Abstract
BackgroundUnremitting fatigue and unrefreshing sleep, hallmark traits of Chronic Fatigue Syndrome (CFS), are also pathognomonic of sleep disorders. Yet, no reproducible perturbations of sleep architecture, multiple sleep latency times or Epworth Sleepiness Scores are found to be associated consistently with CFS. This led us to hypothesize that sleep homeostasis, rather than sleep architecture, may be perturbed in CFS. To probe this hypothesis, we measured and compared EEG frequencies associated with restorative sleep between persons with CFS and matched controls, both derived from a population-based sample.MethodsWe evaluated overnight polysomnography (PSG) in 35 CFS and 40 control subjects. PSG records were manually scored and epochs containing artifact removed. Fast Fourier Transformation was utilized to deconstruct individual EEG signals into primary frequency bands of alpha, delta, theta, sigma, and beta frequency domains. The spectral power of each frequency domain for each sleep state was compared between persons with CFS and matched controls.ResultsIn persons with CFS, delta power was diminished during slow wave sleep, but elevated during both stage 1 and REM. Alpha power was reduced during stage 2, slow wave, and REM sleep. Those with CFS also had significantly lower theta, sigma, and beta spectral power during stage 2, Slow Wave Sleep, and REM.DiscussionEmploying quantitative EEG analysis we demonstrate reduced spectral power of cortical delta activity during SWS. We also establish reduced spectral power of cortical alpha activity, with the greatest reduction occurring during REM sleep. Reductions in theta, beta, and sigma spectral power were also apparent.ConclusionUnremitting fatigue and unrefreshing sleep, the waking manifestations of CFS, may be the consequence of impaired sleep homeostasis rather than a primary sleep disorder.
Highlights
Unremitting fatigue and unrefreshing sleep, hallmark traits of Chronic Fatigue Syndrome (CFS), are pathognomonic of sleep disorders
To assess the relationship between sleep disorders with symptoms of CFS, and avoid potential confounds associated with studying clinic-based patients, we recruited persons with CFS who were identified during the Centers for Disease Control and Prevention's CFS population surveillance of Wichita, Kansas [8]
Remaining participants were excluded on the basis of significant medical or psychiatric exclusionary criteria that emerged during clinical evaluation, or else symptoms were insufficient to be classified as CFS
Summary
Unremitting fatigue and unrefreshing sleep, hallmark traits of Chronic Fatigue Syndrome (CFS), are pathognomonic of sleep disorders. No reproducible perturbations of sleep architecture, multiple sleep latency times or Epworth Sleepiness Scores are found to be associated consistently with CFS. This led us to hypothesize that sleep homeostasis, rather than sleep architecture, may be perturbed in CFS. Behavioral and Brain Functions 2009, 5:43 http://www.behavioralandbrainfunctions.com/content/5/1/43 ratory abnormalities further create a diagnostic challenge [1]. Adding to this complexity, the clinical picture of CFS is similar to that observed with sleep disorders [2]. During a 2-day in-hospital research study we evaluated nocturnal sleep characteristics with polysomnography (PSG) and daytime sleepiness with multiple sleep latency testing (MSLT) and questionnaires
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