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Meresh E, Khieu K, Krupa J, Bull M, Shah M, Aijazi S, Jain D, Bae J. Correlation of Psychological Factors, Obesity, Serum Cortisol, and C-Reactive Protein in Patients with Fibromyalgia Diagnosed with Obstructive Sleep Apnea and Other Comorbidities. Biomedicines 2024; 12:1265. [PMID: 38927472 PMCID: PMC11201760 DOI: 10.3390/biomedicines12061265] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2024] [Revised: 05/12/2024] [Accepted: 06/03/2024] [Indexed: 06/28/2024] Open
Abstract
BACKGROUND Fibromyalgia (FM) is a chronic pain disorder and is associated with disability, and high levels of pain and suffering. FM is known to co-occur with obesity and obstructive sleep apnea (OSA). Individuals with FM often experience symptoms of pain, depression and anxiety, sleep disturbances, and fatigue. These symptoms may be exacerbated by OSA and contribute to the symptoms' severity in FM. Obesity is a common comorbidity in OSA patients, and as FM and OSA are related in some patients, obesity also may contribute to FM symptom severity. For healthcare providers to effectively manage FM patients, a better understanding of the co-occurrence between these FM comorbidities and psychological factors is needed. METHODS This study was approved by IRB and conducted using a retrospective EPIC chart review. To identify FM, the following ICD-9 codes were used: (729.1) and ICD-10 (M79.7) codes. To identify patients with OSA, the following ICD-9 codes were used: (327.23) and ICD-10 (G47.33). Body Mass Index (BMI), the total number of medical diagnoses, and psychiatric conditions were documented for each patient. The prevalence of psychiatric conditions including depression and anxiety was compared between patients with and without obesity (BMI > 30), and patients with fewer than 25 medical diagnoses and those with 25 or more diagnoses. A chart review was conducted to identify patients with fibromyalgia with prior serum cortisol testing within the last ten years. Cortisol levels were compared and patients were divided into six groups: 1. FM without identified psychiatric conditions; 2. FM with psychiatric diagnosis of adjustment disorders and insomnia; 3. FM with psychiatric diagnosis of depressive disorders; 4. FM with psychiatric diagnosis of bipolar disorders; 5. FM with psychiatric diagnosis of mixed anxiety and depression; 6. FM with psychiatric diagnosis of anxiety disorders. Available C-reactive protein (CRP) values were gathered. RESULTS The total FM and OSA population was N = 331. The mean age of the patient population was 63.49 years old, with 297 being female. The diagnoses mean was 31.79 ± 17.25 and the mean total psychiatric diagnoses was 2.80 ± 1.66. The mean BMI was 36.69 ± 8.86, with obesity present in 77.95% of the patients. A total of 66.99% of patients had comorbid anxiety and depression with 25 or more medical problems vs. 33.01% of patients who had fewer than 25 medical problems (odds ratio = 1.50). Patients with a BMI < 30 (N = 71) had rates of anxiety and depression at 64.79% and a mean total of 2.79 ± 1.66 psychiatric diagnoses, whereas patients with a BMI > 30 (N = 258) had rates of anxiety and depression at 61.63% (odds ratio = 1.28) and a mean total of 2.80 ± 1.66 psychiatric diagnoses. The most common other psychiatric conditions among FM/OSA patients included hypersomnia and substance use disorders. Cortisol data: Available cortisol results: FM n = 64, female: 59, male: 5, mean age: 63, average BMI: 38.8. The averages for serum cortisol alone for groups 1-6, respectively, are 9.06, 5.49, 13.00, 14.17, 12.25, and 16.03 μg/dL. These results indicate a relatively upward cortisol serum value by the addition of several psychiatric conditions, with the most notable being anxiety for patients with FM. CRP values were available for 53 patients with an average CRP of 4.14. DISCUSSION Higher rates of anxiety and depression were present in FM patients with 25 or more diagnoses. The odds ratios indicate that a patient with 25 or more medical problems was 1.5 times more likely to have anxiety and depression than those with fewer diagnoses. Additionally, those with a BMI > 30 were 1.3 times more likely to have anxiety and depression than those with a normal BMI. CONCLUSION addressing psychological factors in FM and OSA is important as high healthcare utilization is common in patients with FM and OSA.
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Affiliation(s)
- Edwin Meresh
- Department of Psychiatry & Behavioral Neurosciences, Loyola University Medical Center, 2160 South First Avenue, Maywood, IL 60153, USA
| | - Kristine Khieu
- Stritch School of Medicine, Loyola University Chicago, 2160 S First Ave, Maywood, IL 60153, USA; (K.K.); (J.K.); (M.B.); (M.S.); (S.A.); (D.J.); (J.B.)
| | - Jennifer Krupa
- Stritch School of Medicine, Loyola University Chicago, 2160 S First Ave, Maywood, IL 60153, USA; (K.K.); (J.K.); (M.B.); (M.S.); (S.A.); (D.J.); (J.B.)
| | - McKinney Bull
- Stritch School of Medicine, Loyola University Chicago, 2160 S First Ave, Maywood, IL 60153, USA; (K.K.); (J.K.); (M.B.); (M.S.); (S.A.); (D.J.); (J.B.)
| | - Miloni Shah
- Stritch School of Medicine, Loyola University Chicago, 2160 S First Ave, Maywood, IL 60153, USA; (K.K.); (J.K.); (M.B.); (M.S.); (S.A.); (D.J.); (J.B.)
| | - Safiya Aijazi
- Stritch School of Medicine, Loyola University Chicago, 2160 S First Ave, Maywood, IL 60153, USA; (K.K.); (J.K.); (M.B.); (M.S.); (S.A.); (D.J.); (J.B.)
| | - Drishti Jain
- Stritch School of Medicine, Loyola University Chicago, 2160 S First Ave, Maywood, IL 60153, USA; (K.K.); (J.K.); (M.B.); (M.S.); (S.A.); (D.J.); (J.B.)
| | - Jade Bae
- Stritch School of Medicine, Loyola University Chicago, 2160 S First Ave, Maywood, IL 60153, USA; (K.K.); (J.K.); (M.B.); (M.S.); (S.A.); (D.J.); (J.B.)
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He J, Chen M, Huang N, Wang B. Fibromyalgia in obstructive sleep apnea-hypopnea syndrome: a systematic review and meta-analysis. Front Physiol 2024; 15:1394865. [PMID: 38831795 PMCID: PMC11144865 DOI: 10.3389/fphys.2024.1394865] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2024] [Accepted: 05/06/2024] [Indexed: 06/05/2024] Open
Abstract
Introduction: Fibromyalgia (FM) is a common condition in patients with obstructive sleep apnea-hypopnea syndrome (OSAHS). This meta-analysis aimed to evaluate differences in sleep monitoring indicators between patients with OSAHS and positive FM and patients with OSAHS and negative FM and to determine the incidence of FM in patients with OSAHS. Methods: An exhaustive literature review was conducted to analyze the incidence of FM in patients with OSAHS, using online databases, including PubMed, EMBASE, Web of Science, CNKI, and Wanfang, both in English and Chinese. The quality of the included studies was assessed by two researchers using the Newcastle-Ottawa Scale scores. The acquired data were analyzed using Stata 11.0 software. Continuous variables were combined and analyzed using the weighted mean difference as the effect size. Conjoint analyses were performed using random-effects (I2 > 50%) or fixed-effect (I2 ≤ 50%) models based on I2 values. Results: Fourteen studies met the inclusion criteria. This study showed that 21% of patients with OSAHS experienced FM. Subgroup analyses were performed based on race, age, sex, body mass index, and diagnostic criteria for patients with OSAHS. These findings indicate that obese patients with OSAHS have a higher risk of FM, similar to females with OSAHS. Regarding most sleep monitoring indicators, there were no discernible differences between patients with OSAHS with positive FM and those with negative FM. However, patients with positive FM had marginally lower minimum arterial oxygen saturation levels than those with negative FM. The current literature suggests that patients with OSAHS have a high incidence of FM (21%), and FM has little effect on polysomnographic indicators of OSAHS. Systematic Review Registration: https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42024510786, identifier CRD42024510786.
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Affiliation(s)
- Jie He
- Clinical Medical College of Chengdu Medical College, Chengdu, Sichuan, China
- Department of Pulmonary and Critical Care Medicine, The First Affiliated Hospital of Chengdu Medical College, Chengdu, Sichuan, China
| | - Meifeng Chen
- Clinical Medical College of Chengdu Medical College, Chengdu, Sichuan, China
- Department of Pulmonary and Critical Care Medicine, The First Affiliated Hospital of Chengdu Medical College, Chengdu, Sichuan, China
| | - Na Huang
- Clinical Medical College of Chengdu Medical College, Chengdu, Sichuan, China
- Department of Pulmonary and Critical Care Medicine, The First Affiliated Hospital of Chengdu Medical College, Chengdu, Sichuan, China
| | - Bo Wang
- Clinical Medical College of Chengdu Medical College, Chengdu, Sichuan, China
- Department of Pulmonary and Critical Care Medicine, The First Affiliated Hospital of Chengdu Medical College, Chengdu, Sichuan, China
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Meresh ES, Xu S, Palomino A, Artin H, Padiyara J, Stasieluk C, Khurshid A. The Correlation of Pain, Psychological Aspects, and Sleep in Fibromyalgia: A Cross-Sectional Analysis. Open Access Rheumatol 2023; 15:237-246. [PMID: 38143566 PMCID: PMC10748695 DOI: 10.2147/oarrr.s438931] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Accepted: 12/13/2023] [Indexed: 12/26/2023] Open
Abstract
Background This pilot study measures pain perception, somatosensory amplification and its relationship to health anxiety in patients with fibromyalgia (FM) and patients with FM and obstructive sleep apnea (OSA); this study also examines the effects of OSA on pain perception in patients with FM. Methods In this pilot study, patients diagnosed with FM or FM and OSA, completed three self-reported questionnaires: Short-Form McGill Pain Questionnaire (SF-MPQ), Somatosensory Amplification Scale (SSAS), and Illness Behavior Questionnaire (IBQ). Sleep study results were analyzed. Scores were summarized using medians and interquartile ranges and are compared using Wilcoxon rank sum tests. Results Overall FM (n = 25), female n=23 male n=3 mean age, 57.48 years. OSA n=17 (68%) and 8 (32%) were not. The SF-MPQ Sensory sub-scale scores and the SF-MPQ overall scores differed significantly between patients with and without OSA. The SF-MPQ Sensory sub-scale scores were significantly lower for patients with OSA (p=0.03), as were SF-MPQ overall scores (p=0.04). SSAS overall scores and IBQ overall scores did not differ significantly by OSA diagnosis. Correlations of the different dimensions of IBQ with SSAS and mean number of diagnoses in FM and FM+OSA, mean number of diagnoses in problem list of SSAS ≤30 was 29.5, mean number of diagnoses in SSAS ≥30 was 34.9. Discussion Developing a better understanding of the effects of OSA on pain perception in patients with FM is needed for improved health status. More research is needed to see if higher pain perception and SSAS score lead to increased health care utilization and to evaluate the relationship between untreated disordered sleeping and pain perception in patients with FM. Conclusion Our findings highlight the need for more research to evaluate the relationship between treated and untreated disordered sleeping, pain perception, somatization and illness behavior in the health status of individuals with FM.
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Affiliation(s)
- Edwin S Meresh
- Department of Psychiatry, Loyola University Medical Center, Maywood, IL, 60153, USA
| | - Sarah Xu
- Loyola Stritch School of Medicine, Maywood, IL, 60153, USA
| | | | - Hewa Artin
- Loyola Stritch School of Medicine, Maywood, IL, 60153, USA
| | - Julia Padiyara
- Loyola Medicine Center for Sleep Disorders, Loyola University Medical Center, Maywood, IL, 60153, USA
| | - Conrad Stasieluk
- Department of Psychiatry, Loyola University Medical Center, Maywood, IL, 60153, USA
| | - Abid Khurshid
- Pulmonary Medicine, Loyola University Medical Center, Maywood, IL, 60153, USA
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Larsen DB, Bendix L, Abeler K, Petersen KK, Sprehn M, Bruun KD, Blichfeldt-Eckhardt MR, Vaegter HB. Obstructive sleep apnea is common in patients with high-impact chronic pain - an exploratory study from an interdisciplinary pain center. Scand J Pain 2022; 22:106-117. [PMID: 34643073 DOI: 10.1515/sjpain-2021-0112] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Accepted: 09/27/2021] [Indexed: 02/04/2023]
Abstract
OBJECTIVES Sleep disturbances are increasingly recognized as a major part of chronic pain pathology. Obstructive sleep apnea (OSA) is a common occurrence in patients with chronic pain attending specialized pain clinics, yet its prevalence remains unclear. Using screening tools such as the Berlin and STOP-BANG questionnaires may aid in early identification of OSA and improve clinical care. This study i) examined the frequency of OSA based on objective sleep monitoring in patients with high-impact chronic pain, ii) explored potential differences in self-reported pain and sleep characteristics between patients with and without OSA, and iii) tested the agreement between OSA classification based on objective assessment and two OSA screening questionnaires. METHODS A consecutive cohort of 90 patients (71 women and 19 men; mean age: 47.1 ± 11.0 years) referred for interdisciplinary pain treatment, underwent one night of sleep monitoring using portable respiratory polygraphy (RP), and suspected OSA was confirmed with polysomnography (PSG). Self-reported data on clinical pain (severity, pain drawings and health-related quality of life), sleep characteristics (sleep quality insomnia, sleepiness), and risk of OSA (Berlin and STOP-BANG questionnaires) were collected the day before RP assessment. RESULTS Forty-six (51.1%) patients were classified with OSA according to RP and verified with PSG. Twenty-eight patients (31.1%) had moderate or severe OSA (apnea-hypopnea index [AHI] >15). Patients with OSA reported lower sleep quality compared with patients without OSA. Scores on pain severity, disability, quality of life, insomnia and sleepiness were comparable between patients with and without OSA. Sensitivity and specificity were 78.6 and 45.2% respectively for the Berlin questionnaire, and 71.4 and 58.1% respectively for the STOP-BANG questionnaire. The agreement for both questionnaires with objective assessment was poor-to-fair. Both questionnaires had acceptable negative predictive values but low positive predictive values reducing the clinical utility to identify patients with low OSA-risk in this sample. CONCLUSIONS The current study demonstrates a high prevalence of OSA in patients with high-impact chronic pain referred to specialized pain treatment, however the clinical pain profiles were similar in patients with and without OSA. The Berlin and STOP-BANG questionnaires have poor specificity and low-to-fair agreement with RP/PSG questioning their clinical utility in identifying OSA in this sample.
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Affiliation(s)
- Dennis Boye Larsen
- Department of Health Science and Technology, SMI, School of Medicine, Aalborg University, Aalborg, Denmark
- Department of Health Science and Technology, Center for Neuroplasticity and Pain (CNAP), SMI, School of Medicine, Aalborg University, Aalborg, Denmark
| | - Laila Bendix
- Department of Anesthesiology and Intensive Care Medicine, Pain Research Group, Pain Center, University Hospital Odense, Odense, Denmark
| | - Karin Abeler
- Department of Neurology and Neurophysiology, University Hospital of North Norway, Tromsø, Norway
| | - Kristian Kjær Petersen
- Department of Health Science and Technology, SMI, School of Medicine, Aalborg University, Aalborg, Denmark
- Department of Health Science and Technology, Center for Neuroplasticity and Pain (CNAP), SMI, School of Medicine, Aalborg University, Aalborg, Denmark
| | - Michael Sprehn
- Department of Anesthesiology and Intensive Care Medicine, Respiration Center South, University Hospital Odense, Odense, Denmark
| | - Karin Due Bruun
- Department of Anesthesiology and Intensive Care Medicine, Pain Research Group, Pain Center, University Hospital Odense, Odense, Denmark
- Department of Clinical Research, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
| | - Morten Rune Blichfeldt-Eckhardt
- Department of Anesthesiology and Intensive Care Medicine, Pain Research Group, Pain Center, University Hospital Odense, Odense, Denmark
- Department of Clinical Research, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
| | - Henrik Bjarke Vaegter
- Department of Anesthesiology and Intensive Care Medicine, Pain Research Group, Pain Center, University Hospital Odense, Odense, Denmark
- Department of Clinical Research, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
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Chao LL, Kanady JC, Crocker N, Straus LD, Hlavin J, Metzler TJ, Maguen S, Neylan TC. Cognitive behavioral therapy for insomnia in veterans with gulf war illness: Results from a randomized controlled trial. Life Sci 2021; 279:119147. [PMID: 33549595 PMCID: PMC8217272 DOI: 10.1016/j.lfs.2021.119147] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Revised: 01/15/2021] [Accepted: 01/24/2021] [Indexed: 01/08/2023]
Abstract
Aims: To examine whether cognitive behavioral therapy for insomnia (CBT-I), delivered by telephone, improves sleep and non-sleep symptoms of Gulf War Illness (GWI). Main methods: Eighty-five Gulf War veterans (21 women, mean age: 54 years, range 46–72 years) who met the Kansas GWI case definition, the Centers for Disease Control and Prevention (CDC) case definition for Chronic Multisymptom Illness (CMI), and research diagnostic criteria for insomnia disorder were randomly assigned to CBT-I or monitor-only wait list control. Eight weekly sessions of individual CBT-I were administered via telephone by Ph.D. level psychologists to study participants. Outcome measures included pre-, mid-, and post-treatment assessments of GWI and insomnia symptoms, subjective sleep quality, and continuous sleep monitoring with diary. Outcomes were re-assessed 6-months post-treatment in participants randomized to CBT-I. Key findings: Compared to wait list, CBT-I produced significant improvements in overall GWI symptom severity, individual measures of fatigue, cognitive dysfunction, depression and anxiety, insomnia severity, subjective sleep quality, and sleep diary outcome measures. The beneficial effects of CBT-I on overall GWI symptom severity and most individual GWI symptom measures were maintained 6-months after treatment. Significance: GWI symptoms have historically been difficult to treat. Because CBT-I, which is associated with low stigma and is increasingly readily available to veterans, improved both sleep and non-sleep symptoms of GWI, these results suggest that a comprehensive approach to the treatment of GWI should include behavioral sleep interventions.
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Affiliation(s)
- Linda L Chao
- San Francisco Veterans Affairs Health Care System, San Francisco, CA 94121, USA; University of California, San Francisco, CA 94143, USA.
| | | | - Nicole Crocker
- San Francisco Veterans Affairs Health Care System, San Francisco, CA 94121, USA
| | - Laura D Straus
- San Francisco Veterans Affairs Health Care System, San Francisco, CA 94121, USA; University of California, San Francisco, CA 94143, USA; Sierra Pacific Mental Illness Research, Education, and Clinical Center, San Francisco, CA 94121, USA
| | - Jennifer Hlavin
- San Francisco Veterans Affairs Health Care System, San Francisco, CA 94121, USA
| | - Thomas J Metzler
- San Francisco Veterans Affairs Health Care System, San Francisco, CA 94121, USA; University of California, San Francisco, CA 94143, USA; Sierra Pacific Mental Illness Research, Education, and Clinical Center, San Francisco, CA 94121, USA
| | - Shira Maguen
- San Francisco Veterans Affairs Health Care System, San Francisco, CA 94121, USA; University of California, San Francisco, CA 94143, USA; Sierra Pacific Mental Illness Research, Education, and Clinical Center, San Francisco, CA 94121, USA
| | - Thomas C Neylan
- San Francisco Veterans Affairs Health Care System, San Francisco, CA 94121, USA; University of California, San Francisco, CA 94143, USA; Sierra Pacific Mental Illness Research, Education, and Clinical Center, San Francisco, CA 94121, USA
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Comparison of sleep structure in patients with fibromyalgia and healthy controls. Sleep Breath 2020; 24:1591-1598. [PMID: 32100235 DOI: 10.1007/s11325-020-02036-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2019] [Revised: 02/02/2020] [Accepted: 02/10/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND Sleep disturbances such as nonrestorative sleep and nighttime awakenings play a crucial role in fibromyalgia (FMS). Pain and sleep disturbances show a bidirectional relationship which affect outcomes in FMS. This study aims to compare sleep structures between patients with fibromyalgia and healthy controls. METHODS We evaluated subjective and objective sleep structures of 33 patients with fibromyalgia and 34 healthy controls using the Pittsburgh Sleep Quality Index, Epworth Sleepiness Scale, and polysomnography. Student's T test, chi-square, discriminant analysis, the Kruskal-Wallis, and Mann-Whitney U test were used for statistical analysis. RESULTS Patients with FMS reported poorer sleep quality than controls (p = 0.003). Polysomnography data showed patients with FMS exhibited a greater number of awakenings (p = 0.01), more arousals (p = 0.00), higher arousal index (p = 0.00), greater apnea hypopnea index (p = 0.03), and less N1 sleep (p = 0.02) than healthy controls. The discriminant analysis revealed that number of arousals, arousal index, and N1 sleep were able to distinguish patients with FMS from healthy controls with 78.5% accuracy. Twelve of the 33 patients with FMS were diagnosed with obstructive sleep apnea syndrome (OSAS). When we excluded patients with OSAS, a statistically significant difference was maintained. CONCLUSIONS Our findings may explain the deterioration of subjective sleep, symptoms as unrefreshing sleep, fatigue, and pain in patients with FMS. Despite similar clinical manifestations, patients with FMS should be evaluated for OSAS due to treatment differences. The role of sleep alterations in the clinical manifestation and severity of FMS suggest that effective treatments to improve sleep quality may lead to more effective management of FMS.
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Meresh ES, Artin H, Joyce C, Birch S, Daniels D, Owens JH, La Rosa AJ, Rao MS, Halaris A. Obstructive sleep apnea co-morbidity in patients with fibromyalgia: a single-center retrospective analysis and literature review. Open Access Rheumatol 2019; 11:103-109. [PMID: 31118843 PMCID: PMC6500898 DOI: 10.2147/oarrr.s196576] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2018] [Accepted: 02/22/2019] [Indexed: 12/22/2022] Open
Abstract
Background: Fibromyalgia (FM) is a chronic medical condition characterized by widespread pain, sleep disturbance, and cognitive dysfunction. Sleep disorders are thought to play a prominent role in the etiology and symptomatic management of FM, specifically obstructive sleep apnea (OSA). In order to provide collaborative care, we need a better understanding of any overlapping presentation of FM and OSA. We conducted a site-wide review of patients from 2012-2016 to identify FM patients diagnosed with OSA. Methods: Charts were reviewed in patients aged 18 and above from 2012-2016 using ICD codes from a clinical data repository. Intersection of patients with a diagnosis of FM and OSA in clinics of psychiatry, sleep, rheumatology, and other outpatient clinics was compared. Polysomnography order patterns for FM patients were investigated. Results: Co-morbidity was highest in the sleep clinic (85.8%) compared to psychiatry (42.0%), rheumatology (18.7%), and other outpatient clinics (3.6%) (p<0.001). In the rheumatology and other outpatient clinics, 93.5% and 96% of patients respectively, had no polysomnography ordered. Pairwise comparison of co-morbidity in clinics: sleep vs psychiatry, sleep vs rheumatology, sleep vs other clinics, psychiatry vs rheumatology, psychiatry vs other clinics, and rheumatology vs other clinics were statistically significant after applying a Sidak adjustment to the p-values (all p<0.001). Conclusion: Our analysis suggests that there could be a correlation between FM and OSA, and referral to sleep studies is recommended in the management of patients with FM. The varying prevalence of FM patients with co-morbid OSA in sleep clinics when compared to other outpatient clinics suggests a discrepancy in the identification of FM patients with OSA. When properly screened, OSA co-morbidity has the potential to be higher in other outpatient clinics.
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Affiliation(s)
- Edwin S Meresh
- Department of Psychiatry, Loyola University Medical Center, Maywood, IL 60153, USA
| | - Hewa Artin
- Loyola Stritch School of Medicine, Maywood, IL 60153, USA
| | - Cara Joyce
- Biostatistics Core, Clinical Research Office, Loyola University Medical Center, Maywood, IL 60153, USA
| | - Steven Birch
- Informatics and Systems Development, Loyola University Medical Center, Maywood, IL 60153, USA
| | - David Daniels
- Department of Psychiatry, Loyola University Medical Center, Maywood, IL 60153, USA
| | - Jack H Owens
- Department of Psychiatry, Loyola University Medical Center, Maywood, IL 60153, USA
| | - Alvaro J La Rosa
- Department of Psychiatry, Loyola University Medical Center, Maywood, IL 60153, USA
| | - Murali S Rao
- Department of Psychiatry, Loyola University Medical Center, Maywood, IL 60153, USA
| | - Angelos Halaris
- Department of Psychiatry, Loyola University Medical Center, Maywood, IL 60153, USA
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Pejovic S, Natelson BH, Basta M, Fernandez-Mendoza J, Mahr F, Vgontzas AN. Chronic fatigue syndrome and fibromyalgia in diagnosed sleep disorders: a further test of the 'unitary' hypothesis. BMC Neurol 2015; 15:53. [PMID: 25884538 PMCID: PMC4405866 DOI: 10.1186/s12883-015-0308-2] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2013] [Accepted: 02/18/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Since chronic fatigue syndrome (CFS) and fibromyalgia (FM) often co-exist, some believe they reflect the same process, somatization. Against that hypothesis are data suggesting FM but not CFS was common in patients with sleep-disordered breathing (SDB). The presence of discrete case definitions for CFS and FM allowed us to explore rates of CFS alone, CFS with FM, and FM alone in SDB patients compared to those with sleep complaints that fulfilled criteria for insomnia. METHODS Participants were 175 sequential patients with sleep-related symptoms (122 had SDB and 21 had insomnia) and 39 healthy controls. Diagnoses were made by questionnaires, tender point count, and rule out labs; sleepiness was assessed with Epworth Sleepiness Scale and mood with Beck Depression Inventory. RESULTS Rates of CFS, FM or CFS + FM were high: 13% in SDB and 48% in insomnia. CFS occurred frequently in SDB and insomnia, but FM occurred frequently only in insomnia. SDB patients with CFS and/or FM had higher daytime sleepiness than those without these disorders. CONCLUSION CFS patients should complete Epworth scales, and sleep evaluation should be considered for those with scores ≥ 16 before receiving the diagnosis of CFS; the coexistence of depressed mood in these patients suggests some may be helped by treatment of their depression. That FM was underrepresented in SDB suggests FM and CFS may have different underlying pathophysiological causes.
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Affiliation(s)
- Slobodanka Pejovic
- Department of Psychiatry, Sleep Research and Treatment Center, Penn State College of Medicine, Hershey, PA, 17033, USA.
| | - Benjamin H Natelson
- Department of Neurology, Pain and Fatigue Study Center, Mount Sinai Beth Israel, Icahn School of Medicine at Mount Sinai, New York, NY, 10003, USA.
| | - Maria Basta
- Department of Psychiatry, School of Medicine, University of Crete, Iraklion, Greece.
| | - Julio Fernandez-Mendoza
- Department of Psychiatry, Sleep Research and Treatment Center, Penn State College of Medicine, Hershey, PA, 17033, USA.
| | - Fauzia Mahr
- Department of Psychiatry, Sleep Research and Treatment Center, Penn State College of Medicine, Hershey, PA, 17033, USA.
| | - Alexandros N Vgontzas
- Department of Psychiatry, Sleep Research and Treatment Center, Penn State College of Medicine, Hershey, PA, 17033, USA.
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McNallen AT, McCain NL, Elswick RK, Menzies V, Leszczyszyn DJ. Fatigue, sleep, and stress: dynamic relationships in fibromyalgia. FATIGUE-BIOMEDICINE HEALTH AND BEHAVIOR 2013. [DOI: 10.1080/21641846.2012.741783] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Hamilton NA, Pressman M, Lillis T, Atchley R, Karlson C, Stevens N. Evaluating Evidence for the Role of Sleep in Fibromyalgia: A Test of the Sleep and Pain Diathesis Model. COGNITIVE THERAPY AND RESEARCH 2011; 36:806-814. [PMID: 24501433 DOI: 10.1007/s10608-011-9421-8] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
The Sleep and Pain Diathesis (SAPD) Model predicts that sleep quality is related to Fibromylagia (FM) outcomes such as disability and depression and that these relationships are mediated by both pain and impaired emotional dysregulation. The purpose of this paper is to provide a preliminary test of this model using cross-sectional data. 35 adult women, who had been living with FM for an average of 13 years, completed a battery of questionnaires that included reports of pain, sleep, affect, and disability. Consistent with this model, FM patients who reported more disrupted sleep also reported higher levels of psychological disability (i.e., BDI depression symptoms) and physical disability. Moreover, the trajectory of the relationship between sleep and pain appears to be mediated by cognitive processes such as increased pain helplessness and, thus, the relationship between sleep and disability appears to be mediated via pain. These data are consistent with the SAPD model, and lend support for the need to include sleep related factors as a critical contributor to our understanding of FM.
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Hamilton NA, Atchley RA, Karlson CW, Taylor D, McCurdy D. The Role of Sleep and Attention in the Etiology and Maintenance of Fibromyalgia. COGNITIVE THERAPY AND RESEARCH 2011. [DOI: 10.1007/s10608-011-9390-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
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Functional somatic syndromes, anxiety disorders and the upper airway: a matter of paradigms. Sleep Med Rev 2011; 15:389-401. [PMID: 21295503 DOI: 10.1016/j.smrv.2010.11.004] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2010] [Revised: 11/18/2010] [Accepted: 11/28/2010] [Indexed: 02/07/2023]
Abstract
The relationship between the functional somatic syndromes, anxiety disorders and the upper airway (particularly, sleep disordered breathing) remains ambiguous. This ambiguity, despite a growing body of research supporting a relationship, may result from the absence of a paradigm to explain how upper airway dysfunction can promote disorders commonly associated with one's mental health. This review models the functional somatic syndromes and anxiety disorders as consequences of chronically increased hypothalamic-pituitary-adrenal axis activity. It then examines the literature supporting a relationship between these disorders and upper airway dysfunction during wakefulness and sleep. Finally, building upon an existing paradigm of neural sensitization, sleep disordered breathing is linked to functional somatic syndromes and anxiety disorders through chronic activation of the hypothalamic-pituitary-adrenal axis.
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The effects of pregabalin on sleep disturbance symptoms among individuals with fibromyalgia syndrome. Sleep Med 2009; 10:604-10. [DOI: 10.1016/j.sleep.2009.01.009] [Citation(s) in RCA: 72] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2008] [Revised: 01/23/2009] [Accepted: 01/31/2009] [Indexed: 11/21/2022]
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Moldofsky H. Importance du cycle veille-sommeil dans la compréhension des douleurs musculosquelettiques diffuses et de la fatigue au cours de la fibromyalgie et des syndromes apparentés. ACTA ACUST UNITED AC 2008. [DOI: 10.1016/j.rhum.2008.01.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Moldofsky H. The significance of the sleeping–waking brain for the understanding of widespread musculoskeletal pain and fatigue in fibromyalgia syndrome and allied syndromes. Joint Bone Spine 2008; 75:397-402. [DOI: 10.1016/j.jbspin.2008.01.021] [Citation(s) in RCA: 82] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2007] [Accepted: 01/17/2008] [Indexed: 11/30/2022]
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Togo F, Natelson BH, Cherniack NS, FitzGibbons J, Garcon C, Rapoport DM. Sleep structure and sleepiness in chronic fatigue syndrome with or without coexisting fibromyalgia. Arthritis Res Ther 2008; 10:R56. [PMID: 18474105 PMCID: PMC2483445 DOI: 10.1186/ar2425] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2007] [Revised: 03/28/2008] [Accepted: 05/13/2008] [Indexed: 02/06/2023] Open
Abstract
Introduction We evaluated polysomnograms of chronic fatigue syndrome (CFS) patients with and without fibromyalgia to determine whether patients in either group had elevated rates of sleep-disturbed breathing (obstructive sleep apnea or upper airway resistance syndrome) or periodic leg movement disorder. We also determined whether feelings of unrefreshing sleep were associated with differences in sleep architecture from normal. Methods We compared sleep structures and subjective scores on visual analog scales for sleepiness and fatigue in CFS patients with or without coexisting fibromyalgia (n = 12 and 14, respectively) with 26 healthy subjects. None had current major depressive disorder, and all were studied at the same menstrual phase. Results CFS patients had significant differences in polysomnograpic findings from healthy controls and felt sleepier and more fatigued than controls after a night's sleep. CFS patients as a group had less total sleep time, lower sleep efficiency, and less rapid eye movement sleep than controls. A possible explanation for the unrefreshing quality of sleep in CFS patients was revealed by stratification of patients into those who reported more or less sleepiness after a night's sleep (a.m. sleepier or a.m. less sleepy, respectively). Those in the sleepier group reported that sleep did not improve their symptoms and had poorer sleep efficiencies and shorter runs of sleep than both controls and patients in the less sleepy group; patients in the less sleepy group reported reduced fatigue and pain after sleep and had relatively normal sleep structures. This difference in sleep effects was due primarily to a decrease in the length of periods of uninterrupted sleep in the a.m. sleepier group. Conclusion CFS patients had significant differences in polysomnographic findings from healthy controls and felt sleepier and more fatigued than controls after a night's sleep. This difference was due neither to diagnosable sleep disorders nor to coexisting fibromyalgia but primarily to a decrease in the length of periods of uninterrupted sleep in the patients with more sleepiness in the morning than on the night before. This sleep disruption may explain the overwhelming fatigue, report of unrefreshing sleep, and pain in this subgroup of patients.
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Affiliation(s)
- Fumiharu Togo
- Pain and Fatigue Study Center, Department of Neurosciences, University of Medicine and Dentistry of New Jersey-New Jersey Medical School, 30 Bergen Street, Newark, NJ 07103, USA.
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Shaver JL. Sleep Disturbed by Chronic Pain in Fibromyalgia, Irritable Bowel, and Chronic Pelvic Pain Syndromes. Sleep Med Clin 2008. [DOI: 10.1016/j.jsmc.2007.10.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
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