title: Effect of musculoskeletal pain on sleep architecture in patients with obstructive sleep apnea.
abstract: BACKGROUND
  Obstructive sleep apnea and chronic musculoskeletal pain both affect sleep. Sleep architecture of patients suffering from both is largely unknown.
  
  
  OBJECTIVE
  This study seeks to define the sleep architecture of patients with chronic musculoskeletal pain and obstructive sleep apnea.
  
  
  METHODS
  Patients with obstructive sleep apnea diagnosed by sleep study during the past 3 years were included. Patients with clinical documentation of chronic musculoskeletal pain constituted cases, while others were classified as controls.
  
  
  METHODS
  Demographics, clinical factors affecting sleep, medications affecting sleep, Epworth sleepiness scores, and polysomnographic parameters; total sleep time, sleep efficiency, sleep stages, rapid eye movement (REM) sleep onset, apnea-hypopnea index, arousal index, and periodic leg movements were recorded.
  
  
  RESULTS
  There were 393 subjects: 200 cases (obstructive sleep apnea and chronic musculoskeletal pain) and 193 controls (obstructive sleep apnea alone). There was significant difference in total sleep time (274.5 ± 62.5 vs. 302.2 ± 60.1 min, p = 0.0001), sleep efficiency (73.54 ± 15.8 vs. 78.76 ± 14.3%, p = 0.0003), and REM sleep onset (148.18 ± 80.5 vs. 124.8 ± 70.9 min, p = 0.006). Subgroup analysis within the obstructive sleep apnea with chronic musculoskeletal pain group revealed that subjects had better total sleep time and sleep efficiency if they were on REM sleep affecting medications (suppressants and stimulants). Those on REM sleep suppressants slept 25.7 min longer and had 6.4% more efficient sleep than those not on REM suppressants (p = 0.0034 and p = 0.0037).
  
  
  CONCLUSIONS
  Patients with obstructive sleep apnea and chronic musculoskeletal pain sleep not only significantly less but also with inferior sleep quality. Their REM sleep is also less in duration and its onset is delayed. Despite low TST and SE, these patients may not exhibit sleepiness.
authors: RFUMS, North Chicago, IL, USA, nadeem.dr@gmail.com.
authors: Rashid
authors: R
authors: Nadeem
authors: Hasnain
authors: H
authors: Bawaadam
authors: Asma
authors: A
authors: Asif
authors: Irfan
authors: I
authors: Waheed
authors: Ahmed
authors: A
authors: Ghadai
authors: Adnan
authors: A
authors: Khan
authors: Sara
authors: S
authors: Hamon
mesh_terms: D000368:Aged; D059350:Chronic Pain / Q000175:diagnosis* / Q000503:physiopathology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D059352:Musculoskeletal Pain / Q000175:diagnosis* / Q000503:physiopathology*; D010147:Pain Measurement; D017286:Polysomnography; D012189:Retrospective Studies; D020181:Sleep Apnea, Obstructive / Q000175:diagnosis* / Q000503:physiopathology*; D012893:Sleep Wake Disorders / Q000175:diagnosis / Q000503:physiopathology; D012895:Sleep, REM / Q000502:physiology; D013223:Statistics as Topic