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A comparative polysomnography analysis of sleep in healthy controls and patients with CFS

Kyla

ᴀɴɴɪᴇ ɢꜱᴀᴍᴩᴇʟ
Messages
721
Location
Canada
http://www.tandfonline.com/doi/abs/10.1080/21641846.2016.1167470

A comparative polysomnography analysis of sleep in healthy controls and patients with chronic fatigue syndrome


DOI:
10.1080/21641846.2016.1167470
Zoe M. Gottsa*, Vincent Dearya, Julia L. Newtonbcd & Jason G. Ellisa

ABSTRACT
Background: Sleep disturbance affects almost 95% of people with chronic fatigue syndrome (CFS). However, existing studies of sleep in CFS have shown mixed results and methodological issues prevent between-study comparisons.

Purpose: To redress this, the present study aimed to investigate whether there are differences in the sleep of patients with CFS and healthy controls, using a comparative analysis of polysomnography over three consecutive nights.

Methods: Twenty-two patients with CFS (1994 Centers for Disease Control and Prevention criteria) and 22 healthy controls underwent three nights of polysomnographic sleep assessment. Groups were compared on their objective sleep variables derived from the third night of assessment, to allow for participant adaptation to the sleep study.

Results: 9.1% of patients met criteria for an objectively verifiable sleep disorder. Differences in sleep were observed between CFS patients and healthy controls on four objectively derived sleep variables (wake after sleep onset, sleep efficiency, percentage wake and REM Latency). In addition, people with CFS reported more severe symptoms of insomnia than healthy controls.

Conclusions: The study reports on key differences in sleep between people with CFS and healthy individuals. The potential presence of a sleep disorder in this patient population is high, it is therefore important that during early evaluation, a detailed history of sleep is taken to rule out a sleep disorder in CFS. In addition, patients with CFS show poorer sleep as defined by objectively derived measures and also self-report poorer quality sleep. Improving sleep is a potential treatment target in CFS.
 
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barbc56

Senior Member
Messages
3,657
I'm wondering if the sleep issues are a cause or effect of mecfs. I have had sleep issues my whole life.

My doctor says there are some indications that RLS may mean you are predisposed to eventually getting FM but it hasn't been proven. Plus, not everyone who has RLS ends up getting me/cfs.

Maybe it's indicative of a dysfuncting nervous system?

Are there other illnesses with similar sleep profiles?
 

barbc56

Senior Member
Messages
3,657
Prior to ME, I got excellent sleep. 9-10 hours, always felt well-rested.

Maybe I should do a poll. Not that it would be rigorous evidence but more out of curiosity.

I do have to say, since getting sick, these sleep problems became much worse.

Sometimes I think I've never awakened feeling refreshed, even as a child. That's an exaggeration of course but it's certainly been a consistent pattern in my life.
 

MeSci

ME/CFS since 1995; activity level 6?
Messages
8,231
Location
Cornwall, UK
I'm wondering if the sleep issues are a cause or effect of mecfs. I have had sleep issues my whole life.

My doctor says there are some indications that RLS may mean you are predisposed to eventually getting FM but it hasn't been proven. Plus, not everyone who has RLS ends up getting me/cfs.

Maybe it's indicative of a dysfuncting nervous system?

Are there other illnesses with similar sleep profiles?
I have had sleep problems most of my life too, but ME/CFS only (obviously at least) for the last 21, out of 61.
 

ukxmrv

Senior Member
Messages
4,413
Location
London
I slept really well before I got ME. We were always a family of night owls and when I got ME that got much worse. I wouldn't rank the sleep problems I have as a major symptom though apart from waking unrefreshed which started overnight with the acute onset viral ME.

As I have said before on other threads it is as if "something" resets in my overnight that leaves me worse in the morning than when I went to bed.

Still remember what it was like though to wake refreshed and full of energy and go outside in the sun on a beautiful morning to bring the milk bottles in.

Not experienced that for over 30 years now and I miss it.
 
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Dolphin

Senior Member
Messages
17,567
I don't believe they do any so group analyses to see whether this makes any difference.
Six CFS patients (40%) were taking sleepaltering medications at participation (selective serotonin re-uptake inhibitors, N = 6; gabapentin, N = 1). Five were taking one sleep-altering medication and one participant was on both a selective serotonin re-uptake inhibitor (SSRI) and Gabapentin.
 

Dolphin

Senior Member
Messages
17,567
I think a retrospective survey of sleep problems might have problems. Some people could have had mild ME but not have been diagnosed. I was undiagnosed for over 5 years. For the first 4 years of those I was fairly high functioning (full-time education at a high level). The biggest problem from me was I couldn't exercise and had lots of muscle problems (if I had not been so sporty before becoming ill my sedentary lifestyle might have seemed normal). I recall never feeling I got enough sleep. So the sleep issues seem to be there even with the mildly affected unlike some other symptoms.
 

Belbyr

Senior Member
Messages
602
Location
Memphis
I slept well before ME too. No issues whatsoever.

Could be that our sympathetic tone is upped with this illness. I have elevated levels of norepinephrine while lying and even higher when standing. (This was one of the POTS tests at Mayo Clinic)
 

Dolphin

Senior Member
Messages
17,567
The differences were for sleep onset latency P= .06 and number of awakenings was P= .08.

Numerically the sleep onset latency was an average of 28.95 minutes for the CFS group and 14.73 minutes for the control group i.e. nearly double for the CFS group.
 

Dolphin

Senior Member
Messages
17,567
There were significant group differences on all but one component of the Pittsburgh sleep quality index (PSQI).
This is a self-report questionnaire.

It was P equals .07 for medication use. However to take part in the study you needed to be free from any sleeping medication for at least 3 weeks prior to the recording so the sample may be biased.

One hundred per cent of patients had PSQI global scores of 5 or more, exceeding the threshold that is indicative of poor quality sleep (≥5).
 

Dolphin

Senior Member
Messages
17,567
There were no significant differences in sleep parameters between the second and third nights of assessment (data not shown) and therefore the third night data are presented.
They had been concerned that readings from their 2nd night might not give accurate results. This is because people often sleep poorly on the 1st night of testing and then there can be a rebound effect on the 2nd night where people catch up with missed sleep from the 1st night.
 

Dolphin

Senior Member
Messages
17,567
The total sleep times recorded in a diary and by objective measurements were almost exactly the same: 448.68 minutes versus 453.91 minutes.

Sleep onset latency was recorded in a diary as 33.95 minutes but was only 22.47 minutes by objective measurements. These results did not correlate statistically.

The average minutes awake after sleep onset were recorded in the diary is 41.58 minutes but were were measured objectively as 37.13 minutes. These results did not correlate statistically.
 

Dolphin

Senior Member
Messages
17,567
Despite patients’ demonstrating impairments in symptoms of fatigue and social functioning, there was no relationship between objective sleep and symptoms in patients (see eResults1 in the supplement), suggesting that further work is needed to explore the relationship between sleep abnormalities and fatigue in this patient group, and that formal sleep studies are needed.

By symptoms they mean fatigue symptoms. Possibly also pain symptoms as one of the subscales of the SF 36 looks at pain.

Results. Patients’ mean fatigue levels (24.40, SD=7.78) were higher than what is considered within the normal range for fatigue, based on the Likert-based scoring threshold (<18), with 100% (19/19) of patients having scores equalling to or greater than 18 on the questionnaire. Patients also demonstrated functional impairment as measured by the SF- 36; scores were lower than the general population norm on all QoL domains, and 84.2% (16/19) had lower than normal values (≤50) on general health perceptions (mean=29.5, SD=17.91). However, in light of associations with objective sleep, the multiple regression analyses were not significant; the objective sleep parameters did not predict daytime levels of fatigue or quality of life in patients with CFS (data not shown).
 

Dolphin

Senior Member
Messages
17,567
The Ford Insomnia Response to Stress Test (FORD) is a 9-item screening tool to identify individuals predisposed to developing insomnia, testing the likelihood that an individual will have sleep disturbances following stressful events.
They mentioned this in the list of outcome measures but then don't mention it again it seems to me from both reading it and now searching for Ford in the text
 

Dolphin

Senior Member
Messages
17,567
Although differences in sleep efficiency were observed, these were in the normal range (>85%) for both groups. CFS patients also reported significantly poorer sleep quality and more severe insomnia-related symptoms than the healthy control group.
Sleep efficiency index (%)
CFS 91.64 (7.35)
healthy controls 96.52 (2.37)