Causal Mediation in the Development of Painful Temporomandibular Disorder

We explored causal mediation of sleep quality and perceived stress in development of painful temporomandibular disorder (TMD). Sleep quality and perceived stress were assessed at baseline and quarterly intervals thereafter in 2,737 initially-TMD-free adults in the OPPERA prospective cohort study. During follow-up, incident TMD cases were classified using Research Diagnostic Criteria. Mediation analysis was conducted using a weighted Cox proportional hazards regression model that estimated hazard ratios and 95% confidence limits (HR, 95% CL) of first-onset TMD.

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