Skip to main content

Comparison of sleep structure in patients with fibromyalgia and healthy controls

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.

This is a preview of subscription content, access via your institution.

References

  1. 1.

    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

    Article  Google Scholar 

  2. 2.

    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

    Article  PubMed  Google Scholar 

  3. 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

    CAS  Article  PubMed  Google Scholar 

  4. 4.

    Moldofsky H (1989) Sleep and fibrositis syndrome. Rheum Dis Clin N Am 15:91–103

    CAS  Google Scholar 

  5. 5.

    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

    CAS  Article  PubMed  Google Scholar 

  6. 6.

    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

    CAS  Article  PubMed  Google Scholar 

  7. 7.

    Hauri P, Hawkins DR (1973) Alpha-delta sleep. Electroencephalogr Clin Neurophysiol 34:233–237. https://doi.org/10.1016/0013-4694(73)90250-2

    CAS  Article  PubMed  Google Scholar 

  8. 8.

    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

    Article  PubMed  PubMed Central  Google Scholar 

  9. 9.

    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

    Article  Google Scholar 

  10. 10.

    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

    CAS  Article  Google Scholar 

  11. 11.

    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

    Google Scholar 

  12. 12.

    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

    PubMed  Google Scholar 

  13. 13.

    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

    Article  PubMed  Google Scholar 

  14. 14.

    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

    Article  PubMed  Google Scholar 

  15. 15.

    Besteiro JL, Suarez TV, Arboleya L, Muniz J, Lemos S, Alvarez FA (2011) Sleep architecture in patients with fibromyalgia. Psicothema 23:368–373

    Google Scholar 

  16. 16.

    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

    CAS  Article  Google Scholar 

  17. 17.

    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

    CAS  Article  PubMed  Google Scholar 

  18. 18.

    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

    CAS  PubMed  Google Scholar 

  19. 19.

    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

    CAS  PubMed  Google Scholar 

  20. 20.

    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

    Article  Google Scholar 

  21. 21.

    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

    Article  PubMed  Google Scholar 

  22. 22.

    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

    Article  Google Scholar 

  23. 23.

    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

    Article  PubMed  Google Scholar 

  24. 24.

    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

    Article  PubMed  PubMed Central  Google Scholar 

  25. 25.

    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

    Article  PubMed  Google Scholar 

  26. 26.

    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

    Article  PubMed  Google Scholar 

  27. 27.

    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

    Article  PubMed  PubMed Central  Google Scholar 

  28. 28.

    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

  29. 29.

    Ağargün MY, Kara H, Anlar Ö (1996) Pittsburgh Uyku Kalitesi İndeksi’nin geçerliği ve güvenirliği. Turk Psikiyatri Derg 7:107–115

    Google Scholar 

  30. 30.

    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

    CAS  Article  PubMed  Google Scholar 

  31. 31.

    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

    Google Scholar 

  32. 32.

    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

    Article  Google Scholar 

  33. 33.

    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

    CAS  Article  PubMed  Google Scholar 

  34. 34.

    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

    Google Scholar 

  35. 35.

    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

    Article  PubMed  Google Scholar 

  36. 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

    Article  PubMed  Google Scholar 

  37. 37.

    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

    Article  PubMed  Google Scholar 

  38. 38.

    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

    Article  PubMed  Google Scholar 

  39. 39.

    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

    Article  Google Scholar 

Download references

Funding

This study received no funding.

Author information

Affiliations

Authors

Corresponding author

Correspondence to Buğra Çetin.

Ethics declarations

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.

Ethical approval

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

Informed consent was obtained from all individual participants included in the study.

Additional information

Publisher’s note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

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

Download citation

Keywords

  • Sleep
  • Fibromyalgia
  • Obstructive sleep apnea
  • Polysomnography