Prados Germán, Miró Elena, Martínez M Pilar, Sánchez Ana I, Pichot Vincent, Medina-Casado Marta, Chouchou Florian
Department of Nursing, Faculty of Health Sciences, University of Granada, 18016 Granada, Spain.
Instituto de Investigación Biosanitaria ibs.GRANADA, 18012 Granada, Spain.
Brain Sci. 2022 Jul 20;12(7):947. doi: 10.3390/brainsci12070947.
Objective: fibromyalgia is a complex chronic pain syndrome characterized by widespread musculoskeletal pain, insomnia and autonomic alterations. Cognitive-behavioral therapy (CBT) is regarded as a promising treatment in fibromyalgia, but its impact on autonomic function remains uncertain. In this research, we studied the effect of CBT on autonomic functions in fibromyalgia. Methods: Twenty-five participants underwent overnight polysomnographic recordings before and after CBT programs focused on pain (CBT-P) or a hybrid modality focused on pain and insomnia (CBT-C). Sleep quality, daily pain, depression and anxiety were assessed by self-reported questionnaires. We analyzed heart rate variability (HRV) using high-frequency power (HF) as a marker for parasympathetic activity, and low-frequency power (LF) and the LF/HF ratio as relative sympathetic markers during wakefulness and at each sleep stage. Results: After treatment, 14 patients (/25, 58.0%) reported improvement in their sleep: 6 in the CBT-P condition (/12, 50%), and 8 in the CBT-C condition (/13, 61.5%). We found that, regardless of the type of CBT, patients who reported improvement in sleep quality (n = 14, 58%) had an increase in HF during stages N2 (p < 0.05) and N3 (p < 0.05). These changes were related to improvement in sleep quality (N2, r = −0.43, p = 0.033) but not to pain, depression or anxiety. Conclusions: This study showed an improvement in parasympathetic cardiac control during non-rapid-eye-movement sleep following CBT in fibromyalgia participants who reported better sleep after this therapy. CBT may have a cardio-protective effect and HRV could be used as a sleep monitoring tool in fibromyalgia.
纤维肌痛是一种复杂的慢性疼痛综合征，其特征为广泛的肌肉骨骼疼痛、失眠和自主神经功能改变。认知行为疗法（CBT）被认为是治疗纤维肌痛的一种有前景的方法，但其对自主神经功能的影响仍不确定。在本研究中，我们探讨了CBT对纤维肌痛患者自主神经功能的影响。方法：25名参与者在接受专注于疼痛的CBT项目（CBT-P）或专注于疼痛和失眠的混合模式（CBT-C）前后进行了夜间多导睡眠图记录。通过自我报告问卷评估睡眠质量、每日疼痛程度、抑郁和焦虑情况。我们分析了心率变异性（HRV），使用高频功率（HF）作为副交感神经活动的标志物，低频功率（LF）和LF/HF比值作为清醒和每个睡眠阶段相对交感神经的标志物。结果：治疗后，14名患者（/25，58.0%）报告睡眠改善：CBT-P组6名（/12，50%），CBT-C组8名（/13，61.5%）。我们发现，无论CBT的类型如何，报告睡眠质量改善的患者（n = 14，58%）在N2期（p < 0.05）和N3期（p < 0.05）的HF增加。这些变化与睡眠质量的改善有关（N2期，r = -0.43，p = 0.033），但与疼痛、抑郁或焦虑无关。结论：本研究表明，在接受CBT治疗后睡眠改善的纤维肌痛参与者中，非快速眼动睡眠期间副交感神经对心脏的控制有所改善。CBT可能具有心脏保护作用，HRV可作为纤维肌痛患者的睡眠监测工具。
