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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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Cigdem Karacay B, Sahbaz T, Zerman N, Tuncay F. 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. Sleep Breath 2023; 27:1473-1479. [PMID: 37071285 DOI: 10.1007/s11325-023-02831-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Revised: 03/30/2023] [Accepted: 04/07/2023] [Indexed: 04/19/2023]
Abstract
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.
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Affiliation(s)
- B Cigdem Karacay
- Department of Physical Medicine and Rehabilitation, Faculty of Medicine, Kirsehir Ahi Evran University, Kirsehir, Turkey.
| | - T Sahbaz
- Department of Physical Medicine and Rehabilitation, Faculty of Medicine, Beykent University, Istanbul, Turkey
| | - N Zerman
- Department of Pulmonary Diseases, Faculty of Medicine, Kirsehir Ahi Evran University, Kirsehir, Turkey
| | - F Tuncay
- Department of Physical Medicine and Rehabilitation, Faculty of Medicine, Kirsehir Ahi Evran University, Kirsehir, Turkey
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Li MT, Robinson CL, Ruan QZ, Surapaneni S, Southerland W. The Influence of Sleep Disturbance on Chronic Pain. Curr Pain Headache Rep 2022; 26:795-804. [PMID: 36190680 DOI: 10.1007/s11916-022-01074-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/27/2022] [Indexed: 12/01/2022]
Abstract
PURPOSE OF REVIEW The purpose of this review is to present an overview of common sleep disturbance pathologies and their impact on chronic pain, while examining various factors that are implicit in the relationship between sleep disturbance and chronic pain, including neurobiochemistry, anatomy, and systemic mediators, and reviewing recent and landmark literature. RECENT FINDINGS Earlier literature reviews and studies have introduced the bidirectional relationship between sleep disturbance and chronic pain; that is, impaired sleep may worsen chronic pain, and chronic pain causes sleep disturbance. However, more recent reviews and studies seem to show a more associative, rather than causative relationship. There have been recent studies that attempt to determine mechanisms that link sleep disturbance and chronic pain; the results of these studies were more varied, ultimately concluding that there may be a separate, yet-to-be discovered mechanism that shows the causative relationship between sleep disturbance and pain. There are several neurotransmitters that are involved in the mediation of chronic pain and sleep disturbance as separate entities, and some studies have shown that there may be mechanisms that govern both chronic pain and sleep disturbance as a single unit. Other neuroendocrine substances also serve to mediate chronic pain and sleep disturbance. All these substances are found to be associated with various sleep disorders and are also associated with chronic pain symptoms as well. Inflammation plays a role in chronic pain and sleep disturbance, with an increase in inflammatory substances and mediators associated with an increase or worsening in chronic pain symptoms and sleep disorders. The HPA axis plays a role in chronic pain and sleep disorders, influencing pain and sleep pathways through stress response, inflammation, and maintenance of homeostasis. There are several variables that influence both chronic pain and sleep disturbance, and more research into these variables may further our understanding into the complex pathways governing the influence of sleep disturbance on pain, and ultimately to improve treatment for this issue.
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Affiliation(s)
- Michael T Li
- Department of Anesthesia, Critical Care, and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA.
| | - Christopher Louis Robinson
- Department of Anesthesia, Critical Care, and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Qing Zhao Ruan
- Department of Anesthesia, Critical Care, and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Sindhuja Surapaneni
- Department of Anesthesia, Critical Care, and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Warren Southerland
- Department of Anesthesia, The Hospital of the University of Pennsylvania, Philadelphia, PA, USA
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Climent-Sanz C, Gea-Sánchez M, Fernández-Lago H, Mateos-García JT, Rubí-Carnacea F, Briones-Vozmediano E. Sleeping is a nightmare: A qualitative study on the experience and management of poor sleep quality in women with fibromyalgia. J Adv Nurs 2021; 77:4549-4562. [PMID: 34268797 DOI: 10.1111/jan.14977] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Revised: 06/01/2021] [Accepted: 06/27/2021] [Indexed: 12/15/2022]
Abstract
AIM This study aimed to explore the experience and management of poor sleep quality in Spanish women with fibromyalgia (FM). DESIGN This was a qualitative study based on one-to-one interviews. METHODS Twenty-one adult women diagnosed with FM were recruited from the community between January and March 2020. Data were collected through in-depth semistructured one-to-one interviews, using an interview guide of open questions about the experience and management of poor sleep quality, and were analyzed with thematic qualitative analysis. The symptom management theory was used as a biopsychosocial conceptual framework. RESULTS The results were organized into two themes: (a) experience of poor sleep quality and (b) management strategies for poor sleep quality. Poor sleep quality was found to be a severe symptom of FM that negatively impacts pain, fatigue, stiffness, mental health, and quality of life. The participants perceived pharmacological treatment to be the main approach of health care professionals for improving sleep, and most did not want this form of treatment. Self-management strategies lack clear beneficial effects on sleep quality. CONCLUSION Women with FM recognize that they need to receive more information from nurses and allied professions about sleep in the context of FM and how to effectively manage poor sleep quality. IMPACT This study contributes to a better understanding of how women with FM experience and manage poor sleep quality. More information about management strategies for poor sleep quality from nurses and other health care professionals is needed in women with FM. The results of this study can be applied by nurses and health care professionals, including sleep educators, in the treatment of this patient group.
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Affiliation(s)
- Carolina Climent-Sanz
- Department of Nursing and Physiotherapy, University of Lleida, Lleida, Spain.,Grup d'Estudis Societat, Salut, Educació i Cultura, GESEC, Department of Nursing and Physiotherapy, University of Lleida, Lleida, Spain.,Health Care Research Group (GRECS), Lleida Institute for Biomedical Research Dr. Pifarré Foundation, Lleida, Spain
| | - Montserrat Gea-Sánchez
- Department of Nursing and Physiotherapy, University of Lleida, Lleida, Spain.,Grup d'Estudis Societat, Salut, Educació i Cultura, GESEC, Department of Nursing and Physiotherapy, University of Lleida, Lleida, Spain.,Health Care Research Group (GRECS), Lleida Institute for Biomedical Research Dr. Pifarré Foundation, Lleida, Spain.,Biomedical Research Center for Fragility and Healthy Aging (CIBERFES), Madrid, Spain
| | - Helena Fernández-Lago
- Department of Nursing and Physiotherapy, University of Lleida, Lleida, Spain.,Health Care Research Group (GRECS), Lleida Institute for Biomedical Research Dr. Pifarré Foundation, Lleida, Spain
| | - José Tomás Mateos-García
- Department of Nursing and Physiotherapy, University of Lleida, Lleida, Spain.,Health Care Research Group (GRECS), Lleida Institute for Biomedical Research Dr. Pifarré Foundation, Lleida, Spain
| | - Francesc Rubí-Carnacea
- Department of Nursing and Physiotherapy, University of Lleida, Lleida, Spain.,Grup d'Estudis Societat, Salut, Educació i Cultura, GESEC, Department of Nursing and Physiotherapy, University of Lleida, Lleida, Spain.,Health Care Research Group (GRECS), Lleida Institute for Biomedical Research Dr. Pifarré Foundation, Lleida, Spain
| | - Erica Briones-Vozmediano
- Department of Nursing and Physiotherapy, University of Lleida, Lleida, Spain.,Grup d'Estudis Societat, Salut, Educació i Cultura, GESEC, Department of Nursing and Physiotherapy, University of Lleida, Lleida, Spain.,Health Care Research Group (GRECS), Lleida Institute for Biomedical Research Dr. Pifarré Foundation, Lleida, Spain
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Scarinci F, Patacchioli FR, Parravano M. Exploring the Biopsychosocial Pathways Shared by Obstructive Sleep Apnea (OSA) and Central Serous Chorioretinopathy (CSC): A Literature Overview. J Clin Med 2021; 10:jcm10071521. [PMID: 33917331 PMCID: PMC8038656 DOI: 10.3390/jcm10071521] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Revised: 03/18/2021] [Accepted: 03/31/2021] [Indexed: 12/18/2022] Open
Abstract
This study addressed the following question: “Is it possible to highlight the link between obstructive sleep apnea (OSA) and central serous chorioretinopathy (CSC) through common biopsychosocial pathogenetic pathways?”. The study was conducted through electronic searches of the PubMed, Web of Science, and Scopus databases. All relevant selected human research studies published from January 2003 to December 2020 were included. The scientific literature search was performed through repeated use of the words “OSA” and/or “acute/chronic CSC” paired with “biomedical/biopsychosocial illness model”, “psychopathology”, “stress”, “personality characteristics”, “functional diseases”, “comorbidity”, and “quality of life” in different combinations. Our literature search identified 213 reports, of which 54 articles were ultimately reviewed in this paper. Taken together, the results indicate that there is a cross-link between OSA and CSC that can be classified among biopsychological disorders in which various major biological variables integrate with psychological-functional and sociological variables; many of these variables appear in both diseases. This concept can have important implications for improving patients’ quality of life, thus providing the necessary strategies to cope with challenging life events even through nonpharmacological approaches.
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Mutlu P, Zateri C, Zohra A, Ozerdogan O, Mirici AN. Prevalence of obstructive sleep apnea in female patients with fibromyalgia. Saudi Med J 2020; 41:740-745. [PMID: 32601643 PMCID: PMC7502927 DOI: 10.15537/smj.2020.7.25165] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Objectives: To determine the prevalence of obstructive sleep apnea in female patients with fibromyalgia (FM) presenting to physical therapy outpatient clinics. Methods: The 36-item short form health survey (SF-36) questionnaire, Berlin test, and epworth sleepiness scale were administered, along with a polysomnography to 38 female patients. This cross-sectional study comprised diagnosed with FM according to the diagnostic criteria of the American College of Rheumatology, between March 2017 and August 2019, at the Faculty of Medicine Hospital, Çanakkale Onsekiz Mart University, Çanakkale, Turkey. Results: Of the participants, 65.9% were found to have obstructive sleep apnea (OSA). Patients with OSA were older and had a higher disease activity score for FM. A strong positive correlation was identified between the apnea-hypopnea index (AHI) and the FA disease activity score. A negative correlation was found between AHI and the subscales of SF-36. Conclusion: A clinical assessment of female patients with FM requires a multidisciplinary approach, and patients with excessive daytime sleepiness in particular are recommended to undergo polysomnography. The authors believe that the early detection and treatment of accompanying OSA will contribute not only to the quality of life, but also to the survival of patients with FM.
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Affiliation(s)
- Pinar Mutlu
- Department of Chest Diseases, Faculty of Medicine, Çanakkale Onsekiz Mart University, Çanakkale, Turkey. E-mail.
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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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Clark SD, Salonen BR, Reddy BS NV, Mohabbat AB. Utilization of Overnight Pulse Oximetry in Fibromyalgia Patients. Glob Adv Health Med 2019; 8:2164956119847125. [PMID: 31069165 PMCID: PMC6495439 DOI: 10.1177/2164956119847125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2018] [Revised: 03/06/2019] [Accepted: 04/06/2019] [Indexed: 11/17/2022] Open
Abstract
To assess whether the Berlin Sleep Questionnaire and the Snoring, Tired, Observed, Pressure, Body mass, Age, Neck, and Gender questionnaire (STOP-BANG) might be suitable replacements for an overnight sleep pulse oximetry as screening tools for sleep disordered breathing in patients with fibromyalgia. Participants: From June 8, 2018 through July 25, 2018, adult patients with a confirmed diagnosis of fibromyalgia (via the 1990 and/or 2010 American College of Rheumatology Fibromyalgia Classification Criteria) who attended Mayo Clinic's Fibromyalgia Treatment Program were invited to participate in the study. Methods: The design was a prospective comparative study with a retrospective chart review component. Participants completed 2 validated surveys: the Berlin Sleep Questionnaire and the STOP-BANG. Medical records were reviewed for demographic information and overnight pulse oximetry test results. Results: Results from both questionnaires indicate that there is an association between sleep apnea risk category (defined by questionnaire) and oximetry results. Fisher's exact test for STOP-BANG and Berlin Sleep Questionnaire are statistically significant (P < .001), indicating that participants at high risk for sleep apnea (based on the questionnaires) had a greater prevalence of abnormal oximetry results than those at low risk for sleep apnea. Participants who were classified as high risk (85.7%) or intermediate risk (61.5%) on the STOP-BANG questionnaire for sleep apnea had abnormal oximetry results. Participants who scored as high risk (85.7%) for sleep apnea on the Berlin Sleep Questionnaire had abnormal oximetry results. Conclusions: In patients with fibromyalgia, the Berlin Sleep Questionnaire and the STOP-BANG questionnaires could be beneficial in determining the probability of obstructive sleep apnea and the subsequent need for pulse oximetry testing, in higher risk patients.
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Affiliation(s)
- Stephanie D Clark
- Division of General Internal Medicine, Mayo Clinic, Rochester, Minnesota
| | - Bradley R Salonen
- Division of General Internal Medicine, Mayo Clinic, Rochester, Minnesota
| | - Neha V Reddy BS
- Division of General Internal Medicine, Mayo Clinic, Rochester, Minnesota
| | - Arya B Mohabbat
- Division of General Internal Medicine, Mayo Clinic, Rochester, Minnesota,Arya B Mohabbat, Division of General Internal Medicine, Mayo Clinic, 200 First St SW, Rochester, MN 55905, USA.
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Sleep Disturbance and Pain. Chest 2018; 154:1249-1259. [DOI: 10.1016/j.chest.2018.07.019] [Citation(s) in RCA: 79] [Impact Index Per Article: 13.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2018] [Revised: 06/21/2018] [Accepted: 07/18/2018] [Indexed: 12/19/2022] Open
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