The Overlap Between TMD and OSA: A Call for Integrated Screening

Written by Dr. Agatha Bis

Beyond Isolated Diagnoses

Temporomandibular disorders and obstructive sleep apnea have traditionally been viewed as separate clinical entities. One is musculoskeletal, the other is respiratory. However, evidence now shows strong overlap. Studies indicate that up to 51 percent of OSA patients exhibit TMD signs, and nearly 30 percent of TMD patients present with concurrent OSA.

Shared Pathophysiology

The mechanisms connecting the two include:

• Retrognathia as a risk factor for both airway collapse and altered TMJ loading

• Sleep fragmentation and intermittent hypoxia leading to hyperalgesia and heightened pain perception

• Systemic inflammation mediated by cytokines such as IL-6 and TNF-α

• Psychosocial factors including anxiety and depression, which amplify both pain and sleep disruption

Clinical Relevance

This interplay means that ignoring one condition limits treatment outcomes for the other. A patient treated only for OSA may continue to experience pain and poor sleep if TMD remains unmanaged. Similarly, TMD patients may fail to improve if underlying OSA fragments sleep and perpetuates hyperalgesia.

Integrating Screening

For this reason, bidirectional screening should become standard. Dentists managing TMD must inquire about sleep quality and apnea symptoms. Sleep physicians treating OSA should screen for TMJ pain, dysfunction, or occlusal issues.

A Multidisciplinary Approach

The future of care lies in collaboration between dental sleep medicine, orofacial pain specialists, ENT physicians, and sleep medicine providers. Oral appliances like mandibular advancement devices, when carefully managed, can serve dual roles in improving airway patency and alleviating TMD symptoms.

Dentists, join our Study Club, enrol in TMJ Essentials Level 1, or take part in mentoring to explore how integrated management of TMD and OSA can improve patient outcomes beyond isolated treatment strategies.