title: Relationship between sleep and pain in adolescents with juvenile primary fibromyalgia syndrome.
abstract: OBJECTIVE
  To investigate sleep quality in adolescents with juvenile primary fibromyalgia syndrome (JPFS) and determine whether sleep abnormalities, including alpha-delta sleep (ADS), correlate with pain intensity. We hypothesized that successful treatment for pain with exercise therapy would reduce ADS and improve sleep quality.
  
  
  METHODS
  Single-center preintervention and postintervention (mean = 5.7 ± 1.0 weeks; range = 4.0-7.3 weeks) observational study.
  
  
  METHODS
  Ten female adolescents (mean age = 16.2 ± 0.65 SD yr) who met criteria for JPFS and completed treatment.
  
  
  METHODS
  Multidisciplinary pain treatment, including intensive exercise therapy.
  
  
  RESULTS
  Pain and disability were measured by a pain visual analog scale (VAS) and the functional disability inventory. Subjective sleep measures included a sleep VAS, an energy VAS, and the School Sleep Habits Survey. Objective sleep measures included actigraphy, polysomnography (PSG), and the Multiple Sleep Latency Test. Baseline PSG was compared with that of healthy age- and sex-matched control patients. At baseline, patients had poorer sleep efficiency, more arousals/awakenings, and more ADS (70.3% of total slow wave sleep [SWS] versus 21.9% SWS, P = 0.002) than controls. ADS was unrelated to pain, disability, or subjective sleep difficulty. After treatment, pain decreased (P = 0.000) and subjective sleep quality improved (P = 0.008). Objective sleep quality, including the amount of ADS, did not change.
  
  
  CONCLUSIONS
  Although perceived sleep quality improved in adolescents with JPFS after treatment, objective measures did not. Our findings do not suggest exercise therapy for pain improves sleep by reducing ADS, nor do they support causal relationships between ADS and chronic pain or subjective sleep quality.
authors.affiliation: Division of Rheumatology, The Children's Hospital of Philadelphia, Philadelphia, PA 19104, USA.
authors.forename: Margaret N
authors.initials: MN
authors.lastname: Olsen
authors.forename: David D
authors.initials: DD
authors.lastname: Sherry
authors.forename: Kathleen
authors.initials: K
authors.lastname: Boyne
authors.forename: Rebecca
authors.initials: R
authors.lastname: McCue
authors.forename: Paul R
authors.initials: PR
authors.lastname: Gallagher
authors.forename: Lee J
authors.initials: LJ
authors.lastname: Brooks
mesh_terms: D056044:Actigraphy / Q000379:methods; D000293:Adolescent; D005260:Female; D005356:Fibromyalgia / Q000150:complications* / Q000503:physiopathology*; D006801:Humans; D010146:Pain / Q000150:complications* / Q000503:physiopathology*; D010147:Pain Measurement / Q000379:methods; D017286:Polysomnography / Q000379:methods; D012720:Severity of Illness Index; D012893:Sleep Wake Disorders / Q000150:complications* / Q000503:physiopathology*; D013577:Syndrome
keywords: Adolescents; alpha-delta sleep; juvenile primary fibromyalgia syndrome; pain; polysomnography; sleep
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