# Orofacial pain/headache interlaced to insomnia, sleep apnea and periodic limb movement during sleep/restless leg syndrome: a critical and comprehensive review with insights into social determinants

## TL;DR

This review examines how orofacial pain and headaches are linked to sleep disorders and how social factors affect these conditions.

## Contribution

The paper integrates social determinants into the understanding of sleep-pain comorbidities and emphasizes personalized, interdisciplinary approaches.

## Key findings

- Orofacial pain and sleep disorders create a bidirectional cycle of worsening symptoms.
- Social factors like socioeconomic status and healthcare access influence the severity and management of these conditions.
- Phenotyping and endotyping help identify subgroups for personalized interventions.

## Abstract

This critical review explores the intricate interaction between orofacial pain
and headache disorders and three prevalent sleep disorders: insomnia, obstructive
sleep apnea (OSA) and periodic limb movements (PLMs) during sleep, while
integrating the role of social determinants of health. Orofacial pain conditions,
including temporomandibular disorders (TMD), headache, and burning mouth
syndrome, frequently co-occur with sleep disturbances, creating a bidirectional
cycle where poor sleep exacerbates pain and vice versa. The mechanisms
underlying this relationship involve disrupted restorative sleep,
neuroinflammation, heightened arousal and impaired descending pain modulation.
Importantly, social factors such as socioeconomic status, healthcare access,
education level, and social support influence the prevalence, severity, and
management of these comorbidities, contributing to significant disparities in
outcomes. We present recent advances in the phenotyping and endotyping of
individuals with sleep-pain comorbidities, which aim to identify subgroups with
shared characteristics to guide personalized interventions, emphasizing the need
for interdisciplinary approaches that bridge dentistry, sleep medicine and public
health to address the multifactorial nature of these conditions. Practical
considerations for clinicians managing these patients are discussed, including
screening tools, treatment modalities and the impact of social context. Future
research directions prioritize the integration of measures of social factors into
study designs, advancing personalized medicine and employing innovative
technologies to better understand genotypes and phenotypes involved in pain
perception and sleep characteristics, and manage the interplay between sleep and
orofacial pain. The goal of addressing the interaction between sleep and pain is
to improve health equity and optimize outcomes for individuals affected by these
interrelated conditions.