Abstract
Objectives: Fatigue and unrefreshing sleep are symptoms of fibromyalgia and part of its diagnostic criteria. The literature is inconsistent regarding the prevalence of sleep disorders in fibromyalgia. The purpose of the study was to determine if obstructive sleep apnea (OSA) was more common in patients with fibromyalgia than in a general internal medicine clinic population. Methods: The records of 500 patients seen in a fibromyalgia clinic who fulfilled diagnostic criteria for fibromyalgia were compared with 500 patients seen in a general internal medicine clinic who did not have the diagnosis of fibromyalgia. The presence of a diagnosis of OSA was abstracted from each record. Patients were matched for age, sex, and body mass index. Descriptive statistics were used to characterize the sample. Pearson χ2 test and Fisher exact test were used for analysis. Results: OSA was significantly more common in patients presenting to a fibromyalgia clinic compared with the patient population lacking the fibromyalgia diagnosis. This finding was independent of body mass index in overweight and moderately obese cohorts. Conclusion: Patients with fibromyalgia should be screened for OSA because treatment of sleep disorders may help with symptoms of fatigue and unrefreshing sleep.
Highlights
Obstructive sleep apnea (OSA) is the most common of all sleeprelated breathing disorders
The estimated prevalence in North America is approximately 20% to 25% in males and 10% in females when OSA is defined as an apnea hypopnea index (AHI) greater than or equal to 5 events per hour, as determined by polysomnography (PSG) [1,2,3]
The Pearson χ2 test and Fisher exact test were used for analysis and odds ratios and 95% confidence intervals (CI) were calculated for the overall sample and each body mass index (BMI) category
Summary
Obstructive sleep apnea (OSA) is the most common of all sleeprelated breathing disorders. The estimated prevalence in North America is approximately 20% to 25% in males and 10% in females when OSA is defined as an apnea hypopnea index (AHI) greater than or equal to 5 events per hour, as determined by polysomnography (PSG) [1,2,3]. Sleep-related symptoms such as waking unrefreshed, fatigue, tiredness, and insomnia are common in patients with OSA; these are common concerns for patients with fibromyalgia, a chronic condition characterized by widespread muscle pain and various symptoms such as cognitive difficulty, anxiety, and depression. Given the frequency with which sleep issues are reported, fatigue and waking tired or unrefreshed are included in the American College of Rheumatology diagnostic criteria for fibromyalgia [5]. PSG studies have been conducted in patients with fibromyalgia to delineate the physiologic basis of sleep-related symptoms, and distinctive patterns of alpha intrusion in non–rapid eye movement (REM) sleep have been described (phasic alpha, tonic alpha, and low alpha activity) [6,7,8,9]
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