Sleep apnea in male patients with the fibromyalgia syndrome

doi:10.1016/0002-9343(93)90085-4

The American Journal of Medicine

Volume 94, Issue 5, May 1993, Pages 505-508

https://doi.org/10.1016/0002-9343(93)90085-4 Get rights and content

Abstract

purpose: Fibromyalgia is a common pain syndrome that is often associated with sleep disturbances. The most characteristic pattern noted on formal steep study is α-wave intrusion on δwave sleep. This nonrestorative sleep pattern may be endogenous, or caused by any of a number of sleep disturbances. Our goal was to determine the frequency of sleep apnea and its relationship to a nonrestorative sleep pattern in our patients with fibromyalgia syndrome.

patients and methods: All new fibromyalgia patients seen in the Rheumatology Clinic at Fitzsimons Army Medical Center were screened using history and physical examination for suspicion of sleep apnea. When this condition was suspected, the patients underwent formal polysomnography to delineate any sleep disturbance.

results: Four of 92 women, and 13 of 25 men with the new diagnosis of fibromyalgia syndrome underwent polysomnography. Of the women, 22% (2 of 92) had significant sleep apnea at formal evaluation; both were obese and had obstructive findings. In contrast, 44% (11 of 25) of the men had significant sleep apnea.

conclusions: Sleep apnea is not a significant cause of fibromyalgia symptoms in females. In male patients with fibromyalgia, sleep apnea was observed in a large percentage. Fibromyalgia may be a marker for occult sleep apnea in males.

References (17)

PK Hench
Evaluation and differential diagnosis of fibromyalgia: approach to diagnosis and management
Rheum Dis Clin North Am
(1989)
TL Baker
Introduction to sleep and sleep disorders
Med Clin North Am
(1985)
C Guilleminault
Obstructive sleep apnea: the clinical syndrome and historical perspective
Med Clin North Am
(1985)
MA Cathey et al.
Socioeconomic impact of fibrositis
Am J Med
(1986)
DL Goldenberg
Treatment of fibromyalgia syndrome
Rheum Dis Clin North Am
(1989)
F Wolfe et al.
The American College of Rheumatology 1990 criteria for the classification of fibromyalgia. Report of the multicenter trial committee
Arthritis Rheum
(1990)
DL Goldenberg
Fibromyalgia syndrome: an emerging but controversial condition
JAMA
(1987)
F Wolfe et al.
Fibrositis: symptom frequency and criteria for diagnosis
J Rheumatol
(1985)

There are more references available in the full text version of this article.

Cited by (85)

Comorbidity of sleep apnoea syndrome in patients with fibromyalgia in a sleep clinic
2022, Revista Colombiana de Reumatologia
La fibromialgia (FM) se caracteriza por dolor crónico, cansancio y sueño no reparador. El síndrome de apnea hipopnea obstructiva del sueño (SAHOS) tiene síntomas en común con la FM y su presencia puede confundir el diagnóstico y empeorar la gravedad y el pronóstico de la FM. El objetivo de este estudio fue establecer la presencia de SAHOS en pacientes con FM y alteraciones del sueño en una clínica de sueño.
Estudio observacional, de corte transversal, en pacientes mayores de 18 años con FM remitidos por Reumatología a una clínica de sueño para confirmar SAHOS por medio de polisomnografía, entre el 2015 y el 2018. Se aplicaron herramientas de estadística descriptiva.
Se realizó polisomnografía completa a 51 pacientes con FM y se confirmó SAHOS en el 82%. La edad media fue de 65 años. El 82% de los pacientes estudiados fueron mujeres y, de estas, el 78% tuvo SAHOS. Al 100% de los hombres con FM se les diagnosticó SAHOS. El 27,5% tuvo un peso normal y el 45% sobrepeso. El 23% de los pacientes tuvo SAHOS grave, el 31% moderado y el 45% leve.
Encontramos una alta frecuencia de SAHOS en este grupo de pacientes con FM. Las 2 enfermedades comparten síntomas, por lo que es interesante profundizar más en la investigación de mecanismos fisiopatológicos comunes. La coexistencia de las 2 patologías plantea retos diagnósticos y terapéuticos que vislumbran la necesidad de estudios más profundos a escala local.
Fibromyalgia syndrome (FMS) is characterized by chronic musculoskeletal pain, fatigue, and the sense of waking unrefreshed. Obstructive sleep apnoea syndrome (OSAS) and FMS have symptoms in common and the association of OSAS in these patients could confuse the diagnosis and worsen the severity and prognosis of FMS. The objective of this study was to establish the presence of OSAS in patients with FMS and sleep complaints in a sleep clinic.
A cross-sectional study was conducted in patients aged 18 and above with FMS who were referred by rheumatology to a sleep clinic to confirm OSAS with polysomnography from 2015 to 2018. Descriptive statistics tools were applied.
Polysomnographic investigations were performed in 51 patients with FMS. OSAS was detected in 82% of patients. The mean age was 65 years. Of the patients studied, 82% were women and 78% of them had OSAS. All the male patients with FM had OSAS. Of the patients, 27.5% were normal weight and 45% were overweight. Of the patients, 23% had severe OSAS, 31% moderate and 45% mild.
We found a high frequency of OSAS in this group of FMS patients. Since the 2 diseases share symptoms, it is interesting to delve deeper into the investigation of common pathophysiological mechanisms. The coexistence of the 2 pathologies poses diagnostic and therapeutic challenges that implies the need for further study at local level.
Characterization of fibromyalgia using sleep EEG signals with nonlinear dynamical features
2019, Computers in Biology and Medicine
Citation Excerpt :
Studies have shown abnormalities including prolonged sleep latency [3,4], increased proportion of stage 1 non–rapid eye movement (NREM) sleep [5,6], reduction in slow wave sleep [4,7], reduction in rapid eye movement (REM) sleep percentages [4], as well as an increased number of arousals [6] and restless leg movements [8]. Not all studies have replicated these results, and data on decreased sleep efficiency and association with obstructive sleep apnoea have been conflicting [9,10]. Moreover, no studies have been conducted on the Indian population.
Fibromyalgia is an intense musculoskeletal pain causing sleep, fatigue, and mood problems. Sleep studies have suggested that 70%–80% of fibromyalgia patients complain of non-restorative sleep. The abnormalities in sleep have been implicated as both a cause and effect of the disease. In this paper, the electroencephalogram (EEG) signals of sleep stages 2 and 3 are used to classify the normal and fibromyalgia classes automatically. We have used various nonlinear parameters, namely sample entropy (SampEn), fractal dimension (FD), higher order spectra (HOS), largest Lyapunov exponent (LLE), Kolmogorov complexity (KC), Hurst exponent (HE), energy, and power in various frequency bands from the EEG signals. Then these features are subjected to Student's t-test to select the clinically significant features, and are classified using the support vector machine (SVM) classifier. Our proposed method can classify normal and fibromyalgia subjects using the stage 2 sleep EEG signals with an accuracy of 96.15%, sensitivity and specificity of 96.88% and 95.65%, respectively. Performance of the developed system can be improved further by adding more subjects in each class, and can be employed for clinical use.
Sleep and rheumatic diseases
2019, Best Practice and Research: Clinical Rheumatology
Citation Excerpt :
If it occurs in up to 7% of the general population, the figures are probably significantly higher for patients with rheumatic diseases. However, figures are only available for studies with a small number of cases where OSAS was found in up to 44% of patients [23]. Registry data from Taiwan report a 1.7-fold increased risk for RA patients to develop OSAS [24].
This review article discusses various forms of sleep disorders associated with musculoskeletal diseases (MD). It presents the pathophysiology and interaction of sleep-related disorders and MD and summarizes clinical symptoms and therapies from a somnological perspective.
A large number of patients suffering from MD report fragmented sleep with poor overall sleep quality. Sleep disorders often lead to increased symptoms such as daytime fatigue, depression, or increased pain intensity. In contrast, the perception of pain worsens the quality of sleep.
Sleep is a complex regulation of hormonal and neuromodulatory influences to maintain regenerative processes and signal processing. Furthermore, interleukins (e.g., IL-6 and TNFα), messenger substances, or inflammatory markers (e.g., CRP) may have a regulatory influence on sleep.
Sleep disorders in MD can often be treated with behavioral therapies or drug approaches. Another and very important influence is physical activity. In combination with training, regular physical activity can lead, for instance, to improved sleep quality, endurance performance, and reduced inflammation values. The change of lifestyle with regard to activity and nutrition is another key concept in the optimal therapy of patients with MD.
Chronic Fatigue Syndrome and Fibromyalgia
2019, Handbook of Sleep Disorders in Medical Conditions
Patients with chronic fatigue syndrome (CFS) and fibromyalgia (FM) often have sleep-related problems. In this chapter, we will review studies on sleep in CFS and FM patients in order to better understand their sleep problems, effects of treatment of their sleep problems, and differences between these two conditions. Polysomnographic studies have shown sleep problems in CFS and FM, that is, increased Stage 1 sleep, reduced slow-wave sleep, more arousals, prolonged sleep onset, reduced sleep efficiency, and microarousals or subcortical arousals during sleep, while dynamic aspects of sleep show different patterns between CFS and FM patients. Studies on pharmacological and nonpharmacological interventions such as antidepressants, graded exercise, and cognitive behavior therapy have been shown to produce improvements in sleep problems. However, limited research has been conducted on the effects of nonpharmacological interventions on sleep problems in patients with CFS or FM for revealing the optimal strategy for exercise therapy and cognitive behavior therapy in patients with CFS and/or FM.
Sleep, pain, fibromyalgia, and chronic fatigue syndrome
2011, Handbook of Clinical Neurology
Citation Excerpt :
Patients with SDB, FM, and daytime sleepiness showed a greater number of oxygen desaturations/hour of sleep compared to FM patients without sleepiness in one study (Sarzi-Puttini et al., 2002), but not in another (Lario et al., 1996). Interestingly, a greater number of men with FM have shown evidence of sleep apnea compared to women with FM (May et al., 1993). Based on a single night of PSG, among patients with a diagnosis of CFS or a current psychiatric disorder, 41% had an abnormal Multiple Sleep Latency Test (MSLT) indicative of daytime sleepiness, 44% had sleep apnea, and 41% had idiopathic hypersomnia (Buchwald et al., 1994).
This chapter reviews the research evidence of the bidirectional relation. Current models of pain processing and modulation are briefly discussed as background for a subsequent review of the research evidence about possible gating of pain signals during sleep and about sleep loss effects on pain perception. Research findings from experimental animal and human studies have revealed that sleep exerts minimal sensory gating of physiological pain stimuli, yet perception and motor responses to pain stimuli are reduced during sleep by mechanisms that are poorly understood. Lower pain thresholds and tolerance are common after sleep loss, but the mechanisms or alterations in pain processing that underlie these changes are not known. Electroencephalographic (EEG) studies of sleep in animal models of chronic pain can be attributable to pain processing in the CNS and provide insights into pain related sleep disturbance. Pain, sleep disturbance and fatigue are the most common symptoms of fibromyalgia (FM) and chronic fatigue syndrome (CFS) and sleep has been the most extensively studied using both subjective and objective measures in these disorders. The case definitions, prevalence, models of pathogenesis, pathophysiology, and current treatment recommendations are also discussed.
Pain and the Alpha-Sleep Anomaly: A Mechanism of Sleep Disruption in Facioscapulohumeral Muscular Dystrophy
2013, Pain Medicine (United States)
Citation Excerpt :
The alpha EEG patterns include phasic and tonic alpha EEG sleep as well as periodic K-alpha complexes [16]. This abnormal intrusion of alpha during NREM, previously defined “alpha-delta sleep” [17], was initially considered as a sleep marker of chronic rheumatologic diseases [22], in particular Fibromyalgia syndrome [50,51]. At present, the alpha-sleep anomaly is considered as a rather nonspecific sleep pattern [19,52], as it can be observed in a wide variety of medical and psychiatric conditions [53,54,55,56,57].
To measure the presence of the alpha-sleep anomaly in facioscapulohumeral muscular dystrophy (FSHD) and to evaluate the association between the sleep electroencephalogram (EEG) pattern and the presence of musculoskeletal pain.
Cross-sectional study.
Sleep laboratory.
Fifty-five consecutive adult FSHD patients, 26 women and 29 men, age 49.6 ± 15.1 years (range 18–76).
Questionnaires and polysomnography.
Patients were asked to indicate if in the 3 months before the sleep study they presented persisting or recurring musculoskeletal pain. Patients who reported pain were asked to fill in the Italian version of the Brief Pain Inventory and the McGill Pain questionnaire, and a 101-point visual analog scale (VAS) for pain intensity. Polysomnographic recordings were performed. EEG was analyzed by means of Fast Fourier Transform. Four power spectra bands (δ 0–4 Hz, θ 4–8 Hz, α 8–14 Hz, β 14–32 Hz) were computed. Sleep macrostructure parameters and alpha/delta EEG power ratio during non rapid eye movement (NREM) sleep were compared between patients with and without pain.
Forty-two patients in our sample reported chronic pain. VAS mean score was 55.2 ± 23.8 (range 10–100), pain rating index score was 13.8 ± 10.2, and present pain intensity was 2.5 ± 0.8. The statistical analysis documented an increased occurrence of the alpha and beta rhythms during NREM sleep in FSHD patients with pain. Significant correlations were observed between the alpha/delta power ratio during NREM sleep and pain measures.
Chronic musculoskeletal pain is frequent in FSHD patients, and it represents a major mechanism of sleep disruption.

View all citing articles on Scopus

^☆: The opinions and assertions herein are the opinions of the authors, and are not to be construed as official or reflecting the views of the Department of the Army, the Department of the Air Force, or the Department of Defense.

View full text

Clinical studySleep apnea in male patients with the fibromyalgia syndrome☆

Abstract

Rheum Dis Clin North Am

Med Clin North Am

Med Clin North Am

Am J Med

Rheum Dis Clin North Am

The American College of Rheumatology 1990 criteria for the classification of fibromyalgia. Report of the multicenter trial committee

Arthritis Rheum

Fibromyalgia syndrome: an emerging but controversial condition

JAMA

Fibrositis: symptom frequency and criteria for diagnosis

J Rheumatol

Clinical study
Sleep apnea in male patients with the fibromyalgia syndrome☆