The costs associated with sleep symptoms among patients with fibromyalgia

Health Outcomes Practice, Kantar Health, 11 Madison Avenue, 12th Floor, New York, NY, USA.
Expert Review of Pharmacoeconomics & Outcomes Research (Impact Factor: 1.67). 02/2013; 13(1):131-9. DOI: 10.1586/erp.12.82
Source: PubMed


To assess the costs associated with sleep symptoms among patients with fibromyalgia (FM).

Patients & methods:
Patients reporting physician-diagnosed FM from the National Health and Wellness Survey were categorized into three groups based on the number of sleep symptoms reported: two or more sleep symptoms (n = 1353), one sleep symptom (n = 574) and no sleep symptoms (n = 269). Annual direct and indirect costs were compared among the groups controlling for relevant confounders.

After adjusting for demographic and health characteristics, patients with FM with one, two or more sleep symptoms had higher annual physician costs (US$12,328 and US$12,261, respectively) and higher annual emergency room visit costs (US$846 and US$729, respectively) than patients with FM without any sleep symptoms (physician visit costs: US$9845; emergency room visit costs: US$527; all p < 0.05). Similarly, both patients with one (US$18,100) and two or more sleep symptoms (US$18,428) reported higher total indirect costs compared with those without any sleep symptoms (US$14,711; p < 0.05).

Among the FM population, sleep symptoms were prevalent and associated with higher direct and indirect costs, suggesting improved management may have long-term cost savings.

10 Reads
    • "Depending on the diagnostic criteria and population studied, the prevalence of FMS ranges from 1.1% to 6.4%, being more common among perimenopausal and postmenopausal women [3] [4] [5]. FMS has a severe negative impact on the quality of life [6], and, therefore, FMS patients very frequently use health-care systems [7]. However, pharmacological therapies have limited efficacy, and the access to nonpharmacological therapies (which are often more effective than the former) is not broadly available [8]. "
    [Show abstract] [Hide abstract]
    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.
    No preview · Article · Apr 2015 · Sleep Medicine
  • [Show abstract] [Hide abstract]
    ABSTRACT: Pain is the cardinal feature in fibromyalgia syndrome (FMS) and increases risk of anxiety and depression. Patients with FMS frequently complain of sleep disturbances as well. Sleep may intermediate the association between pain and emotional symptoms, an idea which has been scarce studied. The objective of this study is to uncover the role of subjective and objective sleep characteristics as mediators of the relationship between pain and anxiety and depression in FMS. Fifty-five female patients with FMS (mean age, 47.62±7.64 y) were assessed to obtain self-reports measures of pain, sleep quality, anxiety and depression levels, as well as self-efficacy to cope with pain. An ambulatory polysomnographic recording was performed to assess sleep architecture. Subjective poor sleep quality was found in all patients. Pain correlated with subjective and objective sleep parameters, self-efficacy, anxiety, and, marginally, with depression. The mediated regression analysis suggested that the best models to explain the impact of pain on anxiety and depression included, as mediators, subjective sleep quality, objective sleep efficiency and self-efficacy (these models explained 34% of the variance), objective sleep efficiency being the mediator with the highest influence (P<0.05). These findings show a high prevalence of sleep problems in patients with FMS and suggest that they play a role in the relationship between pain and anxiety and depression. In fact, the impact of chronic pain on the later emotional variables was mediated, not only by self-efficacy, but also by subjective sleep quality and, especially, by objective sleep efficiency.
    No preview · Article · Nov 2013 · The Clinical journal of pain
  • [Show abstract] [Hide abstract]
    ABSTRACT: Although sleep complaints are often reported in patients with fibromyalgia syndrome (FMS), there is no conclusive evidence that these complaints represent symptomatic disorders of sleep physiology. Thus, the question of the role of sleep disturbances as an etiological or maintenance factor in FMS remains open. This study identifies the subjective and objective characteristics of sleep disturbances in adult women diagnosed with FMS. We carried out a systematic review of publications since 1990, the publication year of the American College of Rheumatology criteria of FMS. We selected empirical studies comparing sleep characteristics of adult women with FMS and healthy women or women with rheumatic diseases. We identified 42 articles. Patients with FMS were more likely to exhibit sleep complaints and also a less efficient, lighter and fragmented sleep. The evidence of a FMS signature on objective measures of sleep is inconsistent, however, as the majority of studies lack statistical power. Current evidence cannot confirm the role played by sleep physiology in the pathogenesis or maintenance of FMS symptoms; nonetheless, it is clear that sleep disturbances are present in this syndrome.
    No preview · Article · Apr 2015 · Sleep Medicine Reviews