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Pajediene et al: Sleep patterns among patients with chronic fatigue: a polysomnography-based study

Discussion in 'Latest ME/CFS Research' started by mango, Jul 29, 2017.

  1. mango

    mango Senior Member

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    Sleep patterns among patients with chronic fatigue: a polysomnography-based study

    Pajediene E1, Bileviciute-Ljungar I2, Friberg D3.

    Author information
    1 Department of Neurology, Kaunas Clinics, Hospital of Lithuanian University of Health Sciences, Linköping, Sweden.

    2 Department of Clinical Sciences, Karolinska Institutet and Department of Rehabilitation Medicine, Danderyd University Hospital, Stockholm, Department of Medical and Health Sciences, Faculty of Medicine and Health Sciences, Linköping University, Pain and Rehabilitation Centre, Anaesthetics, Operations and Specialty Surgery Centre, Region Östergotland, Linköping, Sweden.

    3 Department of Clinical Science, Intervention and Technology (CLINTEC), Division of Otorhinolaryngology, Karolinska University Hospital, Stockholm, Sweden.

    Clin Respir J. 2017 Jul 28. doi: 10.1111/crj.12667. [Epub ahead of print]
    Abstract


    OBJECTIVES:

    To detect treatable sleep disorders among patients complaining of chronic fatigue by using sleep questionnaires and polysomnography.

    METHODS:
    Patients were referred to hospital for investigations and rehabilitation due to a suspected diagnosis of myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS). The criteria for further referral to full-night polysomnography (PSG) were symptoms of excessive daytime sleepiness and/or tiredness in the questionnaires.

    RESULTS:
    Of a total of 381 patients, 78 (20.5%) underwent PSG: 66 women and 12 men, mean age 48.6, standard deviation ±9.9 years. On the basis of the PSG, 31 (40.3%) patients were diagnosed with obstructive sleep apnoea, 7 (8.9%) patients with periodic limb movement disorder, 32 (41.0%) patients with restless legs syndrome, and 54 (69.3%) patients had one or more other sleep disorder. All patients were grouped into those who fulfilled the diagnostic criteria for ME/CFS (n = 55, 70.5%) and those who did not (n = 23, 29.5%). The latter group had significantly higher respiratory (p = 0.01) and total arousal (p = 0.009) indexes, and a higher oxygen desaturation index (p = 0.009).

    CONCLUSIONS:
    More than half of these chronic fatigue patients, who also have excessive daytime sleepiness and/or tiredness, were diagnosed with sleep disorders such as obstructive sleep apnoea, periodic limb movement disorder and/or restless legs syndrome. Patients with such complaints should undergo polysomnography, fill in questionnaires, and be offered treatment for sleep disorders before the diagnose ME/CFS is set. This article is protected by copyright. All rights reserved.

    KEYWORDS:
    chronic fatigue syndrome; fatigue; myalgic encephalomyelitis; polysomnography; sleep; sleep apnoea

    https://www.ncbi.nlm.nih.gov/pubmed/28752613

    (Indre Ljungar is one of the most active BPS proponents in Sweden.)
     
  2. Hutan

    Hutan Senior Member

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    I don't know Indre Ljungar, no doubt they have not been helpful if they are an active BPS proponent. But I don't mind this abstract.

    So, they went on to do polysomnography on 78 out of 381 patients with suspected ME/CFS and found that 'more than half' of these 78 had one or more sleep disorders.

    It's perfectly sensible (and desirable) to test (and treat) people for other problems like sleep disorders before putting an ME/CFS label on them.

    I guess the study could have been better if the researchers had given polysomnography to all 381 patients to see if reporting 'excessive day-time sleepiness and/or tiredness' really is key when deciding whether polysomnography is useful.
     
  3. mango

    mango Senior Member

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    @Hutan Have you had a chance to take a look at the questionnaires, and how they are using/interpreting the data from them?
     
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  4. Hutan

    Hutan Senior Member

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    Nope. I'm taking the NICE approach to data review - just skim the abstract and form an opinion. ;)

    Have you? Is there a problem?
     
  5. mango

    mango Senior Member

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    :D
    I haven't had the time to read the full text yet. But yes, I would say that there are problems. This is not the first article based on those old questionnaires. They don't seem to take into account the biomedical reality of ME, and the way the data is interpreted is in my opinion problematic.

    There are many more problematic aspects with the questionnaires and the views of the people at the ME/CFS-centre that collected the data, including informed consent etc. Most of what I know is firsthand accounts from patients who attended the centre and filled out those questionnaires. I'll ask around, maybe some of them would be willing to sum up the main problems.
     
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  6. Demepivo

    Demepivo Dolores Abernathy

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    Hutan likes this.
  7. pattismith

    pattismith Senior Member

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    no hypnic jerks?
     
  8. Sad Dad

    Sad Dad

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    The study population is not what I'd expect for a typical cross section of CFS patients.

     
  9. ash0787

    ash0787 Senior Member

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    usually if I wake up too soon its because acid level in the stomach gets too high and I have to drink water, happens quite often, apart from that not a problem unless I push it too far then I could get nightmares or thought loops etc

    if I need to sleep more frequently than normal its a sign of complete exhaustion / excessive immune activation,
    it usually goes after a few days though

    When they say sleepyness in the daytime do they mean being half asleep as in conserving energy / resting ? if so thats not a negative thing in this context
     
  10. Snow Leopard

    Snow Leopard Hibernating

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    Chronic fatigue syndrome is not chronic daytime sleepiness.

    It is quite possible those complaining about sleepiness have sleep disorders!
     
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  11. Alvin2

    Alvin2 Senior Member

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    This reminds me of a book i once read, if someone who is depressed is diagnosed as hypothyroid and achieves remission from thyroid hormones they are not diagnosed as depressed (and requiring Prozac), they are diagnosed as hypothyroid and treated with thyroid pills. Chasing the rabbit down the wrong hole is a waste. If someone has sleep disorders instead of ME/CFS then they have a sleep disorder...
    They can also be comorbid since a sizeable percentage of the population does have one or more sleep disorder, sleep apnea for example is surprisingly common.
    I would be interested in comparisons with the average population for classical sleep disorder propensity but anyone with sleep issues should be checked for classical sleep issues first as i have mentioned in other threads. Finally i am becoming more convinced acetylcholine is implicated in at least some of our sleep issues (which also fits with the pyruvate dehydrogenase theory), i would be interested in seeing a study of sleep issues in ME/CFS patients before and after acetylcholine boosting treatments.
     
  12. RogerBlack

    RogerBlack Senior Member

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    These stupid single symptom papers need to be refused publication in their typical form.
    Studying a single symptom is great.
    But I've seen 'sleep disturbances' -> 'treat for sleep first', 'pain' -> 'psychotherapy for pain', 'problems focussing' -> eye exercises.

    All of which are basically ridiculous without asking the patient what disturbs them most.
    And worse than ridiculous if they go and explain the disease wholly in terms of this symptom.

    It's a complex multi-symptom disease, and people ignoring symptoms at least as disturbing to the patient as the one under study should mean they don't get published, if they are using it as a treatment rationale.
     
  13. mango

    mango Senior Member

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    Here’s a bit more to read, for those of you who would like to know about some of the underlying problems of this study, and all other studies using the same set of questionnaire data.

    I asked a well-informed friend of mine, who used to be a patient at the ME/CFS-centre that collected the data, to describe the main problems in their own words. They replied in Swedish. Below is my rough translation — any mistakes are mine, not theirs!

    Here’s what they said:
    Many warm thanks to my very helpful friend :hug: who, despite being very ill, so generously offered to share all this. We both feel that this is hugely important info that needs to be shared widely, to make people aware of at least some of the underlying problems.

    (Tagging @Hutan)
     

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