Association of simple snoring and myogenous temporomandibular disorders based on polysomnographic examination

Background: This study aims to evaluate the association between objectively measured snoring characteristics and masticatory muscle pain in patients with myogenous temporomandibular disorders (TMD), while excluding patients with obstructive sleep apnea. Methods: This prospective study included 184 patients (mean age: 33.92 ± 10.05 years; 71.2% female) who underwent overnight polysomnography (PSG) and standardized TMD assessments. Snoring was quantified using acoustic recordings and parameters derived from PSG. Muscle pain intensity was assessed in the bilateral masseter and temporalis muscles. Correlation analyses and group comparisons were performed to examine the relationships between snoring characteristics (e.g., snore index, train frequency, and audio volume) and pain outcomes. Results: No significant associations were found between primary snoring parameters and pain intensity. However, several snoring metrics,particularly those measured during specific body positions and sleep stages, especially during nonsupine rapid eye movement (REM) sleep—showed significant negative correlations with pain, mainly in the left masseter and temporalis muscles. Notably, higher snore intensity was associated with lower muscle pain, suggesting a potential modulatory effect. These relationships were lateralized and dependent on body position. Multivariate analysis did not identify independent predictors of pain. Although no direct link was observed between overall snoring and masticatory muscle pain, certain snoring patterns,particularly during nonsupine REM sleep—were inversely related to pain intensity. Conclusions: These findings suggest a possible protective or modulatory role of snoring in TMD-related muscle pain and highlight the complex influences of sleep stage, body position, and laterality. Clinical Trial Registration: Information on clinical trial registration can be found at www.ClinicalTrials.gov (identifiers: NCT03083405, NCT04214561).

Snoring; Muscle pain; Myofascial pain; TMD; Polysomnography

[1] Durham J, Newton-John TR, Zakrzewska JM. Temporomandibular disorders. The BMJ. 2015; 350: h1154.

[2] National Academies of Sciences, Engineering, and Medicine; Health and Medicine Division; Board on Health Care Services; Board on Health Sciences Policy; Committee on Temporomandibular Disorders (TMDs): From Research Discoveries to Clinical Treatment. Yost O, Liverman CT, English R, Mackey S, Bond EC. Temporomandibular disorders: priorities for research and care. The National Academies Press: Washington (DC), US. 2020.

[3] Dahlström L, Carlsson GE. Temporomandibular disorders and oral health-related quality of life. A systematic review. Acta Odontologica Scandinavica. 2010; 68: 80–85.

[4] Bitiniene D, Zamaliauskiene R, Kubilius R, Leketas M, Gailius T, Smirnovaite K. Quality of life in patients with temporomandibular disorders. A systematic review. Stomatologija. 2018; 20: 3–9.

[5] Zieliński G, Pająk-Zielińska B, Ginszt M. A meta-analysis of the global prevalence of temporomandibular disorders. Journal of Clinical Medicine. 2024; 13: 1365.

[6] Wieckiewicz M, Grychowska N, Nahajowski M, Hnitecka S, Kempiak K, Charemska K, et al. Prevalence and overlaps of headaches and pain-related temporomandibular disorders among the polish urban population. Journal of Oral & Facial Pain and Headache. 2020; 34: 31–39.

[7] Seweryn P, Waliszewska-Prosol M, Petrasova A, Bort M, Seweryn M, Straburzynski M, et al. Central sensitisation, anxiety and depressive symptoms in patients with chronic masticatory muscle pain. Journal of Oral Rehabilitation. 2025; 52: 2010–2020.

[8] Seweryn P, Waliszewska-Prosol M, Straburzynski M, Smardz J, Orzeszek S, Bombala W, et al. Prevalence of central sensitization and somatization in adults with temporomandibular disorders—a prospective observational study. Journal of Oral & Facial Pain and Headache. 2024; 38: 33–44.

[9] Martynowicz H, Marschollek K, Nowacki D, Kanclerska J, Lachowicz G, Jodkowska A, et al. The effect of the arousal threshold on sleep bruxism intensity in coexisting sleep apnea and sleep bruxism: a polysomnographic study. Scientific Reports. 2025; 15: 17044.

[10] Li D, Kuang B, Lobbezoo F, de Vries N, Hilgevoord A, Aarab G. Sleep bruxism is highly prevalent in adults with obstructive sleep apnea: a large-scale polysomnographic study. Journal of Clinical Sleep Medicine. 2023; 19: 443–451.

[11] Palinkas M, Marrara J, Bataglion C, Hallak J, Canto GD, Scalize PH, et al. Analysis of the sleep period and the amount of habitual snoring in individuals with sleep bruxism. Medicina Oral, Patologia Oral, Cirugia Bucal. 2019; 24: e782–e786.

[12] Więckiewicz M, Lavigne G, Martynowicz H. Decrypting the putative interrelation between sleep bruxism, masticatory muscle pain and sleep breathing disorders: nosology and the role of hypoxia. Dental and Medical Problems. 2024; 61: 165–167.

[13] Orzeszek S, Martynowicz H, Smardz J, Kresse-Walczak K, Wojakowska A, Bombała W, et al. Assessment of the relationship between sleep bruxism, reported pain and headache, selected health factors, and general health conditions among temporomandibular disorder patients: a preliminary report. Dental and Medical Problems. 2025; 62: 393–399.

[14] 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: 779–790.

[15] Rehm DD, Progiante PS, Pattussi MP, Pellizzer EP, Grossi PK, Grossi ML. Sleep disorders in patients with temporomandibular disorders (TMD) in an adult population-based cross-sectional survey in Southern Brazil. International Journal of Prosthodontics. 2020; 33: 9–13.

[16] Martynowicz H, Lavigne G, Kato T, Poreba R, Michalek-Zrabkowska M, Macek P, et al. A case-control study on the effect of rhythmic masticatory muscle activity (RMMA) clusters on sleep fragmentation and severity of orofacial muscle pain in sleep bruxism. Journal of Sleep Research. 2024; 33: e14072.

[17] Xu C, Ren X, Lin P, Jin S, Zhang Z. Exploring the causal effects of sleep characteristics on TMD-related pain: a two-sample Mendelian randomization study. Clinical Oral Investigations. 2024; 28: 384.

[18] Seweryn P, Orzeszek SM, Waliszewska-Prosół M, Jenča A, Osiewicz M, Paradowska-Stolarz A, et al. Relationship between pain severity, satisfaction with life and the quality of sleep in Polish adults with temporomandibular disorders. Dental and Medical Problems. 2023; 60: 609–617.

[19] Finan PH, Goodin BR, Smith MT. The association of sleep and pain: an update and a path forward. Journal of Pain. 2013; 14: 1539–1552.

[20] The International Classification of Sleep Disorders (ICSD), ICSD-3, was published by the American Academy of Sleep Medicine (AASM). Available at: https://aasm.org/clinical-resources/international-classification-sleep-disorders/ (Accessed: 20 November 2020).

[21] Kim SG, Cho SW, Kim JW. Definition of the snoring episode index based on the analyses of snoring parameters and the apnea hypopnea index. Scientific Reports. 2022; 12: 6761.

[22] Deary V, Ellis JG, Wilson JA, Coulter C, Barclay NL. Simple snoring: not quite so simple after all? Sleep Medicine Reviews. 2014; 18: 453–462.

[23] Jonczak L, Pływaczewski R, Sliwiński P, Bednarek M, Górecka D, Zieliński J. Evolution of upper airway resistance syndrome. Journal of Sleep Research. 2009; 18: 337–341.

[24] Counter P, Wilson JA. The management of simple snoring. Sleep Medicine Reviews. 2004; 8: 433–441.

[25] Maniaci A, Lavalle S, Anzalone R, Lo Giudice A, Cocuzza S, Parisi FM, et al. Oral health implications of obstructive sleep apnea: a literature review. Biomedicines. 2024; 12: 1382.

[26] Michalek-Zrabkowska M, Wieckiewicz M, Macek P, Gac P, Smardz J, Wojakowska A, et al. The relationship between simple snoring and sleep bruxism: a polysomnographic study. International Journal of Environmental Research and Public Health. 2020; 17: 8960.

[27] Pala Mendes AT, Tardelli JDC, Botelho AL, Dos Reis AC. Is there any association between sleep disorder and temporomandibular joint dysfunction in adults?—A systematic review. Cranio®. 2025; 43: 426–437.

[28] Poothrikovil RP, Al Abri MA. Snoring-induced nerve lesions in the upper airway. Sultan Qaboos University Medical Journal. 2012; 12: 161–168.

[29] Kubin L. Neural control of the upper airway: respiratory and state-dependent mechanisms. Comprehensive Physiology. 2016; 6: 1801–1850.

[30] von Elm E, Altman DG, Egger M, Pocock SJ, Gøtzsche PC, Vandenbroucke JP. The strengthening the reporting of observational studies in epidemiology (STROBE) statement: guidelines for reporting observational studies. Journal of Clinical Epidemiology. 2008; 61: 344–349.

[31] Schiffman E, Ohrbach R, Truelove E, Look J, Anderson G, Goulet JP, et al. Diagnostic criteria for temporomandibular disorders (DC/TMD) for clinical and research applications: recommendations of the international RDC/TMD consortium network* and orofacial pain special interest group†. Journal of Oral & Facial Pain and Headache. 2014; 28: 6–27.

[32] Lobbezoo F, Ahlberg J, Raphael KG, Wetselaar P, Glaros AG, Kato T, et al. International consensus on the assessment of bruxism: report of a work in progress. Journal of Oral Rehabilitation. 2018; 45: 837–844.

[33] American Academy of Sleep Medicine. International Classification of Sleep Disorders. 3rd edn. American Academy of Sleep Medicine: Darien, IL, USA. 2014.

[34] Headache Classification Committee of the International Headache Society (IHS). The international classification of headache disorders, 3rd edition (beta version). Cephalalgia. 2013; 33: 629–808.

[35] Boonstra AM, Stewart RE, Köke AJ, Oosterwijk RF, Swaan JL, Schreurs KM, et al. Cut-off points for mild, moderate, and severe pain on the numeric rating scale for pain in patients with chronic musculoskeletal pain: variability and influence of sex and catastrophizing. Frontiers in Psychology. 2016; 7: 1466.

[36] Herwig U, Satrapi P, Schönfeldt-Lecuona C. Using the international 10–20 EEG system for positioning of transcranial magnetic stimulation. Brain Topography. 2003; 16: 95–99.

[37] Sateia MJ. International classification of sleep disorders-third edition: highlights and modifications. Chest. 2014; 146: 1387–1394.

[38] Berry RB, Budhiraja R, Gottlieb DJ, Gozal D, Iber C, Kapur VK, et al. Rules for scoring respiratory events in sleep: update of the 2007 AASM Manual for the scoring of sleep and associated events. Deliberations of the sleep apnea definitions task force of the American academy of sleep medicine. Journal of Clinical Sleep Medicine. 2012; 8: 597–619.

[39] Snoring Frequency Evaluation and Reporting. 2019. Available at: https://support.noxmedical.com/hc/en-us/articles/115000068594-Snoring-Frequency-Evaluation-and-Reporting (Accessed: 20 November 2020).

[40] Barbon FJ, Costa YM, Castagno CD, Perroni AP, de Oliveira da Rosa WL, Bonjardim LR, et al. Sleep-related factors and orofacial pain symptoms associated with rhythmic masticatory muscle activity frequency scored by polysomnography recordings: a case-control study. Sleep Medicine. 2023; 101: 461–467.

[41] Da-Cas CD, Valesan LF, Nascimento LPD, Denardin ACS, Januzzi E, Fernandes G, et al. Risk factors for temporomandibular disorders: a systematic review of cohort studies. Oral Surgery, Oral Medicine, Oral Pathology, and Oral Radiology. 2024; 138: 502–515.

[42] Machado CAO, de Resende CMBM, Stuginski-Barbosa J, Porporatti AL, Carra MC, Michelloti A, et al. Association between obstructive sleep apnea and temporomandibular disorders: a meta-analysis. Journal of Oral Rehabilitation. 2024; 51: 2220–2233.

[43] Rigon M, Obara K, Paixão L, Cardoso JR, Machado Junior AJ. Relationship between temporomandibular and sleep disorders in adults: an overview of systematic reviews. Sleep Medicine. 2024; 124: 404–415.

[44] de Holanda TA, Castagno CD, Barbon FJ, Costa YM, Goettems ML, Boscato N. Sleep architecture and factors associated with sleep bruxism diagnosis scored by polysomnography recordings: a case-control study. Archives of Oral Biology. 2020; 112: 104685.

[45] Huang Z, Aarab G, Chattrattrai T, Su N, Volgenant CMC, Hilgevoord AAJ, et al. Associated factors of primary snoring and obstructive sleep apnoea in patients with sleep bruxism: a questionnaire study. Journal of Oral Rehabilitation. 2022; 49: 970–979.

[46] Lee YH, Auh QS, Chung EJ. Investigation of snoring and obstructive sleep apnea using portable polysomnography in patients with temporomandibular disorder. Dental Research and Oral Health. 2022; 5: 63–73.

[47] Emodi-Perlman A, Eli I, Morad D, Turchin A, Friedman-Rubin P. Sex differences in a self-report questionnaire related to obstructive sleep apnea: an online cross-sectional survey. Dental and Medical Problems. 2025; 62: 513–520.

[48] Smardz J, Martynowicz H, Wojakowska A, Michalek-Zrabkowska M, Mazur G, Wieczorek T, et al. The meaning of the masticatory muscle tonic-type electromyographic pathway correlated with sleep bruxism and sleep-related breathing disorders—a polysomnographic study. Sleep Medicine. 2020; 68: 131–137.

[49] Martynowicz H, Gac P, Brzecka A, Poreba R, Wojakowska A, Mazur G, et al. The relationship between sleep bruxism and obstructive sleep apnea based on polysomnographic findings. Journal of Clinical Medicine. 2019; 8: 1653.

[50] Wu Y, Xu Y, Bi Z, Chen J, Song X, Liao S, et al. Snoring as a possible protective factor for temporomandibular joint disorders. Journal of Oral Rehabilitation. 2025; 52: 678–692.

[51] Phillips BA, Okeson J, Paesani D, Gilmore R. Effect of sleep position on sleep apnea and parafunctional activity. Chest. 1986; 90: 424–429.

[52] Minervini G, Franco R, Marrapodi MM, Crimi S, Badnjević A, Cervino G, et al. Correlation between temporomandibular disorders (TMD) and posture evaluated trough the diagnostic criteria for temporomandibular disorders (DC/TMD): a systematic review with meta-analysis. Journal of Clinical Medicine. 2023; 12: 2652.

[53] Kang JH, Lee JK. Associations between obstructive sleep apnea and painful temporomandibular disorder: a systematic review. Journal of the Korean Association of Oral and Maxillofacial Surgeons. 2022; 48: 259–266.

[54] Hosoya H, Kitaura H, Hashimoto T, Ito M, Kinbara M, Deguchi T, et al. Relationship between sleep bruxism and sleep respiratory events in patients with obstructive sleep apnea syndrome. Sleep & Breathing. 2014; 18: 837–844.

[55] Abbasi A, Gupta SS, Sabharwal N, Meghrajani V, Sharma S, Kamholz S, et al. A comprehensive review of obstructive sleep apnea. Sleep Science. 2021; 14: 142–154.

[56] Chang HP, Chen YF, Du JK. Obstructive sleep apnea treatment in adults. The Kaohsiung Journal of Medical Sciences. 2020; 36: 7–12.