Department of Affective Disorders, Jagiellonian University Medical College, Kopernika 21a, Krakow, 31- 501, Poland.
Department of Adult Psychiatry, Jagiellonian University Medical College, Krakow, Poland.
Rheumatol Int. 2024 Oct;44(10):1987-1995. doi: 10.1007/s00296-024-05650-0. Epub 2024 Jul 29.
Available data shows associations between chronotype, circadian rhythms, sleep quality and fibromyalgia (FM) presentation. However, no studies have explored links between the chronobiological variables and effectiveness of pharmacotherapy. We aimed to assess the chronotypes, circadian rhythms, sleep-wake cycle and sleep quality in FM and their links to treatment response to serotonin and noradrenalin reuptake inhibitors (SNRI). 60 FM patients: 30 responsive to SNRI (FM T[+]), 30 non-responsive to SNRI (FM T[-]) and 30 healthy controls participated. Subjects were assessed by physician and with questionnaire tools: Composite Scale of Morningness, Biological Rhythms Interview of Assessment in Neuropsychiatry, Sleep-Wake Pattern Assessment Questionnaire, Pittsburgh Sleep Quality Index and Fibromyalgia Impact Questionnaire. ANOVA analysis and simple logistic regressions were used to examine the relationships between chronological variables and response to SNRI. FM T[-] vs. FM T[+] presented lower morning affect (11.50[95%CI 9.96-13.04] vs. 14.00[95%CI 12.42-15.57];p=0.04), anytime wakeability (2.27[95%CI 1.4-3.13] vs. 4.03[95%CI 2.99-5.08];p=0.013) worse overall (11.40[95%CI 9.92-12.88] vs. 7.97[95%CI 6.75-9.19];p=0.002) and subjective (1.70[95%CI 1.30-2.01] vs. 1.17[95%CI 0.94-1.39];p=0.008) sleep quality, higher circadian rhythm disruptions (55.47[95%CI 52.32-58.62] vs. 44.97[95%CI 41.31-48.62];p<0.001), sleep disturbances (1.63[95%CI 1.38-1.68] vs. 1.30[95%CI 1.1-1.5];p=0.04), sleeping-medication use (1.80[95%CI 1.27-2.32] vs. 0.70[95%CI 0.28-1.12];p=0.003). Levels of morningness (AIC=82.91,OR=0.93,p=0.05), morning affect (AIC=81.901,OR=0.86,p=0.03) diurnal dysrhythmia (AIC=69.566,OR=1.14,p<0.001), anytime wakeability (AIC=80.307,OR=0.76,p=0.015), overall sleep quality (AIC=74.665, OR=1.31,p=0.002) subjective sleep quality (AIC=79.353, OR=2.832,p=0.01) and disturbances (AIC=82.669,OR=2.54,p=0.043), sleep medication use (AIC=77.017, OR=1.9,p=0.003) and daytime disfunction (AIC=82.908, OR=1.971,p=0.049) were predictors of non-response to SNRI. Chronobiological variables vary between FM T[+] and FM T[-] and are predictors of non-response to SNRI.
现有数据表明，习惯类型、昼夜节律、睡眠质量与纤维肌痛（FM）的表现之间存在关联。然而，目前还没有研究探索生物节律变量与血清素和去甲肾上腺素再摄取抑制剂（SNRI）药物治疗效果之间的联系。本研究旨在评估 FM 患者的习惯类型、昼夜节律、睡眠-觉醒周期和睡眠质量，以及它们与 SNRI 治疗反应的关系。共纳入 60 例 FM 患者：30 例对 SNRI 有反应（FM T[+]），30 例对 SNRI 无反应（FM T[-]），30 例健康对照者。通过医生评估和问卷调查工具评估受试者：综合晨型量表、神经精神生物学节律访谈评估、睡眠-觉醒模式评估问卷、匹兹堡睡眠质量指数和纤维肌痛影响问卷。采用方差分析和简单逻辑回归分析来研究时间变量与 SNRI 反应之间的关系。FM T[-]与 FM T[+]相比，早晨情绪更低（11.50[95%CI 9.96-13.04] 比 14.00[95%CI 12.42-15.57]；p=0.04），任何时候的觉醒能力更差（2.27[95%CI 1.4-3.13] 比 4.03[95%CI 2.99-5.08]；p=0.013），整体（11.40[95%CI 9.92-12.88] 比 7.97[95%CI 6.75-9.19]；p=0.002）和主观（1.70[95%CI 1.30-2.01] 比 1.17[95%CI 0.94-1.39]；p=0.008）睡眠质量更差，昼夜节律紊乱更严重（55.47[95%CI 52.32-58.62] 比 44.97[95%CI 41.31-48.62]；p<0.001），睡眠障碍更严重（1.63[95%CI 1.38-1.68] 比 1.30[95%CI 1.1-1.5]；p=0.04），使用睡眠药物更多（1.80[95%CI 1.27-2.32] 比 0.70[95%CI 0.28-1.12]；p=0.003）。晨型水平（AIC=82.91，OR=0.93，p=0.05）、早晨情绪（AIC=81.901，OR=0.86，p=0.03）、昼夜节律紊乱（AIC=69.566，OR=1.14，p<0.001）、任何时候的觉醒能力（AIC=80.307，OR=0.76，p=0.015）、整体睡眠质量（AIC=74.665，OR=1.31，p=0.002）、主观睡眠质量（AIC=79.353，OR=2.832，p=0.01）和障碍（AIC=82.669，OR=2.54，p=0.043）、睡眠药物使用（AIC=77.017，OR=1.9，p=0.003）和日间功能障碍（AIC=82.908，OR=1.971，p=0.049）是对 SNRI 无反应的预测因子。FM T[+]和 FM T[-]之间的昼夜节律变量不同，是对 SNRI 无反应的预测因子。
