Unger Elizabeth R, Nisenbaum Rosane, Moldofsky Harvey, Cesta Angela, Sammut Christopher, Reyes Michele, Reeves William C
Division of Viral and Rickettsial Diseases, National Center for Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.
BMC Neurol. 2004 Apr 19;4:6. doi: 10.1186/1471-2377-4-6.
Chronic fatigue syndrome (CFS) is a disabling condition that affects approximately 800,000 adult Americans. The pathophysiology remains unknown and there are no diagnostic markers or characteristic physical signs or laboratory abnormalities. Most CFS patients complain of unrefreshing sleep and many of the postulated etiologies of CFS affect sleep. Conversely, many sleep disorders present similarly to CFS. Few studies characterizing sleep in unselected CFS subjects have been published and none have been performed in cases identified from population-based studies.
The study included 339 subjects (mean age 45.8 years, 77% female, 94.1% white) identified through telephone screen in a previously described population-based study of CFS in Wichita, Kansas. They completed questionnaires to assess fatigue and wellness and 2 self-administered sleep questionnaires. Scores for five of the six sleep factors (insomnia/hypersomnia, non-restorative sleep, excessive daytime somnolence, sleep apnea, and restlessness) in the Centre for Sleep and Chronobiology's Sleep Assessment Questionnaire (SAQ) were dichotomized based on threshold. The Epworth Sleepiness Scale score was used as a continuous variable.
81.4% of subjects had an abnormality in at least one SAQ sleep factor. Subjects with sleep factor abnormalities had significantly lower wellness scores but statistically unchanged fatigue severity scores compared to those without SAQ abnormality. CFS subjects had significantly increased risk of abnormal scores in the non-restorative (adjusted odds ratio [OR] = 28.1; 95% confidence interval [CI]= 7.4-107.0) and restlessness (OR = 16.0; 95% CI = 4.2-61.6) SAQ factors compared to non-fatigued, but not for factors of sleep apnea or excessive daytime somnolence. This is consistent with studies finding that, while fatigued, CFS subjects are not sleepy. A strong correlation (0.78) of Epworth score was found only for the excessive daytime somnolence factor.
SAQ factors describe sleep abnormalities associated with CFS and provide more information than the Epworth score. Validation of these promising results will require formal polysomnographic sleep studies.
慢性疲劳综合征（CFS）是一种致残性疾病，影响着约80万成年美国人。其病理生理学仍不清楚，且没有诊断标志物、特征性体征或实验室异常。大多数CFS患者抱怨睡眠不能解乏，而且许多CFS的假定病因会影响睡眠。相反，许多睡眠障碍的表现与CFS相似。很少有关于未选择的CFS受试者睡眠特征的研究发表，且在基于人群研究中确定的病例中尚未进行过此类研究。
该研究纳入了339名受试者（平均年龄45.8岁，77%为女性，94.1%为白人），这些受试者是在堪萨斯州威奇托市一项先前描述的基于人群的CFS研究中通过电话筛选确定的。他们完成了评估疲劳和健康状况的问卷以及两份自我管理的睡眠问卷。睡眠与生物钟学中心睡眠评估问卷（SAQ）中六个睡眠因素（失眠/嗜睡、非恢复性睡眠、白天过度嗜睡、睡眠呼吸暂停和不安）中的五个因素的得分根据阈值进行二分法划分。Epworth嗜睡量表得分用作连续变量。
81.4%的受试者至少有一个SAQ睡眠因素异常。与没有SAQ异常的受试者相比，有睡眠因素异常的受试者健康得分显著更低，但疲劳严重程度得分在统计学上没有变化。与未疲劳的受试者相比，CFS受试者在非恢复性（调整后的优势比[OR]=28.1；95%置信区间[CI]=7.4 - 107.0）和不安（OR = 16.0；95% CI = 4.2 - 61.6）SAQ因素上得分异常的风险显著增加，但在睡眠呼吸暂停或白天过度嗜睡因素上没有增加。这与研究结果一致，即虽然CFS受试者疲劳，但并不困倦。仅在白天过度嗜睡因素上发现Epworth得分有很强的相关性（0.78）。
SAQ因素描述了与CFS相关的睡眠异常，并且比Epworth得分提供了更多信息。要验证这些有前景的结果需要进行正式的多导睡眠图睡眠研究。
