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Sleep structure and sleepiness in chronic fatigue syndrome with or without coexisting fibromyalgia.

Togo F, Natelson BH, Cherniack NS, FitzGibbons J, Garcon C, Rapoport DM - Arthritis Res. Ther. (2008)

Bottom Line: We also determined whether feelings of unrefreshing sleep were associated with differences in sleep architecture from normal.This difference in sleep effects was due primarily to a decrease in the length of periods of uninterrupted sleep in the a.m. sleepier group.CFS patients had significant differences in polysomnographic findings from healthy controls and felt sleepier and more fatigued than controls after a night's sleep.

View Article: PubMed Central - HTML - PubMed

Affiliation: Pain and Fatigue Study Center, Department of Neurosciences, University of Medicine and Dentistry of New Jersey-New Jersey Medical School, 30 Bergen Street, Newark, NJ 07103, USA. tougou@p.u-tokyo.ac.jp

ABSTRACT

Introduction: We evaluated polysomnograms of chronic fatigue syndrome (CFS) patients with and without fibromyalgia to determine whether patients in either group had elevated rates of sleep-disturbed breathing (obstructive sleep apnea or upper airway resistance syndrome) or periodic leg movement disorder. We also determined whether feelings of unrefreshing sleep were associated with differences in sleep architecture from normal.

Methods: We compared sleep structures and subjective scores on visual analog scales for sleepiness and fatigue in CFS patients with or without coexisting fibromyalgia (n = 12 and 14, respectively) with 26 healthy subjects. None had current major depressive disorder, and all were studied at the same menstrual phase.

Results: CFS patients had significant differences in polysomnograpic findings from healthy controls and felt sleepier and more fatigued than controls after a night's sleep. CFS patients as a group had less total sleep time, lower sleep efficiency, and less rapid eye movement sleep than controls. A possible explanation for the unrefreshing quality of sleep in CFS patients was revealed by stratification of patients into those who reported more or less sleepiness after a night's sleep (a.m. sleepier or a.m. less sleepy, respectively). Those in the sleepier group reported that sleep did not improve their symptoms and had poorer sleep efficiencies and shorter runs of sleep than both controls and patients in the less sleepy group; patients in the less sleepy group reported reduced fatigue and pain after sleep and had relatively normal sleep structures. This difference in sleep effects was due primarily to a decrease in the length of periods of uninterrupted sleep in the a.m. sleepier group.

Conclusion: CFS patients had significant differences in polysomnographic findings from healthy controls and felt sleepier and more fatigued than controls after a night's sleep. This difference was due neither to diagnosable sleep disorders nor to coexisting fibromyalgia but primarily to a decrease in the length of periods of uninterrupted sleep in the patients with more sleepiness in the morning than on the night before. This sleep disruption may explain the overwhelming fatigue, report of unrefreshing sleep, and pain in this subgroup of patients.

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Sleep-wake patterns and survival curves for the duration of every episode of sleep. (a) Representative sleep-wake patterns from one healthy control, one patient in the a.m. less sleepy group, and one patient in the a.m. sleepier group. In contrast to the control and a.m. less sleepy patient, the a.m. sleepier patient shows clustering of her arousals, which is documented in the accompanying panel. (b) Survival curves of every episode of sleep (that is, a bout of sleep preceded and followed by periods of wakefulness) for controls and patients in the a.m. less sleepy and a.m. sleepier groups for whole-night hypnograms stratified by the duration of the sleep episode. To compare sleep continuity between groups, all data from all subjects in each group were pooled and a group survival curve was generated using standard statistical techniques [22]. Patients in the a.m. sleepier group showed a significant shift toward shorter bouts of sleep (P < 0.05) compared with the other groups. CFS, chronic fatigue syndrome.
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Figure 1: Sleep-wake patterns and survival curves for the duration of every episode of sleep. (a) Representative sleep-wake patterns from one healthy control, one patient in the a.m. less sleepy group, and one patient in the a.m. sleepier group. In contrast to the control and a.m. less sleepy patient, the a.m. sleepier patient shows clustering of her arousals, which is documented in the accompanying panel. (b) Survival curves of every episode of sleep (that is, a bout of sleep preceded and followed by periods of wakefulness) for controls and patients in the a.m. less sleepy and a.m. sleepier groups for whole-night hypnograms stratified by the duration of the sleep episode. To compare sleep continuity between groups, all data from all subjects in each group were pooled and a group survival curve was generated using standard statistical techniques [22]. Patients in the a.m. sleepier group showed a significant shift toward shorter bouts of sleep (P < 0.05) compared with the other groups. CFS, chronic fatigue syndrome.

Mentions: Patients in the a.m. sleepier group showed significantly longer sleep latency, poorer sleep efficiency, and shorter duration of median sleep run than healthy controls (Table 3). The survival curve of all sleep runs depicted in Figure 1 shows that patients in the a.m. sleepier group had a lower percentage of long runs of sleep than the other two groups and healthy controls (that is, less continuous sleep). For example, the proportions of runs lasting more than 10 minutes were 39.3%, 45.5%, and 49.0% for patients in the a.m. sleepier group, the a.m. less sleepy group, and healthy controls, respectively. The difference in temporal distribution of periods of wakefulness is evident from the representative data in Figure 1. Both the control subject and the a.m. less sleepy patient have periods of wakefulness that are spaced more evenly over time than is the case for the a.m. sleepier patient, whose periods of wakefulness appear bunched in time (Figure 1a). The frequencies of these bouts occurring after sleep onset did not differ among groups (25 ± 15, 21 ± 5, and 23 ± 7 for patients in the a.m. sleepier group, in the a.m. less sleepy group, and for healthy controls, respectively).


Sleep structure and sleepiness in chronic fatigue syndrome with or without coexisting fibromyalgia.

Togo F, Natelson BH, Cherniack NS, FitzGibbons J, Garcon C, Rapoport DM - Arthritis Res. Ther. (2008)

Sleep-wake patterns and survival curves for the duration of every episode of sleep. (a) Representative sleep-wake patterns from one healthy control, one patient in the a.m. less sleepy group, and one patient in the a.m. sleepier group. In contrast to the control and a.m. less sleepy patient, the a.m. sleepier patient shows clustering of her arousals, which is documented in the accompanying panel. (b) Survival curves of every episode of sleep (that is, a bout of sleep preceded and followed by periods of wakefulness) for controls and patients in the a.m. less sleepy and a.m. sleepier groups for whole-night hypnograms stratified by the duration of the sleep episode. To compare sleep continuity between groups, all data from all subjects in each group were pooled and a group survival curve was generated using standard statistical techniques [22]. Patients in the a.m. sleepier group showed a significant shift toward shorter bouts of sleep (P < 0.05) compared with the other groups. CFS, chronic fatigue syndrome.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2483445&req=5

Figure 1: Sleep-wake patterns and survival curves for the duration of every episode of sleep. (a) Representative sleep-wake patterns from one healthy control, one patient in the a.m. less sleepy group, and one patient in the a.m. sleepier group. In contrast to the control and a.m. less sleepy patient, the a.m. sleepier patient shows clustering of her arousals, which is documented in the accompanying panel. (b) Survival curves of every episode of sleep (that is, a bout of sleep preceded and followed by periods of wakefulness) for controls and patients in the a.m. less sleepy and a.m. sleepier groups for whole-night hypnograms stratified by the duration of the sleep episode. To compare sleep continuity between groups, all data from all subjects in each group were pooled and a group survival curve was generated using standard statistical techniques [22]. Patients in the a.m. sleepier group showed a significant shift toward shorter bouts of sleep (P < 0.05) compared with the other groups. CFS, chronic fatigue syndrome.
Mentions: Patients in the a.m. sleepier group showed significantly longer sleep latency, poorer sleep efficiency, and shorter duration of median sleep run than healthy controls (Table 3). The survival curve of all sleep runs depicted in Figure 1 shows that patients in the a.m. sleepier group had a lower percentage of long runs of sleep than the other two groups and healthy controls (that is, less continuous sleep). For example, the proportions of runs lasting more than 10 minutes were 39.3%, 45.5%, and 49.0% for patients in the a.m. sleepier group, the a.m. less sleepy group, and healthy controls, respectively. The difference in temporal distribution of periods of wakefulness is evident from the representative data in Figure 1. Both the control subject and the a.m. less sleepy patient have periods of wakefulness that are spaced more evenly over time than is the case for the a.m. sleepier patient, whose periods of wakefulness appear bunched in time (Figure 1a). The frequencies of these bouts occurring after sleep onset did not differ among groups (25 ± 15, 21 ± 5, and 23 ± 7 for patients in the a.m. sleepier group, in the a.m. less sleepy group, and for healthy controls, respectively).

Bottom Line: We also determined whether feelings of unrefreshing sleep were associated with differences in sleep architecture from normal.This difference in sleep effects was due primarily to a decrease in the length of periods of uninterrupted sleep in the a.m. sleepier group.CFS patients had significant differences in polysomnographic findings from healthy controls and felt sleepier and more fatigued than controls after a night's sleep.

View Article: PubMed Central - HTML - PubMed

Affiliation: Pain and Fatigue Study Center, Department of Neurosciences, University of Medicine and Dentistry of New Jersey-New Jersey Medical School, 30 Bergen Street, Newark, NJ 07103, USA. tougou@p.u-tokyo.ac.jp

ABSTRACT

Introduction: We evaluated polysomnograms of chronic fatigue syndrome (CFS) patients with and without fibromyalgia to determine whether patients in either group had elevated rates of sleep-disturbed breathing (obstructive sleep apnea or upper airway resistance syndrome) or periodic leg movement disorder. We also determined whether feelings of unrefreshing sleep were associated with differences in sleep architecture from normal.

Methods: We compared sleep structures and subjective scores on visual analog scales for sleepiness and fatigue in CFS patients with or without coexisting fibromyalgia (n = 12 and 14, respectively) with 26 healthy subjects. None had current major depressive disorder, and all were studied at the same menstrual phase.

Results: CFS patients had significant differences in polysomnograpic findings from healthy controls and felt sleepier and more fatigued than controls after a night's sleep. CFS patients as a group had less total sleep time, lower sleep efficiency, and less rapid eye movement sleep than controls. A possible explanation for the unrefreshing quality of sleep in CFS patients was revealed by stratification of patients into those who reported more or less sleepiness after a night's sleep (a.m. sleepier or a.m. less sleepy, respectively). Those in the sleepier group reported that sleep did not improve their symptoms and had poorer sleep efficiencies and shorter runs of sleep than both controls and patients in the less sleepy group; patients in the less sleepy group reported reduced fatigue and pain after sleep and had relatively normal sleep structures. This difference in sleep effects was due primarily to a decrease in the length of periods of uninterrupted sleep in the a.m. sleepier group.

Conclusion: CFS patients had significant differences in polysomnographic findings from healthy controls and felt sleepier and more fatigued than controls after a night's sleep. This difference was due neither to diagnosable sleep disorders nor to coexisting fibromyalgia but primarily to a decrease in the length of periods of uninterrupted sleep in the patients with more sleepiness in the morning than on the night before. This sleep disruption may explain the overwhelming fatigue, report of unrefreshing sleep, and pain in this subgroup of patients.

Show MeSH
Related in: MedlinePlus