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Sleep and circadian rhythm disorders in fibromyalgia

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Abstract

Fibromyalgia (FM) is a syndrome of generalized muscle pain that is also associated with equally distressing symptoms of sleep disturbance and fatigue. FM shows clinical overlap with other stress-associated disorders, including chronic fatigue syndrome (CFS) and depression. All of these conditions have the features of disrupted sleep patterns and dysregulated biologic circadian rhythms, such as stress hormone secretion. This review focuses on the role of sleep and circadian rhythm disorders in FM and, in the absence of any specific treatment for FM, presents a pragmatic therapeutic approach aimed at identifying and treating comorbid sleep and depressive disorders, optimizing sleep habits, and judicious use of pharmacologic agents.

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References and Recommended Reading

  1. Wolfe F, Smythe HA, Yunus MB, et al.: The American College of Rheumatology 1990 criteria for the classification of fibromyalgia: report of the multicenter criteria committee. Arthritis Rheum 1990, 33:160–172.

    Article  PubMed  CAS  Google Scholar 

  2. Crofford LJ, Engleberg NC, Demitrack MA: Neurohormonal perturbations in fibromyalgia. Baillere’s Clinical Rheumatology 1996, 10(2):1–14.

    Google Scholar 

  3. Crofford LJ: Neuroendocrine abnormalities in fibromyalgia and related disorders. Am J Med Sci 1998, 315:359–366.

    Article  PubMed  CAS  Google Scholar 

  4. Born J, Muth S, Fehm HL: The significance of sleep onset and slow wave sleep for nocturnal release of growth hormone (GH) and cortisol. Psychoneuroendocrinology 1988, 13:233–243.

    Article  PubMed  CAS  Google Scholar 

  5. Moldofsky H: Chronobiological influences on fibromyalgia syndrome: theoretical and therapeutic implications. Bailliere’s Clin Rheumatol 1994, 8:801–810.

    Article  CAS  Google Scholar 

  6. Moldofsky H, Scarisbrick P, England R, et al.: Musculoskeletal symptoms and non-REM sleep disturbance in patients with "fibrositis syndrome" and healthy subjects. Psychosom Med 1975, 37:341–351.

    PubMed  CAS  Google Scholar 

  7. Hauri P, Hawkins DR: Alpha delta sleep. Electroencephalogr Clin Neurophysiol 1973, 34:233–237.

    Article  PubMed  CAS  Google Scholar 

  8. Drewes AM, Gade J, Nielsen KD, et al.: Clustering of sleep electroencephalographic patterns in patients with the fibromyalgia syndrome. Br J Rheumatol 1995, 34:1151–1156.

    Article  PubMed  CAS  Google Scholar 

  9. Jennum P, Drewes AM, Andreasen A, et al.: Sleep and other symptoms in primary fibromyalgia and in healthy controls. J Rheum 1993, 20:1756–1759.

    PubMed  CAS  Google Scholar 

  10. Branco J, Atalaia A, Palva T: Sleep cycles and alpha-delta sleep in fibromyalgia syndrome. J Rheum 1994, 21:1113–1117.

    PubMed  CAS  Google Scholar 

  11. Cote KA, Moldofsky H: Sleep, daytime symptoms, and cognitive performance in patients with fibromyalgia. J Rheum 1997, 24:2014–2023.

    CAS  Google Scholar 

  12. Affleck G, Urrows S, Tennen, et al.: Sequential daily relations of sleep, pain intensity, and attention to pain among women with fibromyalgia. Pain 1996, 68:363–368.

    Article  PubMed  CAS  Google Scholar 

  13. Affleck G, Tennen H, Urrows S, et al.: Fibromyalgia and women’s pursuit of personal goals: a daily process analysis. Health Psychol 1998, 17:40–47.

    Article  PubMed  CAS  Google Scholar 

  14. Perlis ML, Giles DE, Bootzin RR, et al.: Alpha sleep and information processing, perception of sleep, pain, and arousability in fibromyalgia. Int J Neurosci 1997, 89:265–280.

    PubMed  CAS  Google Scholar 

  15. Demitrack MA: Chronic fatigue syndrome and fibromyalgia. dilemmas in diagnosis and clinical management. Psych Clin N Am 1998, 21(3):671–692.

    Article  CAS  Google Scholar 

  16. Kathol R, Katon W, Smith GR, et al.: Guidelines for the diagnosis and treatment of depression for primary care physicians. Psychosomatics 1994, 35:1–12.

    PubMed  CAS  Google Scholar 

  17. Tryon W: Activity measurement in psychology and medicine. New York: Plenum; 1991.

    Google Scholar 

  18. Brzezinski A: Melatonin in humans. N Engl J Med 1997, 336(3):186–195.

    Article  PubMed  CAS  Google Scholar 

  19. Lewy A.J, Sack RL, Blod ML, et al.: Melatonin marks circadian phase position and resets the endogenous circadian pacemaker in humans. In Circadian Clocks and their Adjustment. Edited by Chadwick DJ, Ackrill K. New York: John Wiley & Sons; 1995:303–321.

    Google Scholar 

  20. Brismar K, Werner S, Thoren M, Wetterberg L: Metyrapone: an agent for melatonin as well as ACTH and cortisol secretion. J Endocrinol Invest 1985, 8(2):91–95.

    PubMed  CAS  Google Scholar 

  21. Young EA, Haskett RF, Grunhaus L, et al.: Increased circadian activation of the hypothalamic pituitary adrenal axis in depressed patients in the evening. Arch Gen Psych 1994, 51:701–707.

    CAS  Google Scholar 

  22. Leal-Cerro A, Povedano J, Astorga R, et al.: The growth hormone (GH)-releasing hormone-GH-insulin-like growth factor-1 axis in patients with fibromyalgia syndrome. J Clin Endocrinol Metab 1999, 84(9):3378–3381.

    Article  PubMed  CAS  Google Scholar 

  23. Older SA, Battafarano DF, Danning CL, et al.: The effects of delta wave sleep interruption on pain threshold and fibromyalgia-like symptoms in healthy subjects: correlations with insulin-like growth factor I. J Rheum 1998, 25:1180–1186.

    PubMed  CAS  Google Scholar 

  24. Arendt J: Melatonin and the Mammalian Pineal Gland. London:Chapman & Hill; 1995.

    Google Scholar 

  25. Leese G, Chattington P, Fraser W, et al.: Night-shift working mimics the pituitary-adrenocortical dysfunction in chronic fatigue syndrome. J Clin Endocrinol Metab 1996, 81:1867–1870.

    Article  PubMed  CAS  Google Scholar 

  26. Williams G, Pirmohamed J, Minors D, et al.: Dissociation of body-temperature and melatonin secretion circadian rhythms in patients with chronic fatigue syndrome. Clin Physiol 1996, 16(4):327–337.

    PubMed  CAS  Google Scholar 

  27. Korszun A, Papadopoulos E, Engleberg C, et al.: Melatonin and cortisol secretion in women with fibromyalgia and chronic fatigue syndrome. J Rheumatol 1999, 26(12):2675–2680.

    PubMed  CAS  Google Scholar 

  28. Dollins AB, Zhdanova IV, et al.: Effect of inducing nocturnal serum melatonin concentrations in daytime on sleep, mood, body temperature, and performance. Proc Natl Acad Sci USA 1994, 91:1824–1828.

    Article  PubMed  CAS  Google Scholar 

  29. Wikner J, Hirsch U, Wetterberg L, et al.: Fibromyalgia: a syndrome associated with decreased nocturnal melatonin secretion. Clin Endocrinol 1998, 49:179–183.

    Article  CAS  Google Scholar 

  30. Press J, Phillip M, Neumann L, et al.: Normal melatonin levels in patients with fibromyalgia syndrome. J Rheum 1998, 25:551–555.

    PubMed  CAS  Google Scholar 

  31. Goldenberg D, Mayskiy M, Mossey C, et al.: A randomized, double-blind crossover trial of fluoxetine and amitriptyline in the treatment of fibromyalgia. Arthiritis Rheum 1996, 39:1852–1859.

    Article  CAS  Google Scholar 

  32. Branco JC, Martini A, Palva T: Treatment of sleep abnormalities and clinical complaints in fibromyalgia with trazodone. Arthritis Rheum 1996, 39:591.

    Google Scholar 

  33. Gronblad M, Nykanen J, Konttinen Y, et al.: Effect of zopiclone on sleep quality, morning stiffness, widespread tenderness and pain and general discomfort in primary fibromyalgic patients. Clin Rheumatol 1993, 12:186–191.

    Article  PubMed  CAS  Google Scholar 

  34. Scharf MB, Hauck M, Stover R, et al.: Effect of gammahydroxybutyrate on pain, fatigue, and the alpha sleep anomaly in patients with fibromyalgia. Preliminary Report. J Rheum 1998, 25:1986–1990.

    PubMed  CAS  Google Scholar 

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  1. Department of Psychological Medicine, University of Wales College of Medicine, Heath Park, CF4 4XN, Cardiff, UK

    Ania Korszun MD

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  1. Ania Korszun MD
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Korszun, A. Sleep and circadian rhythm disorders in fibromyalgia. Curr Rheumatol Rep 2, 124–130 (2000). https://doi.org/10.1007/s11926-000-0052-4

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  • DOI: https://doi.org/10.1007/s11926-000-0052-4

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