The impact of insomnia in the persistence of pain-related temporomandibular disorders: a six-month cohort study
Bibliographic record
Abstract
Background: Though most pain-related temporomandibular disorders (PTMDs) are mild and self-limiting, a significant frequency of patients experience persistent pain, presenting a great challenge in terms of management and often resulting in substantial disability. Individuals with PTMD commonly exhibit sleep-related comorbidities, with insomnia being a prevalent concern.Objective: The aim of this multicenter cohort study was to assess whether insomnia contributed to the persistence of clinically significant PTMD defined by moderate to severe pain intensity within six months of follow-up.Methods: Participants were enrolled from three clinics in Montreal and one in Ottawa. The diagnosis of PTMD was achieved through the utilization of either the Research Diagnostic Criteria (RDC/TMD) or the Diagnostic Criteria for Temporomandibular Disorders (DC/TMD). Insomnia at baseline visit was assessed using the Insomnia Severity Index (ISI). Persistence of clinically significant PTMD defined by moderate to severe pain intensity was measured using Characteristic Pain Intensity (CPI) scores within six months of follow-up period. Crude and multivariable logistic regression analyses were used to estimate the results.Results: Out of the 456 PTMD participants, 447 answered the baseline questionnaires, 377 (84.3%) and 370 (82.8%) completed the three-month and six-month follow-up periods, respectively. Insomnia increased the likelihood of persistent clinically significant PTMD (CPI ≥ 50) in both the crude (ORc= 1.63, 95%CI: 1.24—2.15, P= 0.0005) and multivariable (ORadj= 1.60, 95%CI: 1.10 - 2.31, P= 0.01) analyses, within the six-month follow-up among the participants. Additional analysis showed that mild insomnia (ORadj= 1.42, 95%CI: 0.94—2.12, P= 0.09), moderate insomnia (ORadj= 1.95, 95%CI: 1.23—3.08, P= 0.004) and severe insomnia (ORadj= 2.43, 95%CI: 1.37—4.31, P= 0.002) contributed to the persistence of clinically significant PTMD in a dose-response manner.Conclusion: These results indicate that insomnia increases the likelihood of persistent clinically significant PTMD within six months of follow-up period, and therefore should be considered as an important factor when evaluating and developing treatment plans for patients with PTMD
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.002 | 0.003 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.001 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.001 | 0.000 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".