Article

Sleep quality perception in the chronic fatigue syndrome: Correlations with sleep efficiency, affective symptoms and intensity of fatigue

Sleep Laboratory, Department of Psychiatry, University Hospital Brugmann, Brussels, Belgium.
Neuropsychobiology (Impact Factor: 2.3). 02/2007; 56(1):40-6. DOI: 10.1159/000110727
Source: PubMed

ABSTRACT One of the core symptoms of the chronic fatigue syndrome (CFS) is unrefreshing sleep and a subjective sensation of poor sleep quality. Whether this perception can be expressed, in a standardized questionnaire as the Pittsburgh Sleep Quality Index (PSQI), has to our knowledge never been documented in CFS. Furthermore, correlations of subjective fatigue, PSQI, affective symptoms and objective parameters such as sleep efficiency are poorly described in the literature.
Using a cross-sectional paradigm, we studied subjective measures like PSQI, Fatigue Severity Scale scores and intensity of affective symptoms rated by the Hamilton Depression and Anxiety scales as well as objective sleep quality parameters measured by polysomnography of 28 'pure' (no primary sleep and no psychiatric disorders) CFS patients compared to age- and gender-matched healthy controls.
The PSQI showed significantly poorer subjective sleep quality in CFS patients than in healthy controls. In contrast, objective sleep quality parameters, like the Sleep Efficiency Index (SEI) or the amount of slow-wave sleep did not differ significantly. Subjective sleep quality showed a correlation trend with severity of fatigue and was not correlated with the intensity of affective symptoms in CFS.
Our findings indicate that a sleep quality misperception exists in CFS or that potential nocturnal neurophysiological disturbances involved in the nonrecovering sensation in CFS are not expressed by sleep variables such as the SEI or sleep stage distributions and proportions.

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    • "Up to 87–95% of patients with CFS have nonrestorative sleep and the associated daytime dysfunction [3]. Subjective sleep quality was significantly worse in CFS patients compared with healthy controls [4]. Psychiatric comorbidity is also common in chronic fatigue and CFS; over 80% of patients with chronic fatigue and CFS had a lifetime history of psychiatric disorders such as depression or generalized anxiety disorder [5] [6]. "
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    • "A global PSQI score above 5 has been shown to indicate severe difficulties in at least two of the above-mentioned components, or moderate difficulty in more than three areas (Buysse et al. 1989). The PSQI has previously been used in CFS and was shown to be highly significant in these patients (Neu et al. 2007). "
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    • "Although the fit indices noticed were not as good as those found by Cole et al. [5], an additional pathway significantly improved its fit [8]. Differences in sample characteristics may account for the different factor structures identified in various studies since sleep patterns, sleep quality and perception of sleep are influenced by a range of factors related to age, health and culture [9] [10] [11]. As a consequence, there is a need for further studies examining the factor structure of the PSQI. "
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