title: Poor sleep quality is associated with greater circulating pro-inflammatory cytokines and severity and frequency of chronic fatigue syndrome/myalgic encephalomyelitis (CFS/ME) symptoms in women.
abstract: Poor sleep quality has been linked to inflammatory processes and worse disease outcomes in the context of many chronic illnesses, but less is known in conditions such as chronic fatigue syndrome/myalgic encephalomyelitis (CFS/ME). This study examines the relationships between sleep quality, pro-inflammatory cytokines, and CFS/ME symptoms.
  
  
  
  Sixty women diagnosed with CFS/ME were assessed using the Pittsburgh Sleep Quality Index (PSQI), Fatigue Symptom Inventory (FSI) and Center for Disease Control and Prevention (CDC)-based CFS/ME symptom questionnaires. Circulating plasma pro-inflammatory cytokine levels were measured by ELISA. Multiple regression analyses examined associations between sleep, cytokines and symptoms, controlling for age, education, and body mass index.
  
  
  
  Poor sleep quality (PSQI global score) was associated with greater pro-inflammatory cytokine levels: interleukin-1β (IL-1β) (β=0.258, p=0.043), IL-6 (β=0.281, p=0.033), and tumor necrosis factor-alpha (TNF-α) (β=0.263, p=0.044). Worse sleep quality related to greater fatigue severity (β=0.395, p=0.003) and fatigue-related interference with daily activities (β=0.464, p<0.001), and more severe and frequent CDC-defined core CFS/ME symptoms (β=0.499, p<0.001, and β=0.556, p<0.001, respectively).
  
  
  
  Results underscore the importance of managing sleep-related difficulties in this patient population. Further research is needed to identify the etiology of sleep disruptions in CFS/ME and mechanistic factors linking sleep quality to symptom severity and inflammatory processes.
authors.affiliation: Department of Psychology, University of Miami, 5665 Ponce de Leon Blvd., Miami, FL 33133, USA.
authors.forename: Sara F
authors.initials: SF
authors.lastname: Milrad
authors.affiliation: Department of Psychiatry, Massachusetts General Hospital/Harvard Medical School, 55 Fruit St., Boston, MA 02114, USA.
authors.forename: Daniel L
authors.initials: DL
authors.lastname: Hall
authors.affiliation: Department of Psychology, University of Miami, 5665 Ponce de Leon Blvd., Miami, FL 33133, USA.
authors.forename: Devika R
authors.initials: DR
authors.lastname: Jutagir
authors.affiliation: Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, 680 N Lake Shore Dr. Suite 1400, Chicago, IL 60611, USA.
authors.forename: Emily G
authors.initials: EG
authors.lastname: Lattie
authors.affiliation: Department of Psychology, University of Miami, 5665 Ponce de Leon Blvd., Miami, FL 33133, USA.
authors.forename: Gail H
authors.initials: GH
authors.lastname: Ironson
authors.affiliation: Department of Sleep Medicine, Miami Veteran Affairs Hospital, 1201 NW 16th St, Miami, FL 33125, USA.
authors.forename: William
authors.initials: W
authors.lastname: Wohlgemuth
authors.affiliation: Institute for Neuro Immune Medicine, Nova Southeastern University, 8501 SW 124th Ave #111, Miami, FL 33183, USA.
authors.forename: Maria Vera
authors.initials: MV
authors.lastname: Nunez
authors.affiliation: Department of Psychiatry and Behavioral Sciences, University of Miami, 1120 NW 14th St., Miami, FL 33136, USA.
authors.forename: Lina
authors.initials: L
authors.lastname: Garcia
authors.affiliation: Department of Psychiatry and Behavioral Sciences, University of Miami, 1120 NW 14th St., Miami, FL 33136, USA.
authors.forename: Sara J
authors.initials: SJ
authors.lastname: Czaja
authors.affiliation: Department of Psychiatry and Behavioral Sciences, University of Miami, 1120 NW 14th St., Miami, FL 33136, USA.
authors.forename: Dolores M
authors.initials: DM
authors.lastname: Perdomo
authors.affiliation: Institute for Neuro Immune Medicine, Nova Southeastern University, 8501 SW 124th Ave #111, Miami, FL 33183, USA.
authors.forename: Mary Ann
authors.initials: MA
authors.lastname: Fletcher
authors.affiliation: Institute for Neuro Immune Medicine, Nova Southeastern University, 8501 SW 124th Ave #111, Miami, FL 33183, USA.
authors.forename: Nancy
authors.initials: N
authors.lastname: Klimas
authors.affiliation: Department of Psychology, University of Miami, 5665 Ponce de Leon Blvd., Miami, FL 33133, USA. Electronic address: mantoni@miami.edu.
authors.forename: Michael H
authors.initials: MH
authors.lastname: Antoni
mesh_terms: D000328:Adult; D015415:Biomarkers / Q000097:blood; D003430:Cross-Sectional Studies; D016207:Cytokines / Q000097:blood* / Q000276:immunology; D015673:Fatigue Syndrome, Chronic / Q000097:blood* / Q000453:epidemiology / Q000276:immunology; D005260:Female; D006801:Humans; D018836:Inflammation Mediators / Q000097:blood* / Q000276:immunology; D008875:Middle Aged; D012720:Severity of Illness Index; D012893:Sleep Wake Disorders / Q000097:blood* / Q000453:epidemiology / Q000276:immunology; D011795:Surveys and Questionnaires
chemical_list: D015415:Biomarkers; D016207:Cytokines; D018836:Inflammation Mediators
keywords: Chronic fatigue syndrome/myalgic encephalomyelitis (CFS/ME); Fatigue; Inflammation; Poor sleep quality; Pro-inflammatory cytokines