SA2 - Are TMJ Symptoms a Clinical Red Flag for Undiagnosed Obstructive Sleep Apnea?

Abstract: The relationship between temporomandibular joint (TMJ) symptoms and sleep-disordered breathing remains incompletely defined. Obstructive sleep apnea (OSA) severity has been shown to be influenced by skeletal and airway relationships.¹ OSA remains a significant surgical condition in oral and maxillofacial practice, with well-established airway and skeletal treatment implications.² While TMJ complaints are frequently encountered in clinical settings, their association with OSA severity and airway compromise has not been clearly established. This study aimed to evaluate whether TMJ symptomatology is associated with increased apnea-hypopnea index (AHI) and reduced airway dimensions.

A retrospective review was conducted of 151 patients who underwent cone-beam computed tomography (CBCT) imaging and polysomnography. TMJ symptomatology was defined as the presence of at least one clinical symptom, including joint pain and/or clicking. Airway volume and minimal cross-sectional area were measured using CBCT. AHI values were obtained from sleep studies. Patients were stratified into TMJ-positive and TMJ-negative groups. Independent samples t-tests were used for group comparisons. Multivariable linear regression was performed to assess the independent association between TMJ symptoms and AHI after adjusting for body mass index (BMI) and sex.

Ninety patients were TMJ-positive and 61 were TMJ-negative. Mean AHI was significantly higher in the TMJ-positive group (20.97 ± 17.12) compared to TMJ-negative patients (7.37 ± 8.50; P < .001). Airway volume was significantly reduced in the TMJ-positive group (14.85 ± 5.80 cc vs 19.04 ± 6.34 cc; P < .001), as was minimal cross-sectional area (133.56 ± 65.13 mm³ vs 214.62 ± 89.29 mm³; P < .001). After adjustment for BMI and sex, TMJ symptomatology remained independently associated with higher AHI values (β = 12.9, P < .001).

TMJ symptomatology is independently associated with increased OSA severity and reduced airway dimensions. These findings suggest that TMJ complaints may serve as a clinically significant indicator of underlying airway compromise. Recognition of this association may facilitate earlier identification of sleep-disordered breathing and influence comprehensive treatment planning in oral and maxillofacial practice.


1. Vaezi T, et al. Skeletal movements and airway response after orthognathic surgery: a systematic review. J Oral Maxillofac Surg. 2020;78(1):121-132.

2. Holty JE. Surgical management of obstructive sleep apnea. Sleep Med Clin. 2019;14(1):101-116.