title: Objective measures of disordered sleep in fibromyalgia.
abstract: OBJECTIVE
  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.
  
  
  METHODS
  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.
  
  
  RESULTS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Michael S Aldrich Sleep Disorders Laboratory, Ann Arbor, MI 48109-5845, USA. chervin@umich.edu
authors.forename: Ronald D
authors.initials: RD
authors.lastname: Chervin
authors.forename: Mihaela
authors.initials: M
authors.lastname: Teodorescu
authors.forename: Ramesh
authors.initials: R
authors.lastname: Kushwaha
authors.forename: Andrea M
authors.initials: AM
authors.lastname: Deline
authors.forename: Christine B
authors.initials: CB
authors.lastname: Brucksch
authors.forename: Christine
authors.initials: C
authors.lastname: Ribbens-Grimm
authors.forename: Deborah L
authors.initials: DL
authors.lastname: Ruzicka
authors.forename: Phyllis K
authors.initials: PK
authors.lastname: Stein
authors.forename: Daniel J
authors.initials: DJ
authors.lastname: Clauw
authors.forename: Leslie J
authors.initials: LJ
authors.lastname: Crofford
mesh_terms: D000328:Adult; D001309:Auditory Threshold / Q000502:physiology; D016022:Case-Control Studies; D004569:Electroencephalography; D005221:Fatigue / Q000503:physiopathology; D005260:Female; D005356:Fibromyalgia / Q000150:complications* / Q000503:physiopathology* / Q000652:urine; D006339:Heart Rate / Q000502:physiology; D006801:Humans; D006854:Hydrocortisone / Q000652:urine; D008875:Middle Aged; D010146:Pain / Q000503:physiopathology; D010865:Pilot Projects; D017286:Polysomnography; D012893:Sleep Wake Disorders / Q000175:diagnosis* / Q000503:physiopathology* / Q000652:urine; D013564:Sympathetic Nervous System / Q000503:physiopathology
chemical_list: D006854:Hydrocortisone
references.citation: Rheum Dis Clin North Am. 1990 Aug;16(3):681-98
references.pmid: 2217965
references.citation: Am J Physiol. 1996 Oct;271(4 Pt 2):R1078-84
references.pmid: 8898003
references.citation: Am J Med. 1996 Jul;101(1):54-60
references.pmid: 8686716
references.citation: Psychosom Med. 1975 Jul-Aug;37(4):341-51
references.pmid: 169541
references.citation: Rheumatol Int. 2006 Mar;26(5):383-7
references.pmid: 15988599
references.citation: Psychosomatics. 2004 Mar-Apr;45(2):129-34
references.pmid: 15016926
references.citation: Sleep Med. 2005 Sep;6(5):451-7
references.pmid: 15994124
references.citation: Sleep. 1996 May;19(4):290-5
references.pmid: 8776786
references.citation: Semin Arthritis Rheum. 2008 Feb;37(4):260-4
references.pmid: 17570473
references.citation: Sleep Med. 2000 Jul 1;1(3):195-207
references.pmid: 10828430
references.citation: Br Heart J. 1994 Jan;71(1):1-2
references.pmid: 8297682
references.citation: Pain. 1978 Jun;5(1):19-29
references.pmid: 673439
references.citation: J Pain. 2008 May;9(5):417-22
references.pmid: 18280211
references.citation: Arthritis Rheum. 1998 Nov;41(11):1966-71
references.pmid: 9811051
references.citation: Semin Arthritis Rheum. 2000 Feb;29(4):197-9
references.pmid: 10707988
references.citation: Arthritis Rheum. 2001 Jan;44(1):222-30
references.pmid: 11212164
references.citation: Arthritis Rheum. 2004 Oct 15;51(5):700-8
references.pmid: 15478168
references.citation: Sleep. 2007 Jun;30(6):755-66
references.pmid: 17580597
references.citation: Arthritis Rheum. 2005 Nov;52(11):3660-9
references.pmid: 16258904
references.citation: Ann Rheum Dis. 1992 Jan;51(1):108-11
references.pmid: 1540013
references.citation: Neuropsychopharmacology. 2003 Jul;28 Suppl 1:S48-53
references.pmid: 12827144
references.citation: Circulation. 1996 Mar 1;93(5):1043-65
references.pmid: 8598068
references.citation: Am J Physiol. 1985 Oct;249(4 Pt 2):H867-75
references.pmid: 4051021
references.citation: J Rheumatol. 1999 Jul;26(7):1586-92
references.pmid: 10405949
references.citation: Am J Physiol. 1985 Jan;248(1 Pt 2):H151-3
references.pmid: 3970172
references.citation: Am J Cardiol. 1994 Apr 7;73(10):3C-9C
references.pmid: 8166052
references.citation: Arthritis Rheum. 1994 Nov;37(11):1583-92
references.pmid: 7980669
references.citation: Am J Med. 1999 May;106(5):534-43
references.pmid: 10335725
references.citation: Pain. 1987 Aug;30(2):191-197
references.pmid: 3670870
references.citation: Ann N Y Acad Sci. 2002 Jun;966:483-90
references.pmid: 12114308
references.citation: Arthritis Rheum. 2005 Nov;52(11):3670-4
references.pmid: 16258905
references.citation: Sleep Med. 2008 Aug;9(6):689-96
references.pmid: 18314389
references.citation: Sleep. 1986 Dec;9(4):519-24
references.pmid: 3809866
references.citation: Clin Exp Rheumatol. 2005 Sep-Oct;23(5):701-3
references.pmid: 16173251
references.citation: Clin Exp Rheumatol. 2002 Jan-Feb;20(1):69-72
references.pmid: 11892714
references.citation: Muscle Nerve. 1999 Jun;22(6):678-95
references.pmid: 10366221
references.citation: Eur Respir J. 1999 Jul;14(1):203-8
references.pmid: 10489852
references.citation: Pain. 1988 Dec;35(3):279-288
references.pmid: 3226757
references.citation: J Rheumatol. 1993 Mar;20(3):469-74
references.pmid: 8386766
references.citation: Hypertension. 1994 Jul;24(1):140-2
references.pmid: 8021002
references.citation: Arthritis Rheum. 1999 Oct;42(10):2189-93
references.pmid: 10524692
references.citation: J Rheumatol. 2003 May;30(5):1070-4
references.pmid: 12734908
references.citation: J Appl Physiol (1985). 2003 Oct;95(4):1394-404
references.pmid: 12819215
references.citation: Sleep. 1992 Apr;15(2):173-84
references.pmid: 11032543
references.citation: Am J Med. 1993 May;94(5):505-508
references.pmid: 8498395
references.citation: Chaos. 1995;5(1):82-7
references.pmid: 11538314
references.citation: Pain. 1980 Dec;9(3):363-373
references.pmid: 7208081
references.citation: J Cardiovasc Electrophysiol. 1994 Mar;5(3):274-86
references.pmid: 8193742
references.citation: Rheum Dis Clin North Am. 2002 May;28(2):353-65
references.pmid: 12122923
references.citation: Arthritis Rheum. 1995 Sep;38(9):1211-7
references.pmid: 7575714