displacement and arthralgia or degenerative joint disease, 11.1%, 10.1%, 27.4% and 11.0%, P<0.05).The comorbidity of self-reported disturbed sleep and psychological distress was significantly higher in the myofascial pain patients than those without myofascial pain (P<0.05). Stepwise logistic regression analysis demonstrated that disturbed sleep (OR=1.74), more specifically, subjective sleep quality (OR=1.69) and sleep disturbance (OR=1.63) respectively, anxiety (OR=3.14) and stress (OR=2.15) were possible risk indicators for myofascial pain, and the results were still significant even after controlling for age, sex, educational level, disease duration, sleep quality, depression, anxiety and stress respectively (P<0.05). Conclusion: Disturbed sleep and psychological distress symptoms are common in TMD patients. Disturbed sleep, anxiety and stress are possible risk indicators for myofascial pain, compared with disc displacement and arthralgia or degenerative joint diseases.

Key words: Temporomandibular joint disorders, Sleep, Anxiety, , Depression

中图分类号:

R782.63

雷杰，刘木清，傅开元. 睡眠问题、焦虑及压力是颞下颌关节紊乱病肌筋膜疼痛发病的风险指标[J]. 北京大学学报(医学版), 2016, 48(4): 692-696.

LEI Jie，LIU Mu-qing，FU Kai-yuan. Disturbedsleep, anxiety and stress are possible risk indicators for temporomandibular disorders with myofascialpain[J]. Journal of Peking University(Health Sciences), 2016, 48(4): 692-696.

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