Clinical phenotype of South-East Asian temporomandibular disorder patients with upper airway resistance syndrome

J Oral Rehabil. 2018 Jan;45(1):25-33. doi: 10.1111/joor.12551. Epub 2017 Nov 10.


Clinical and radiographic characteristics of a subset of South East Asian temporomandibular disorder (TMD) patients with comorbid upper airway resistance syndrome (UARS) were documented in a multi-center prospective series of 86 patients (26 men and 60 women / mean age 35.7 years). All had excessive daytime sleepiness, high arousal index and Apnoea-Hypopnoea Index (AHI) <5. 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 apnoea (OSA), hypertension was uncommon (4·7%) while depression was prevalent at 68·6% with short REM latency of <90 min 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) characterised 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. We postulate 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.

Keywords: obstructive sleep apnoea; oral appliance therapy; persistent oro-facial muscle pain; sleep bruxism; temporomandibular disorders; upper airway resistance syndrome.

Publication types

  • Multicenter Study

MeSH terms

  • Adult
  • Airway Resistance
  • Asia, Southeastern
  • Asian People
  • Body Mass Index
  • Female
  • Humans
  • Male
  • Middle Aged
  • Nasal Obstruction / diagnostic imaging*
  • Nasal Obstruction / physiopathology
  • Phenotype
  • Prospective Studies
  • Radiography
  • Sleep Bruxism / diagnostic imaging*
  • Sleep Bruxism / physiopathology
  • Sleep Wake Disorders / diagnostic imaging*
  • Sleep Wake Disorders / physiopathology
  • Temporomandibular Joint Disorders / complications
  • Temporomandibular Joint Disorders / physiopathology*