Department of Psychiatry, School of Medicine, University of Maltepe, Atatürk Avenue, Çam Street, Number 3, 34843, Maltepe, Istanbul, Turkey.
Department of Psychiatry, Erenköy Psychiatric and Neurological Diseases Training and Research Hospital, University of Health Science, Istanbul, Turkey.
Sleep Breath. 2020 Dec;24(4):1591-1598. doi: 10.1007/s11325-020-02036-x. Epub 2020 Feb 25.
Sleep disturbances such as nonrestorative sleep and nighttime awakenings play a crucial role in fibromyalgia (FMS). Pain and sleep disturbances show a bidirectional relationship which affect outcomes in FMS. This study aims to compare sleep structures between patients with fibromyalgia and healthy controls.
We evaluated subjective and objective sleep structures of 33 patients with fibromyalgia and 34 healthy controls using the Pittsburgh Sleep Quality Index, Epworth Sleepiness Scale, and polysomnography. Student's T test, chi-square, discriminant analysis, the Kruskal-Wallis, and Mann-Whitney U test were used for statistical analysis.
Patients with FMS reported poorer sleep quality than controls (p = 0.003). Polysomnography data showed patients with FMS exhibited a greater number of awakenings (p = 0.01), more arousals (p = 0.00), higher arousal index (p = 0.00), greater apnea hypopnea index (p = 0.03), and less N1 sleep (p = 0.02) than healthy controls. The discriminant analysis revealed that number of arousals, arousal index, and N1 sleep were able to distinguish patients with FMS from healthy controls with 78.5% accuracy. Twelve of the 33 patients with FMS were diagnosed with obstructive sleep apnea syndrome (OSAS). When we excluded patients with OSAS, a statistically significant difference was maintained.
Our findings may explain the deterioration of subjective sleep, symptoms as unrefreshing sleep, fatigue, and pain in patients with FMS. Despite similar clinical manifestations, patients with FMS should be evaluated for OSAS due to treatment differences. The role of sleep alterations in the clinical manifestation and severity of FMS suggest that effective treatments to improve sleep quality may lead to more effective management of FMS.
睡眠障碍，如睡眠质量差和夜间觉醒，在纤维肌痛（FMS）中起着至关重要的作用。疼痛和睡眠障碍呈双向关系，影响 FMS 的结果。本研究旨在比较纤维肌痛患者和健康对照者的睡眠结构。
我们使用匹兹堡睡眠质量指数、埃普沃思嗜睡量表和多导睡眠图评估了 33 例纤维肌痛患者和 34 例健康对照者的主观和客观睡眠结构。采用 Student's T 检验、卡方检验、判别分析、Kruskal-Wallis 检验和 Mann-Whitney U 检验进行统计学分析。
FMS 患者的睡眠质量比对照组差（p=0.003）。多导睡眠图数据显示，FMS 患者觉醒次数较多（p=0.01），觉醒较多（p=0.00），觉醒指数较高（p=0.00），呼吸暂停低通气指数较高（p=0.03），N1 睡眠较少（p=0.02）。判别分析显示，觉醒次数、觉醒指数和 N1 睡眠可将 FMS 患者与健康对照组区分开来，准确率为 78.5%。33 例 FMS 患者中有 12 例被诊断为阻塞性睡眠呼吸暂停综合征（OSAS）。当我们排除 OSAS 患者时，仍保持统计学意义。
我们的研究结果可能解释了 FMS 患者主观睡眠恶化、症状如睡眠质量差、疲劳和疼痛的原因。尽管临床表现相似，但由于治疗方法不同，FMS 患者应评估是否存在 OSAS。睡眠改变在 FMS 的临床表现和严重程度中的作用表明，改善睡眠质量的有效治疗方法可能会导致 FMS 的更有效管理。
