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.
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.
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.
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.
This is a preview of subscription content, access via your institution.
Buy single article
Instant access to the full article PDF.
Price includes VAT (USA)
Tax calculation will be finalised during checkout.
Wolfe F, Clauw DJ, Fitzcharles MA, Goldenberg DL, Hauser W, Katz RL et al (2016) Revisions to the 2010/2011 fibromyalgia diagnostic criteria. Semin Arthritis Rheum 46:319329. https://doi.org/10.1016/j.semarthrit.2016.08.012
Roizenblatt S, Neto NS, Tufik S (2011) Sleep disorders and fibromyalgia. Curr Pain Headache Rep 15:347–357. https://doi.org/10.1007/s11916-011-0213-3
Shaver JL, Lentz M, Landis CA, Heitkemper MM, Buchwald DS, Woods NF (1997) Sleep, psychological distress, and stress arousal in women with fibromyalgia. Res Nurs Health 20:247–257. https://doi.org/10.1002/(SICI)1098-240X(199706)20:3<247::AIDNUR7>3.0.CO;2-I
Moldofsky H (1989) Sleep and fibrositis syndrome. Rheum Dis Clin N Am 15:91–103
Roizenblatt S, Moldofsky H, Benedito-Silva AA, Tufik S (2001) Alpha sleep characteristics in fibromyalgia. Arthritis Rheum 44:222–230. https://doi.org/10.1002/15290131(200101)44:1<222::AID-ANR29>3.0.CO;2-K
Affleck G, Urrows S, Tennen H, Higgins P, Abeles M (1996) Sequential daily relations of sleep, pain intensity, and attention to pain among women with fibromyalgia. Pain 68:363–368. https://doi.org/10.1016/S0304-3959(96)03226-5
Hauri P, Hawkins DR (1973) Alpha-delta sleep. Electroencephalogr Clin Neurophysiol 34:233–237. https://doi.org/10.1016/0013-4694(73)90250-2
Chervin RD, Teodorescu M, Kushwaha R, Deline AM, Brucksch CB, Ribbens-Grimm C, Ruzicka DL, Stein PK, Clauw DJ, Crofford LJ (2009) Objective measures of disordered sleep in fibromyalgia. J Rheumatol 36:2009–2016. https://doi.org/10.3899/jrheum.090051
Choy EHS (2015) The role of sleep in pain and fibromyalgia. Nat Rev Rheumatol 11:513520–513520. https://doi.org/10.1038/nrrheum.2015.56
Wittig RM, Zorick FJ, Blumer D, Heilbronn M, Roth T (1982) Disturbed sleep in patients complaining of chronic pain. J Nerv Ment Dis 170:429–431
Touchon J, Besset A, Billiard M, Simon L, Herrison C, Cadihac J (1988) Fibrositis syndrome: polysomnographic and psychological aspects. In: Koella WP, Oba’l F, Schulz H, Visser P (eds) Sleep ‘86. Gustav Fischer Verlag, Stuttgart, pp 445–447
Rizzi M, Sarzi-Puttini P, Atzeni F, Capsoni F, Andreoli A, Pecis M, Colombo S, Carrabba M, Sergi M (2004) Cyclic alternating pattern: a new marker of sleep alteration in patients with fibromyalgia? J Rheumatol 31:1193–1199
Diaz-Piedra C, Catena A, Sanchez AI, Miro E, Martinez MP, Buela-Casal G (2015) Sleep disturbances in fibromyalgia syndrome: the role of clinical and polysomnographic variables explaining poor sleep quality in patients. Sleep Med 16:917–925. https://doi.org/10.1016/j.sleep.2015.03.011
Wu YL, Chang LY, Lee HC, Fang SC, Tsai PS (2017) Sleep disturbances in fibromyalgia: a meta-analysis of case-control studies. J Psychosom Res 96:89–97. https://doi.org/10.1016/j.jpsychores.2017.03.011
Besteiro JL, Suarez TV, Arboleya L, Muniz J, Lemos S, Alvarez FA (2011) Sleep architecture in patients with fibromyalgia. Psicothema 23:368–373
Horne JA, Shackell BS (1991) Alpha-like EEG activity in non-REM sleep and the fibromyalgia (fibrositis) syndrome. Electoenceph Clin Neurophysiol 79:271–276. https://doi.org/10.1016/0013-4694(91)90122-K
Drewes AM, Nielsen KD, Taagholt SJ, Bjerregard K, Svendsen L, Gade J (1995) Sleep intensity in fibromyalgia: focus on the microstructure of the sleep process. Br J Rheumatol 34:629–635. https://doi.org/10.1093/rheumatology/34.7.629
Sarzi-Puttini P, Rizzi M, Andreoli A, Panni B, Pecis M, Colombo S, Turiel M, Carrabba M, Sergi M (2002) Hypersomnolence in fibromyalgia syndrome. Clin Exp Rheumatol 20:69–72
Jennum P, Drewes AM, Andreasen A, Nielsen KD (1993) Sleep and other symptoms in primary fibrolmyalgia syndrome and healthy controls. J Rheumatol 20:1756–1759
Roehrs T, Diederichs C, Gillis M, Burger AJ, Stout RA, Lumley MA et al (2013) Nocturnal sleep, daytime sleepiness and fatigue in fibromyalgia patients compared to rheumatoid arthritis patients and healthy controls: a preliminary study. Sleep Med 14:109115. https://doi.org/10.1016/j.sleep.2012.09.020
Roth T, Brown PB, Pitman VW, Roehrs TA, Resnick EM (2016) Characteristics of disturbed sleep in patients with fibromyalgia compared with insomnia or with pain-free volunteers. Clin J Pain 32:302–307. https://doi.org/10.1097/AJP.0000000000000261
Marvisi M, Balzarini L, Mancini C, Ramponi S, Marvisi C (2015) Fibromyalgia is frequent in obstructive sleep apnea and responds to CPAP therapy. Eur J Intern Med 26:4950. https://doi.org/10.1016/j.ejim.2015.06.010
Rosenfeld VW, Rutledge DN, Stern JM (2015) Polysomnography with quantitative EEG in patients with and without fibromyalgia. J Clin Neurophysiol 32:164–170. https://doi.org/10.1097/WNP.0000000000000134
Köseoğlu Hİ, İnanır A, Kanbay A, Okan S, Demir O, Çeçen O, İnanır S (2017) Is there a link between obstructive sleep apnea syndrome and fibromyalgia syndrome? Turk Thorac J 18:40–46. https://doi.org/10.5152/TurkThoracJ.2017.16036
Burns JW, Crofford LJ, Chervin RD (2008) Sleep stage dynamics in fibromyalgia patients and controls. Sleep Med 9:689–696. https://doi.org/10.1016/j.sleep.2007.10.022
Yeung WK, Morgan K, McKenna F (2018) Comparison of sleep structure and psychometric profiles in patients with fibromyalgia, ostheoarthritis and healthy controls. J Sleep Res 27:290–298. https://doi.org/10.1111/jsr.12588
Kapur VK, Auckley DH, Chowduri S, Kuhlmann DC, Mehra R, Ramar K et al (2017) Clinical practice guideline for diagnostic testing for adult obstructive sleep apnea: an AmericanAcademy of sleep medicine clinical practice guideline. J Clin Sleep Med 13(3):479–504. https://doi.org/10.5664/jcsm.6506
Buysse DJ, Reynolds CF III, Monk TH, Berman SR, Kupfer DJ (1989) The Pittsbugh sleep quality index: a new instrument for psychiatric practice and research. Psychiatry Res:193–213. https://doi.org/10.1016/0165-1781(89)90047-4
Ağargün MY, Kara H, Anlar Ö (1996) Pittsburgh Uyku Kalitesi İndeksi’nin geçerliği ve güvenirliği. Turk Psikiyatri Derg 7:107–115
Johns MW (1991) A new method for measuring daytime sleepiness: the Epworth sleepiness scale. Sleep 14:540–545. https://doi.org/10.1093/sleep/14.6.540
Ağargün MY, Çilli AS, Kara H, Bilici M, Telcioğlu M, Semiz ÜB et al (1999) Epworth uykululuk ölçeğinin geçerliği ve güvenirliği. Turk Psikiyatri Derg 10:261–267
Sugi T, Kawana F, Nakamura M (2009) Automatic EEG arousal detection for sleep apnea syndrome. Biomed Signal Process Control 4(4):329–337. https://doi.org/10.1016/j.bspc.2009.06.004
Jennum P, Riha RL (2009) Epidemiology of sleep apnoea/hypopnoea syndrome and sleep-disordered breathing. Eur Respir J 33:907–914. https://doi.org/10.1183/09031936.00180108
Welsh GA, Whipple MO, Olson EJ, Vincent A, Loehrer LL, Cha SS et al (2015) Obstructive sleep apnea in patients with fibromyalgia: report from a fibromyalgia clinic. J Sleep Disord Ther 4:211
Shah MA, Feinberg S, Krishnan E (2006) Sleep-disordered breathing among women with fibromyalgia syndrome. J Clin Rheumatol 12:277–281. https://doi.org/10.1097/01.rhu.0000249771.97221.36
Sepici V, Tosun A, Köktürk O (2007) Obstructive sleep apnea syndrome as an uncommon cause of fibromyalgia: a case report. Rheumatol Int 28:69–71. https://doi.org/10.1007/s00296-007-0375-9
Gold AR, Dipalo F, Gold MS, Broderick J (2004) Inspiratory airflow dynamics during sleep in women with fibromyalgia. Sleep 27:459–466. https://doi.org/10.1093/sleep/27.3.459
May KP, West SG, Baker MR, Everett DW (1993) Sleep apnea in male patients with fibromyalgia syndrome. Am J Med 94:505–508. https://doi.org/10.1016/00029343(93)90085-4
Alvarez LB, Teran J, Alonso JL, Alegre J, Arroyo I, Viejo JL (1992) Lack of association between fibromyalgia and sleep apnea syndrome. Ann Rheum Dis 51:108–111. https://doi.org/10.1136/ard.51.1.108
This study received no funding.
Conflict of interest
Author Buğra Çetin declares that he has no conflict of interest. Author Esra Aydın Sünbül declares that she has no conflict of interest. Author Hayal Toktaş declares that she has no conflict of interest. Author Merve Karaca declares that she has no conflict of interest. Author Özgür Ulutaş declares that he has no conflict of interest. Author Hüseyin Güleç declares that he has no conflict of interest.
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.
Human and animal rights statement
This article does not contain any studies with animals performed by any of the authors.
Informed consent was obtained from all individual participants included in the study.
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
About this article
Cite this article
Çetin, B., Sünbül, E.A., Toktaş, H. et al. Comparison of sleep structure in patients with fibromyalgia and healthy controls. Sleep Breath 24, 1591–1598 (2020). https://doi.org/10.1007/s11325-020-02036-x
- Obstructive sleep apnea