Nicassio Perry M, Moxham Ellen G, Schuman Catherine E, Gevirtz Richard N
California School of Professional Psychology, San Diego, 10455 Pomerado Road, San Diego, CA 92131, USA Department of Psychiatry, University of California, San Diego, CA, USA Baron Center, Inc., 10299 Scripps Trail, PMB 122, San Diego, CA 92131, USA University of Vermont, and Fletcher Allen Health Care, Psychological Services, Patrick 406, 111 Colchester Avenue, Burlington, VT 15401-1473, USA.
Pain. 2002 Dec;100(3):271-279. doi: 10.1016/S0304-3959(02)00300-7.
The major objective of this research was to evaluate the predictors of fatigue in patients with fibromyalgia (FM), using cross-sectional and daily assessment methodologies. In the cross-sectional phase of the research involving a sample of 105 FM patients, greater depression and lower sleep quality were concurrently associated with higher fatigue. While pain was correlated with fatigue, it did not independently contribute to fatigue in the regression equation. For a subset of patients from the cross-sectional sample (n=63) who participated in a week of prospective daily assessment of their pain, sleep quality, and fatigue, multiple regression analysis of aggregated (averaged) daily scores revealed that previous day's pain and sleep quality predicted next day's fatigue. Depression from the cross-sectional phase was not related to aggregated daily fatigue scores. A path analytic framework was tested with disaggregated (removing between subjects variability) data in which pain was predicted to contribute to lower sleep quality which, in turn, was predicted to lead to greater fatigue. The results revealed that poor sleep quality fully accounted for the positive relationship between pain and fatigue, thus substantiating the mediational role of sleep quality. The findings are indicative of a dysfunctional, cyclical pattern of heightened pain and non-restful sleep underlying the experience of fatigue in FM.
本研究的主要目的是采用横断面和每日评估方法，评估纤维肌痛（FM）患者疲劳的预测因素。在涉及105名FM患者样本的研究横断面阶段，抑郁程度越高和睡眠质量越低与疲劳程度越高同时存在关联。虽然疼痛与疲劳相关，但在回归方程中它并非疲劳的独立影响因素。对于横断面样本中的一部分患者（n = 63），他们参与了为期一周的关于疼痛、睡眠质量和疲劳的前瞻性每日评估，对汇总（平均）每日得分进行的多元回归分析显示，前一天的疼痛和睡眠质量可预测次日的疲劳。横断面阶段的抑郁与汇总的每日疲劳得分无关。使用分解后（去除个体间差异）的数据对一个路径分析框架进行了检验，其中预计疼痛会导致睡眠质量下降，而睡眠质量下降又预计会导致更严重的疲劳。结果显示，睡眠质量差完全解释了疼痛与疲劳之间的正相关关系，从而证实了睡眠质量的中介作用。这些发现表明，FM患者疲劳体验背后存在疼痛加剧和睡眠不安的功能失调的循环模式。
