Prevalence of obstructive sleep apnea in female patients with fibromyalgia

Fibromyalgia in obstructive sleep apnea-hypopnea syndrome: a systematic review and meta-analysis

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.

The impact of fibromyalgia syndrome on obstructive sleep apnea syndrome in terms of pain threshold, daytime symptoms, anxiety, depression, disease severity, and sleep quality: a polysomnographic study

BACKGROUND

Current studies have focused on the association of fibromyalgia syndrome (FMS) and obsctructive sleep apnea syndrome (OSAS). Results of these studies on the effect of this association have been inconsistent. The current study aimed to investigate the effect of FMS on OSAS regarding sleep quality, pressure pain threshold, fatigue, daytime symptoms, anxiety, and depression, and also to determine the relationship between OSAS severity and FMS.

METHODS

In a cross-sectional design, patients diagnosed with OSAS were evaluated in two groups comparing those with and those without FMS. Data on demographics, headache, morning fatigue, and chronic pain duration were collected. Questionnaires including the Fatigue Severity Scale (FSS), Fibromyalgia Impact Questionnaire (FIQ), Beck Depression Inventory (BDI), and Beck Anxiety Inventory (BAI) were completed. Pressure pain threshold, tender points, and polysomnographic data were recorded.

RESULTS

Of 69 patients, 27 were diagnosed with FMS + OSAS and 42 were diagnosed as OSAS only. Statistically significant differences were found between the two groups in VAS, pain duration, morning fatigue, headache, BAI, tender point count, FIQ and FSS scores, and algometer measurements. All polysomnografic data were compared, and no statistically significant differences were found between the two groups. There were no statistically significant differences in the algometer, BDI, BAI, FIQ, and FSS scores when analyzed according to the severity of OSAS.

CONCLUSION

The findings suggest that FMS has no effect on polysomnographic parameters of OSAS. Headache, daytime fatigue, anxiety, depression, pain duration, and pain intensity are higher while the pressure pain threshold is lower when FMS is present. No correlation was found between OSAS severity and FMS, fatigue, pressure pain threshold, depression, and anxiety.

CLINICAL TRIAL REGISTRATION NUMBER

NCT05367167/date: April 8, 2022.

Determinants of sleep disturbance and sleep quality in children of mothers with fibromyalgia

Objectives

This study aimed to determine whether maternal diagnosis of Fibromyalgia syndrome (FMS) affects the sleep quality of children.

Patients and methods

This prospective study was conducted with 80 female participants (mean age: 36.2±5.9 years; range 25 to 50 years) and their 80 children (27 males, 53 females; mean age: 6.6±2.6 years; range 2 to 12 years) between August 2019 and November 2020. The FMS group included 40 female FMS patients and their children, whereas the control group consisted of 40 healthy females and their children. In addition to sociodemographic variables, functional status was evaluated by the Fibromyalgia Impact Questionnaire (FIQ), which was completed by mothers with FMS, and the Children's Sleep Habits Questionnaire (CSHQ) was used to evaluate the sleep quality of all children.

Results

There was no statistically significant difference between the two groups in terms of demographic characteristics (p>0.05). The CSHQ score of the two groups was above 41 points and was at a clinically significant level. The median value for the CSHQ score was 60.5 and 52 in the FMS and control groups, respectively. Sleep time, waking up at night, parasomnias, disrupted breathing during sleep, and sleepiness scores were higher in the FMS group than in the control group, and the differences were statistically significant (p<0.001). The delayed falling asleep score, which was reversely coded, was lower in the FMS group than in the control group, and the difference was statistically significant (p<0.001).

Conclusion

This pilot study showed that the children of mothers with high Fibromyalgia Impact Questionnaire scores had sleep disorders. Maternal diagnosis of FMS negatively affects the sleep quality of children.

Elevated highly sensitive C-reactive protein in fibromyalgia associates with symptom severity

Objectives

Fibromyalgia (FM), a common pain syndrome, is thought to be a non-inflammatory, nociplastic condition, but evidence implicating neuroinflammation has been increasing. Systemic inflammation may be associated with more severe symptoms in some FM patients. We studied healthy controls and FM patients with and without systemic inflammation detectable using high-sensitivity CRP (hsCRP) measurement.

Methods

We measured hsCRP levels and gathered clinical and questionnaire data [including the Fibromyalgia Impact Questionnaire (FIQ)] from 40 female FM patients and 30 age-matched healthy women. An hsCRP level &gt;3 mg/l was considered elevated.

Results

FM patients had significantly higher mean hsCRP levels than controls, explained by overweight and lower leisure-time physical activity. Eight FM patients had elevated hsCRP levels and 29 had normal hsCRP levels. Levels of hsCRP were significantly correlated with FIQ scores. Patients with elevated hsCRP had higher FIQ scores, with worse physical functioning and greater pain and were less likely to be employed than patients with normal hsCRP. These patient groups did not differ by blood count, liver function or lipid profiles, nor by education, psychological measures, sleep disturbance, smoking or comorbidities.

Conclusion

Some FM patients have elevated hsCRP, mostly due to overweight and physical inactivity. They have worse symptoms and their ability to work is impaired. Measurement of hsCRP may help to identify FM patients in greatest need of interventions supporting working ability.

Trial registration

ClinicalTrials.gov (https://clinicaltrials.gov), NCT03300635

Correlating cognition and cortical excitability with pain in fibromyalgia: a case control study

BACKGROUND

Fibromyalgia is a chronic pain disorder characterized by widespread musculoskeletal symptoms, primarily attributed to sensitization of somatosensory system carrying pain. Few reports have investigated the impact of fibromyalgia symptoms on cognition, corticomotor excitability, sleepiness, and the sleep quality - all of which can deteriorate the quality of life in fibromyalgia. However, the existing reports are underpowered and have conflicting directions of findings, limiting their generalizability. Therefore, the present study was designed to compare measures of cognition, corticomotor excitability, sleepiness, and sleep quality using standardized instruments in the recruited patients of fibromyalgia with pain-free controls.

METHODS

Diagnosed cases of fibromyalgia were recruited from the Rheumatology department for the cross-sectional, case-control study. Cognition (Mini-Mental State Examination, Stroop color-word task), corticomotor excitability (Resting motor threshold, Motor evoked potential amplitude), daytime sleepiness (Epworth sleepiness scale), and sleep quality (Pittsburgh sleep quality index) were studied according to the standard procedure.

RESULTS

Thirty-four patients of fibromyalgia and 30 pain-free controls were recruited for the study. Patients of fibromyalgia showed decreased cognitive scores (p = 0.05), lowered accuracy in Stroop color-word task (for color: 0.02, for word: 0.01), and prolonged reaction time (< 0.01, < 0.01). Excessive daytime sleepiness in patients were found (< 0.01) and worsened sleep quality (< 0.01) were found. Parameters of corticomotor excitability were comparable between patients of fibromyalgia and pain-free controls.

CONCLUSIONS

Patients of fibromyalgia made more errors, had significantly increased reaction time for cognitive tasks, marked daytime sleepiness, and impaired quality of sleep. Future treatment strategies may include cognitive deficits and sleep disturbances as an integral part of fibromyalgia management.