Chervin Ronald D, Teodorescu Mihaela, Kushwaha Ramesh, Deline Andrea M, Brucksch Christine B, Ribbens-Grimm Christine, Ruzicka Deborah L, Stein Phyllis K, Clauw Daniel J, Crofford Leslie J
Michael S Aldrich Sleep Disorders Laboratory, Ann Arbor, MI 48109-5845, USA.
J Rheumatol. 2009 Sep;36(9):2009-16. doi: 10.3899/jrheum.090051. Epub 2009 Aug 14.
Patients with fibromyalgia syndrome (FM) complain of inadequate sleep, which could contribute to common symptoms including sleepiness, fatigue, or pain. However, measures that consistently and objectively distinguish FM patients remain elusive.
Fifteen women with FM and 15 age- and gender-matched controls underwent 3 nights of polysomnography; Multiple Sleep Latency Tests to assess sleepiness; testing of auditory arousal thresholds during non-REM stage 2 and stage 4 sleep; overnight assessment of urinary free cortisol; and analysis of 24-hour heart rate variability.
On the second night of polysomnography, women with FM in comparison to controls showed more stage shifts (p = 0.04) but did not differ significantly on any other standard polysomnographic measure or on the Multiple Sleep Latency Tests. Alpha EEG power during deep non-REM sleep, alone or as a proportion of alpha power during remaining sleep stages, also failed to distinguish the groups, as did auditory arousal thresholds. Urinary free cortisol did not differ between FM and control subjects in a consistent manner. However, decreased short-term heart rate variability (HRV) and especially ratio-based HRV among FM subjects suggested diminished parasympathetic and increased sympathetic activity, respectively. Other HRV measures suggested decreased complexity of HRV among the FM subjects.
Standard measures of sleep, a gold-standard measure of sleepiness, quantified alpha-delta EEG power, auditory arousal thresholds, and urinary free cortisol largely failed to distinguish FM and control subjects. However, HRV analyses showed more promise, as they suggested both increased sympathetic activity and decreased complexity of autonomic nervous system function in FM.
纤维肌痛综合征（FM）患者抱怨睡眠不足，这可能导致包括嗜睡、疲劳或疼痛在内的常见症状。然而，始终如一地客观区分FM患者的方法仍然难以捉摸。
15名患有FM的女性和15名年龄及性别匹配的对照者接受了3晚的多导睡眠图检查；多次睡眠潜伏期测试以评估嗜睡程度；在非快速眼动睡眠第2阶段和第4阶段测试听觉唤醒阈值；夜间评估尿游离皮质醇；并分析24小时心率变异性。
在多导睡眠图检查的第二晚，与对照组相比，FM女性表现出更多的睡眠阶段转换（p = 0.04），但在任何其他标准多导睡眠图测量或多次睡眠潜伏期测试中没有显著差异。深度非快速眼动睡眠期间的α脑电活动，单独或作为其余睡眠阶段α脑电活动的比例，也未能区分两组，听觉唤醒阈值也是如此。FM组和对照组的尿游离皮质醇没有一致的差异。然而，FM患者的短期心率变异性（HRV）降低，尤其是基于比率的HRV降低，分别提示副交感神经活动减弱和交感神经活动增强。其他HRV测量表明FM患者的HRV复杂性降低。
睡眠的标准测量、嗜睡的金标准测量、量化的α-δ脑电活动、听觉唤醒阈值和尿游离皮质醇在很大程度上未能区分FM患者和对照者。然而，HRV分析显示出更大的前景，因为它们提示FM患者交感神经活动增加且自主神经系统功能复杂性降低。
