Rheumatology International

, Volume 35, Issue 2, pp 281–287 | Cite as

Obesity and sleepiness in women with fibromyalgia

  • Tânia Aparecida de Araújo
  • Maria Carliana Mota
  • Cibele Aparecida Crispim
Original Article

Abstract

Fibromyalgia (FM) is associated with a number of comorbidities, including chronic widespread pain, fatigue and non-restorative sleep. Evidence has shown that FM is closely associated with overweight and obesity. The objective of the present study was to investigate the relationship between obesity and sleepiness in women with FM. A total of 100 adult female patients with a prior medical diagnosis of FM participated in the study. Body mass, height and waist circumference were measured, and body mass index (BMI) was calculated. The diet quality was evaluated by the Healthy Eating Index. Subjective analyses of daytime sleepiness [Epworth Sleepiness Scale (ESS)] and sleep quality (Pittsburgh Sleep Quality) were performed. An obesity rate of 41 % was found in all women (56.1 % were sleepy and 43.9 % were not, p = 0.04). Obese women showed a greater level of sleepiness when compared with non-obese (10.2 and 7.0, respectively, p = 0.004). Sleepy women showed a greater weight gain after the diagnosis of FM when compared with non-sleepy women (11.7 and 6.4 kg, respectively, p = 0.04). A positive and significant correlation between BMI and sleepiness (r = 0.35, p = 0.02) was also found. In multivariate logistic regression, moderate or severe sleepiness (ESS >12) was associated with obesity (odds ratio 3.44, 95 % CI 1.31–9.01, p = 0.04). These results demonstrate an important association between sleepiness and FM, suggesting that the occurrence of obesity may be involved with sleepiness in these patients.

Keywords

Fibromyalgia Obesity Sleepiness Nutrition 

References

  1. 1.
    Bradley LA (2009) Pathophysiology of fibromyalgia. Am J Med 122(12):1–13CrossRefGoogle Scholar
  2. 2.
    Wolfe F, Clauw DJ, Fitzcharles MA, Goldenberg DL, Katz RS, Mease P et al (2010) The American College of Rheumatology preliminary diagnostic criteria for fibromyalgia and measurement of symptom severity. Arthritis Care Res (Hoboken) 62(5):600–610CrossRefGoogle Scholar
  3. 3.
    Ursini F, Naty S, Grembiale RD (2011) Fibromyalgia and obesity: the hidden link. Rheumatol Int 31:1403–1408PubMedCrossRefGoogle Scholar
  4. 4.
    Wolfe F, Brähler E, Hinz A, Häuser W (2013) Fibromyalgia prevalence, somatic symptom reporting, and the dimensionality of polysymptomatic distress: results from a survey of the general population. Arthritis Care Res 65(5):777–785CrossRefGoogle Scholar
  5. 5.
    Senna ER, Barros ALP, Silva EO, Costa IF, Pereira LVB, Ciconelli RM, Ferraz MB (2004) Prevalence of rheumatic diseases in Brazil: a study using the COPCORD approach. J Rheumatol 31(3):594–597PubMedGoogle Scholar
  6. 6.
    Yunus MB, Arslan S, Aldag JC (2002) Relationship between body mass index and fibromyalgia features. Scand J Rheumatol 31(1):27–31PubMedCrossRefGoogle Scholar
  7. 7.
    Bennett RM, Jones J, Turk DC, Russell IJ, Matallana L (2007) An internet survey of 2,596 people with fibromyalgia. BMC Musculoskelet Disord 8:27PubMedCrossRefPubMedCentralGoogle Scholar
  8. 8.
    Neumann L, Lerner E, Glazer Y, Bolotin A, Shefer A, Buskila D (2008) A cross-sectional study of the relationship between body mass index and clinical characteristics, tenderness measures, quality of life, and physical functioning in fibromyalgia patients. Clin Rheumatol 27(12):1543–1547PubMedCrossRefGoogle Scholar
  9. 9.
    Okifuji A, Bradshaw DH, Olson C (2009) Evaluating obesity in fibromyalgia: neuroendocrine biomarkers, symptoms, and functions. Clin Rheumatol 28(4):475–478PubMedCrossRefPubMedCentralGoogle Scholar
  10. 10.
    Okifuji A, Donaldson GW, Barck L, Fine PG (2010) Relationship between fibromyalgia and obesity in pain, function, mood, and sleep. J Pain 11(12):1329–1337PubMedCrossRefPubMedCentralGoogle Scholar
  11. 11.
    Kim CH, Luedtke CA, Vincent A, Thompson JM, Terry HOH (2012) Association of body mass index with symptom severity and quality of life in patients with fibromyalgia. Arthritis Care Res 64(2):222–228CrossRefGoogle Scholar
  12. 12.
    Homann D, Goes SM, Timossi LS, Leite N (2011) Avaliação da capacidade funcional de mulheres com fibromialgia: métodos diretos e autorrelatados. Rev Bras Cineantropom Desempenho Hum 13(4):292–298CrossRefGoogle Scholar
  13. 13.
    Senna MK, Ahmad HS, Fathi W (2013) Depression in obese patients with primary fibromyalgia: the mediating role of poor sleep and eating disorder features. Clin Rheumatol 32:369–375PubMedCrossRefGoogle Scholar
  14. 14.
    Arranz LI, Canela MA, Rafecas M (2010) Fibromyalgia and nutrition, what do we know? Rheumatol Int 30(11):1417–1427PubMedCrossRefGoogle Scholar
  15. 15.
    Moldofsky H, Scarisbrick P, England R, Smythe H (1975) Musculoskeletal symptoms and non-REM sleep disturbance in patients with “fibrositis syndrome” and healthy subjects. Psychosom Med 37(4):41–351CrossRefGoogle Scholar
  16. 16.
    Korszun A (2000) Sleep and circadian rhythm disorders in fibromyalgia. Curr Rheumatol Rep 2:124–130PubMedCrossRefGoogle Scholar
  17. 17.
    Theadom A, Cropley M, Humphrey KL (2007) Exploring the role of sleep and coping in quality of life in fibromyalgia. J Psychosom Res 62:145–151PubMedCrossRefGoogle Scholar
  18. 18.
    Moldofsky H, Harris HW, Archambault TW, Kwong T, Lederman S (2011) Effects of bedtime very low dose cyclobenzaprine on symptoms and sleep physiology in patients with fibromyalgia syndrome: a double-blind randomized placebo-controlled study. J Rheumatol 38:2653–2663PubMedCrossRefGoogle Scholar
  19. 19.
    Roehrs T, Diederichs C, Gillis M, Burger AJ, Stout RA, Lumley MA, Roth T (2013) Nocturnal sleep, daytime sleepiness and fatigue in fibromyalgia patients compared to rheumatoid arthritis patients and healthy controls: a preliminary study. Sleep Med 14:109–115PubMedCrossRefGoogle Scholar
  20. 20.
    Sarzi-Puttini P, Rizzi M, Pecis M, Colombo S, Turiel M, Carrabba M, Sergi M (2002) Hypersomnolence in fibromyalgia syndrome. Clin Rheumatol 20:69–72Google Scholar
  21. 21.
    Patel SR (2009) Reduced sleep as an obesity risk factor. Obes Rev 10(2):61–68PubMedCrossRefGoogle Scholar
  22. 22.
    Van Cauter E, Spiegel K, Tasali E, Leproult R (2008) Metabolic consequences of sleep and sleep loss. Sleep Med 9(1):S23–S28PubMedCrossRefGoogle Scholar
  23. 23.
    Killgore WDS, Schwab ZJ, Weber M et al (2013) Daytime sleepiness affects prefrontal regulation of food intake. NeuroImage 71:216–223PubMedCrossRefGoogle Scholar
  24. 24.
    Spiegel K, Tasali E, Penev P, Van Cauter E (2004) Brief communication: sleep curtailment in healthy young men is associated with decreased leptin levels, elevated ghrelin levels, and increased hunger and appetite. Ann Intern Med 141:846–850PubMedCrossRefGoogle Scholar
  25. 25.
    Taheri S, Lin L, Austin D, Young T, Mignot E (2004) Short sleep duration is associated with reduced leptin, elevated ghrelin, and increased body mass index. PLoS Med 1:210–217CrossRefGoogle Scholar
  26. 26.
    Taheri S (2006) The link between short sleep duration and obesity: we should recommend more sleep to prevent obesity. Arch Dis Child 91:881–884PubMedCrossRefPubMedCentralGoogle Scholar
  27. 27.
    WHO (World Health Organization Tech Rep Ser) (2000) Obesity: preventing and managing the global epidemic. Report of a WHO consultation 894:1–253Google Scholar
  28. 28.
    Jackson AS, Pollock ML (1978) Generalized equations for predicting body density of men. Br J Nutr 40:497–504PubMedCrossRefGoogle Scholar
  29. 29.
    Siri WE (1956) Apparatus for measuring human body volume. Rev Sci Instr 27(9):729–738CrossRefGoogle Scholar
  30. 30.
    Heyward VH, Stolarczyk IM (2000) Avaliação da composição corporal aplicada. Manole, São PauloGoogle Scholar
  31. 31.
    Mota JF, Rinaldi AEM, Pereira AF, Maestá N, Scarpin MM, Burini RC (2008) Adaptation of the healthy eating index to the food guide of the Brazilian population. Rev Nutr 21:545–552CrossRefGoogle Scholar
  32. 32.
    Philippi ST, Latterza AR, Cruz ATR, Ribeiro LC (1999) Adapted food pyramid: a guide for a right food choice. Rev Nutr 12:65–80CrossRefGoogle Scholar
  33. 33.
    Bertolazi AN, Fagondes SC, Hoff LS, Dartra EG, Miozzo IC, Barba ME, Barreto SS (2011) Validation of the Brazilian Portuguese version of the Pittsburgh Sleep Quality Index. Sleep Med 12(1):70–75PubMedCrossRefGoogle Scholar
  34. 34.
    Buysse DJ, Reynolds CF, Monk TH, Berman SR, Kupfer DJ (1989) The Pittsburgh Sleep Quality Index: a new instrument for psychiatric practice and research. Psychiatry Res 28:193–213PubMedCrossRefGoogle Scholar
  35. 35.
    Bertolazi AN, Fagondes SC, Hoff LS, Pedro VD, Barreto SSM, Johns MW (2009) Portuguese-language version of the Epworth sleepiness scale: validation for use in Brazil. J Bras Pneumol 35(9):877–883PubMedCrossRefGoogle Scholar
  36. 36.
    Johns MW (1991) A new method for measuring daytime sleepiness: the Epworth sleepiness scale. Sleep 14:540–545PubMedGoogle Scholar
  37. 37.
    Instituto Brasileiro de Geografia e Estatística (IBGE) (2010) Pesquisa de Orçamentos Familiares 2008–2009. Antropometria e Estado Nutricional de Crianças, Adolescentes e Adultos no Brasil, Rio de JaneiroGoogle Scholar
  38. 38.
    American Academy of Sleep Medicine (2001) International classification of sleep disorders, revised: diagnostic and coding manual. American Academy of Sleep Medicine, ChicagoGoogle Scholar
  39. 39.
    Burns JW, Crofford LJ, Chervin RD (2008) Sleep stage dynamics in fibromyalgia patients and controls. Sleep Med 9:689–696PubMedCrossRefGoogle Scholar
  40. 40.
    Togo F, Natelson BH, Cherniack NS, Gibbons JF, Garcon C, Rapoport DM (2008) Sleep structure and sleepiness in chronic fatigue syndrome with or without coexisting fibromyalgia. Arthritis Res Ther 10(3):R56PubMedCrossRefPubMedCentralGoogle Scholar
  41. 41.
    Spaeth MD, Rizzi M, Sarzi-Puttini P (2011) Fibromyalgia and sleep. Best Pract Res Clin Rheumatol 25:227–239PubMedCrossRefGoogle Scholar
  42. 42.
    Panossian LA, Veasey SC (2012) Daytime sleepiness in obesity: mechanisms beyond obstructive sleep apnea—a review. Sleep 35(5):605–615PubMedPubMedCentralGoogle Scholar
  43. 43.
    Crispim CA, Zalcman I, Dáttilo M, Padilha HG, Edwards B, Waterhouse J, Tufik S, Mello MT (2007) The influence of sleep and sleep loss upon food intake and metabolism. Nutr Res Rev 20:195–212PubMedCrossRefGoogle Scholar
  44. 44.
    Spaeth M, Bennett RM, Benson BA, Wang YG, Lai C, Choy EH (2012) Sodium oxybate therapy provides multidimensional improvement in fibromyalgia: results of an international phase 3 trial. Ann Rheum Dis 71:935–942PubMedCrossRefPubMedCentralGoogle Scholar
  45. 45.
    Arranz LI, Canela MI, Rafecas M (2012) Dietary aspects in fibromyalgia patients: results of a survey on food awareness, allergies, and nutritional supplementation. Rheumatol Int 32:1417–1427Google Scholar
  46. 46.
    Markwald RR, Melanson EL, Smith MR, Higgins J, Perreault L, Eckel RH, Wright KP Jr (2013) Impact of insufficient sleep on total daily energy expenditure, food intake, and weight gain. Proc Natl Acad Sci USA 110(14):5695–5700PubMedCrossRefPubMedCentralGoogle Scholar
  47. 47.
    Haghighatdoost F, Karimi G, Esmaillzadeh A, Azadbakht L (2012) Sleep deprivation is associated with lower diet quality indices and higher rate of general and central obesity among young female students in Iran. Nutrition 28(11–12):1146–1150PubMedCrossRefGoogle Scholar
  48. 48.
    Hänninen O, Kaartinen K, Rauma AL, Nenonen M, Törrönen R, Häkkinen S, Adlercreutz H, Laakso J (2000) Antioxidants in vegan diet and rheumatic disorders. Toxicology 155:45–53PubMedCrossRefGoogle Scholar
  49. 49.
    Kaartinen K, Lammi K, Hypen M, Nenonen M, Hänninen O, Rauma AL (2000) Vegan diet alleviates fibromyalgia symptoms. Scand J Rheumatol 29:308–313PubMedCrossRefGoogle Scholar
  50. 50.
    Donaldson MS, Speight N, Loomis S (2001) Fibromyalgia syndrome improved using a mostly raw vegetarian diet: an observational study. BMC Complementary and Alternative Medicine 1:7PubMedCrossRefPubMedCentralGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2014

Authors and Affiliations

  • Tânia Aparecida de Araújo
    • 1
  • Maria Carliana Mota
    • 1
  • Cibele Aparecida Crispim
    • 1
  1. 1.Post Graduate Program in Health Sciences, Faculty of MedicineFederal University of UberlândiaUberlândiaBrazil

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