Article record

COMITAR——共病性失眠、颞下颌关节紊乱与上气道阻力综合征——一项50年回顾

COMITAR - CO-Morbid Insomnia Temporomandibular disorder upper Airway Resistance syndrome - a 50-year review.

综述 Meta鼻科IF 1.1Q3

文献信息

PMID	42805456
原文	在 PubMed 查看原文 ↗
发表日期	2026
作者	Kenny P Pang 查看其他 5 位作者 Claudio Vicini；Manuele Casale；Charlotte E Pang；Antonio Moffa；Andrea De Vito
作者单位	Otolaryngology, Asia Sleep Centre, Paragon, Singapore. Electronic address: drkpang@gmail.com. 查看其他 5 条单位信息 GVM Care & ENT Research Group, Forlì and Faenza, Italy.；Otolaryngology, Università Campus Bio-Medico di Roma, Via Álvaro del Portillo, Rome, Italy.；Student, Nanyang Girls High School, Singapore.；Otolaryngology, Fondazione Policlinico Universitario Campus Bio-Medico.；ENT Unit Director, Forlì & Faenza Public Hospitals, Dept of Surgery, HLA of Romagna, Italy.
期刊	Acta otorrinolaringologica espanola
SCI 分区	Q3
IF	1.1
研究类型	综述 Meta · 临床
所属专科	鼻科

中文摘要

目的： 介绍一种新的联合关联——失眠、颞下颌关节紊乱（TMD）与上气道阻力综合征（UARS）的组合，即COMITAR。
方法： 对MEDLINE、Google Scholar、Cochrane Library和Evidence Based Medicine Reviews进行系统综述，以识别1973年至2026年3月间与UARS、失眠、口面部疼痛及颞下颌关节紊乱相关的出版物。
结果： 本项50年系统综述共纳入8项研究，总计5,442例UARS患者。所有8篇文章不仅证明了UARS与失眠之间的关联，这些UARS患者中失眠的患病率为50%至58.6%，还说明了过度嗜睡的UARS患者却患有失眠这一悖论。4篇文章还描述了该组UARS/失眠患者中的颞下颌关节问题/磨牙症，发生率为16.7%至90.7%，相关的头痛、颈痛和抑郁较为常见。相比之下，COMISA患者的AHI>5，可能伴有高血压，但很少有TMD问题；而这些COMITAR患者的AHI<5，伴有低血压，且非常常见TMD伴磨牙症/紧咬牙。治疗方面也有文献记载存在差异，大多数UARS和COMITAR患者对CPAP耐受不佳，但通过鼻部手术治疗和口腔矫治器可获得更好的效果。
结论： 存在一个具有UARS、失眠和TMD问题共病的独特患者群体，值得单独描述，因为其临床表型和治疗方式独特且不同。
证据等级： III级。

英文摘要

OBJECTIVE: To introduce a new association of combined insomnia, temporomandibular joint disorder (TMD) and upper airway resistance syndrome (UARS) -- COMITAR.
METHODOLOGY: Systemic review of MEDLINE, Google Scholar, Cochrane Library and Evidence Based Medicine Reviews to identify publications relevant to UARS, insomnia, orofacial pain and temporomandibular joint disorders between 1973 to March 2026.
RESULTS: Eight studies included in this 50-year systematic review with a total of 5,442 UARS patients. All eight articles not only demonstrate the association between UARS and insomnia, with prevalence of insomnia in these UARS patients ranging from 50% to 58.6%, they also illustrate the paradox of the excessively sleepy UARS patient having insomnia. Four articles also described temporomandibular joint issues / bruxism in these group of UARS / insomnia patients, ranging from 16.7% to 90.7%, with associated headaches, neckaches and depression being common. Comparatively, COMISA patients have AHI > 5 and possibly hypertension with rarely any TMD issues, these COMITAR patients have AHI < 5, hypotension and very commonly TMD with bruxism/clenching. Treatment has also been documented to be different, most UARS and COMITAR patients do not tolerate CPAP well but have better results with nasal surgery treatment and oral appliances.
CONCLUSION: There is distinct group of patients with co-morbid UARS, insomnia and TMD issues that warrant a separate description, as their clinical phenotype and treatment modalities are distinct and different.
LEVEL OF EVIDENCE: III.