The significance of the sleeping-waking brain for the understanding of widespread musculoskeletal pain and fatigue in fibromyalgia syndrome and allied syndromes. Joint Bone Spine

Faculty of Medicine, University of Toronto, Sleep Disorders Clinic of the Centre for Sleep and Chronobiology, 340 College Street, Suite 580, Toronto, ON MST 3A9, Canada.
Joint, bone, spine: revue du rhumatisme (Impact Factor: 2.9). 08/2008; 75(4):397-402. DOI: 10.1016/j.jbspin.2008.01.021
Source: PubMed


The clinical focus of rheumatologists on the widespread pain and numerous tender points in specific anatomic regions in their patients who show no evidence for disease pathology has lead to the characterization of such peripheral symptoms as a specific disorder of the musculoskeletal system, now commonly known as fibromyalgia. This rheumatologic diagnostic entity has resulted in relative inattention to an understanding of their patients' common complaints of unrefreshing sleep, chronic fatigue and psychological distress. Experimental evidence from humans and animal studies indicate that there is an inter-relationship of disturbances in the physiology of the sleeping-waking brain with the widespread musculoskeletal pain, chronic fatigue, and psychological distress in patients with hitherto unexplained pain/fatigue illnesses, e.g., fibromyalgia and chronic fatigue syndromes. The emerging knowledge of the dysfunction of the nervous system in such patients has lead to the study of novel medications that affect neurotransmitter functions, e.g., pregabalin, serotonin/noradrenaline compounds and sodium oxybate that are shown to improve many of the symptoms of such patients.

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    • "Sleep disturbances are especially relevant as well, as they are reported to be highly debilitating [12] [13]. FMS patients consistently complain of poor sleep quality, exhibiting insomnia symptoms, and feelings of unrefreshing sleep, daytime tiredness, and sleepiness [14] [15]. However, some authors (eg, Ref. [16]) still maintain that those sleep complaints would reflect some kind of sleep misperception in FMS. "
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    ABSTRACT: Sleep complaints are one of the most frequent and relevant symptoms that characterize fibromyalgia syndrome (FMS). However, objective sleep disturbances have not been consistently described across FMS studies. It is therefore commonly accepted that FMS patients experience sleep misperception, even though no studies have investigated the contribution of polysomnographic parameters to determine subjective sleep quality in FMS. We aimed to compare sleep variables (polysomnographic parameters and subjective sleep quality) between FMS patients and healthy controls. Furthermore, we also aimed to define the predictors of subjective sleep quality in FMS. We performed in-home polysomnography to 99 women (53 FMS patients and 36 healthy controls). We also collected subjective ratings of sleep quality, daytime sleepiness, pain, depression, and anxiety. Multivariate analysis showed that groups differed in polysomnographic parameters (p = 0.015) - after accounting for age, body mass index, and antidepressant consumption. Specifically, FMS patients exhibited lower sleep efficiency, greater percentage of stage N1 and wakefulness, and more frequent awakenings than controls (p-values < 0.05). Patients also complained about poorer subjective sleep quality (p <0.001). Percentage of time awake (as obtained by polysomnography), depression levels, and antidepressant consumption predicted self-reported sleep quality in FMS patients (adjusted R(2) = 0.33, p <0.001). One night of in-home polysomnography supports the hypothesis that women with FMS show polysomnographic alterations compared to age-matched controls. In addition, the time spent awake is the best predictor of subjective sleep quality, although greater levels of depression and antidepressant consumption might result in exaggerated complaints. These findings contribute to our understanding of FMS symptoms and its management. Copyright © 2015 Elsevier B.V. All rights reserved.
    Sleep Medicine 04/2015; DOI:10.1016/j.sleep.2015.03.011 · 3.15 Impact Factor
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    • "Experimental studies involving humans have established that pain and sleep disruption occur in reciprocal, bidirectional relations. Experimentally reducing total sleep and disrupting slow-wave and rapideye-movement stages of sleep evoke musculoskeletal pain (Moldofsky, 2008), decreased pain thresholds, increased pain sensitivity (Onen et al., 2001), and lowered antinociceptive potency of morphine (Skinner et al., 2011). "
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    ABSTRACT: The authors tested the hypothesis that obstructive sleep apnea (OSA) signs/symptoms are associated with the occurrence of temporomandibular disorder (TMD), using the OPPERA prospective cohort study of adults aged 18 to 44 years at enrollment (n = 2,604) and the OPPERA case-control study of chronic TMD (n = 1,716). In both the OPPERA cohort and case-control studies, TMD was examiner determined according to established research diagnostic criteria. People were considered to have high likelihood of OSA if they reported a history of sleep apnea or ≥ 2 hallmarks of OSA: loud snoring, daytime sleepiness, witnessed apnea, and hypertension. Cox proportional hazards regression estimated hazard ratios (HRs) and 95% confidence limits (CL) for first-onset TMD. Logistic regression estimated odds ratios (OR) and 95% CL for chronic TMD. In the cohort, 248 individuals developed first-onset TMD during the median 2.8-year follow-up. High likelihood of OSA was associated with greater incidence of first-onset TMD (adjusted HR = 1.73; 95% CL, 1.14, 2.62). In the case-control study, high likelihood of OSA was associated with higher odds of chronic TMD (adjusted OR = 3.63; 95% CL, 2.03, 6.52). Both studies supported a significant association of OSA symptoms and TMD, with prospective cohort evidence finding that OSA symptoms preceded first-onset TMD.
    Journal of dental research 05/2013; 92(S7). DOI:10.1177/0022034513488140 · 4.14 Impact Factor
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    • "One of the common complaints and sufferings of people with chronic pain, including FM, is insomnia (Moldofsky, 2008; O'Brien et al., 2010). Cortical GABAergic neurons play important roles in sleep/wake regulation (Gottesmann, 2004; Kilduff et al., 2011), and disturbance of this system may lead to the pathogenesis of insomnia in these patients. "
    New Insights into Fibromyalgia, 01/2012; , ISBN: 978-953-307-407-8
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