Stehlik Romana, Ulfberg Jan, Zou Ding, Hedner Jan, Grote Ludger
Multidisciplinary Pain Centre, Uppsala University Hospital, S-751 85 Uppsala, Sweden, Phone: +46 767036667.
Department of Surgical Sciences, Uppsala University, Uppsala, Sweden.
Scand J Pain. 2018 Apr 25;18(2):187-194. doi: 10.1515/sjpain-2018-0026.
Chronic widespread pain (CWP) is associated with poor quality of sleep, but the detailed underlying mechanisms are still not fully understood. In this study we investigated the influence of CWP on morning cortisol and fasting glucose concentrations as well as sleep disordered breathing.
In this case-control study, subjects with CWP (n=31) and a control group without CWP (n=23) were randomly selected from a population-based cohort of women. Current pain intensity, sleep quality, excessive daytime sleepiness [Epworth sleepiness scale (ESS)], psychiatric comorbidity and occurrence of restless legs syndrome (RLS) were assessed. Overnight polygraphy was applied to quantify sleep apnoea, airflow limitation and attenuations of finger pulse wave amplitude (>50%) as a surrogate marker for increased skin sympathetic activity. Morning cortisol and fasting glucose concentrations were determined. Generalised linear models were used for multivariate analyses.
CWP was associated with higher cortisol (464±141 vs. 366±111 nmol/L, p=0.011) and fasting glucose (6.0±0.8 vs. 5.4±0.7 mmol/L, p=0.007) compared with controls. The significance remained after adjustment for age, body mass index, RLS and anxiety status (β=122±47 nmol/L and 0.89±0.28 mmol/L, p=0.009 and 0.001, respectively). The duration of flow limitation in sleep was longer (35±22 vs. 21±34 min, p=0.022), and pulse wave attenuation was more frequent (11±8 vs. 6±2 events/h, p=0.048) in CWP subjects compared with controls. RLS was associated with higher ESS independent of CWP (β=3.1±1.3, p=0.018).
Elevated morning cortisol, impaired fasting glucose concentration and increased skin sympathetic activity during sleep suggested an activated adrenal medullary system in subjects with CWP, which was not influenced by comorbid RLS.
CWP is associated with activated stress markers that may deteriorate sleep.
慢性广泛性疼痛（CWP）与睡眠质量差有关，但具体潜在机制仍未完全明确。在本研究中，我们调查了CWP对清晨皮质醇和空腹血糖浓度以及睡眠呼吸障碍的影响。
在这项病例对照研究中，从一个基于人群的女性队列中随机选取了患有CWP的受试者（n = 31）和无CWP的对照组（n = 23）。评估了当前的疼痛强度、睡眠质量、日间过度嗜睡[爱泼华嗜睡量表（ESS）]、精神共病情况以及不安腿综合征（RLS）的发生情况。采用夜间多导睡眠图来量化睡眠呼吸暂停、气流受限以及手指脉搏波幅度衰减（>50%），以此作为皮肤交感神经活动增加的替代指标。测定了清晨皮质醇和空腹血糖浓度。使用广义线性模型进行多变量分析。
与对照组相比，CWP患者的皮质醇水平更高（464±141对366±111nmol/L，p = 0.011），空腹血糖水平也更高（6.0±0.8对5.4±0.7mmol/L，p = 0.007）。在对年龄、体重指数、RLS和焦虑状态进行调整后，差异仍然显著（β分别为122±47nmol/L和0.89±0.28mmol/L，p分别为0.009和0.001）。与对照组相比，CWP患者睡眠中气流受限的持续时间更长（35±22对21±34分钟，p = 0.022），脉搏波衰减更频繁（11±8对6±2次/小时，p = 0.048）。RLS与较高的ESS相关，且独立于CWP（β = 3.1±1.3，p = 0.018）。
清晨皮质醇升高、空腹血糖浓度受损以及睡眠期间皮肤交感神经活动增加表明CWP患者的肾上腺髓质系统被激活，这不受合并RLS的影响。
CWP与可能使睡眠恶化的激活应激标志物有关。
