A Report of the Autonomic Symptom Profile in Patients With Fibromyalgia

Abstract

Autonomic dysregulation is thought to contribute to the pathophysiology and symptoms in patients with fibromyalgia (FM). The majority of studies in FM that have reported autonomic dysregulation have relied on heart rate variability measurement and report increased sympathetic and decreased parasympathetic tone, chronotropic incompetence, and impaired autonomic cardiovascular regulation with blunted sympathetic reactivity to acute stress. 1Y3 These results may have clinical implications as increased sympathetic tone contributes to symptoms such as muscle tension and pain, fatigue, heightened stress response, and unrefreshing sleep, all common patient-reported symptoms in FM. 1,3Y6 The Autonomic Symptom Profile (ASP) is a validated selfreport questionnaire that comprehensively assesses autonomic symptoms across 11 subscales and yields a Composite Autonomic Symptoms Scale (COMPASS) score. 7 The ASP is unique in comparison to other commonly utilized self-report measures in that it assesses both symptoms and functional status. For example, the secretomotor subscale of the ASP assesses secretomotor symptoms such as sweating with vigorous exercise, ability to tolerate heat, and mucosal secretory dysfunction including dry eyes and dry mouth. 8 Similarly, the pupillomotor subscale of the ASP assesses pupillomotor symptoms such as light sensitivity, visual blurring, and dysfunction pupillomotor including trouble focusing eyes and difficulty seeing at night. 8 The ASP also includes a sleep subscale that evaluates presence of sleep disorders such as narcolepsy, obstructive sleep apnea, and abnormal sleeping patterns in addition to assessment of sleep quality. This is relevant as sleep and autonomic function are interdependent by virtue of their common controls, regulatory neurochemicals, and functions, but also because unrefreshing sleep is a predominant complaint in patients with FM. 9,10 There is one previous report utilizing the ASP in patients with FM. In this study, the Spanish version of the ASP was administered to 20 patients with FM, and results were compared with those of 30 patients with rheumatoid arthritis and 30 control subjects. 11 Patients with FM had the highest COMPASS scores in comparison with patients with rheumatoid arthritis and control subjects. In addition, total COMPASS scores correlated with FIQ total scores, suggesting a potential association between FM severity and autonomic dysfunction. 11 Our objective was to assess autonomic symptoms utilizing the ASP and their correlation with the Fibromyalgia Impact QuestionnaireYRevised (FIQ-R) in a large sample of patients with FM. METHODS Participants