title: Rheumatic manifestations of sleep disorders.
abstract: OBJECTIVE
  We have long assumed that rheumatic pain causes sleep problems, fatigue, and functional disability. This paper reviews the accumulating evidence from human and animal experimental research studies that show a bidirectional relationship of disordered sleep to pain and fatigue.
  
  
  RESULTS
  The studies demonstrate that both disturbances of sleep and sleep restriction result in increased sensitivity to noxious stimuli and musculoskeletal pain symptoms. The notion of central nervous system hypersensitivity affecting widespread pain in patients with fibromyalgia syndrome is the result of a reduction in neurophysiologic inhibition of perception of noxious stimuli that is provoked by disordered sleep. Clinical and epidemiological studies show that sleep disturbances directly influence musculoskeletal pain, fatigue, mood, and overall well-being. Indeed, the interrelationships of the sleeping/waking brain with cytokine and cellular immune functions have important implications for the understanding of rheumatic disease pathology and management with disease-modifying antirheumatic drugs.
  
  
  CONCLUSIONS
  The determination of how disordered sleep affects musculoskeletal pain, fatigue, mood, and behavior is important in the assessment and management of patients with rheumatic illness. The high prevalence of obstructive sleep apnea and restless legs syndromes requires more research to determine whether treatments of these sleep disorders will benefit the symptoms of rheumatic diseases.
authors.affiliation: Faculty of Medicine, University of Toronto, Canada. h.moldofsky@utoronto.ca
authors.forename: Harvey
authors.initials: H
authors.lastname: Moldofsky
mesh_terms: D000818:Animals; D018501:Antirheumatic Agents / Q000627:therapeutic use; D001921:Brain / Q000276:immunology / Q000503:physiopathology; D016207:Cytokines / Q000378:metabolism; D004195:Disease Models, Animal; D006801:Humans; D007107:Immune System / Q000503:physiopathology*; D019964:Mood Disorders / Q000150:complications / Q000276:immunology / Q000503:physiopathology; D009140:Musculoskeletal Diseases / Q000175:diagnosis / Q000276:immunology / Q000503:physiopathology*; D012216:Rheumatic Diseases / Q000150:complications / Q000276:immunology / Q000503:physiopathology*; D012890:Sleep / Q000276:immunology; D012893:Sleep Wake Disorders / Q000150:complications / Q000276:immunology / Q000503:physiopathology*
chemical_list: D018501:Antirheumatic Agents; D016207:Cytokines