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

Abstract

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.