Abnormalities of sleep in patients with the chronic fatigue syndrome.

OBJECTIVE--To determine whether patients with the chronic fatigue syndrome have abnormalities of sleep which may contribute to daytime fatigue. DESIGN--A case-control study of the sleep of patients with the chronic fatigue syndrome and that of healthy volunteers. SETTING--An infectious disease outpatient clinic and subjects'' homes. SUBJECTS--12 patients who met research criteria for the chronic fatigue syndrome but not for major depressive disorder and 12 healthy controls matched for age, sex, and weight. MAIN OUTCOME MEASURES--Subjective reports of sleep from patients'' diaries and measurement of sleep patterns by polysomnography. Subjects'' anxiety, depression, and functional impairment were assessed by interview. RESULTS--Patients with the chronic fatigue syndrome spent more time in bed than controls (544 min v 465 min, p < 0.001) but slept less efficiently (90% v 96%, p < 0.05) and spent more time awake after initially going to sleep (31.9 min v 16.6 min, p < 0.05). Seven patients with the chronic fatigue syndrome had a sleep disorder (four had difficulty maintaining sleep, one had difficulty getting to sleep, one had difficulty in both initiating and maintaining sleep, and one had hypersomnia) compared with none of the controls (p = 0.003). Those with sleep disorders showed greater functional impairment than the remaining five patients (score on general health survey 50.4% v 70.4%, p < 0.05), but their psychiatric scores were not significantly different. CONCLUSIONS--Most patients with the chronic fatigue syndrome had sleep disorders, which are likely to contribute to daytime fatigue. Sleep disorders may be important in the aetiology of the syndrome.     

Musculoskeletal Pain as a Marker of Health Quality. Findings from the Epidemiological Sleep Study among the Adult Population of S?o Paulo City

BackgroundWe are witnessing the growth of urban populations, particularly in the developing world. São Paulo, the largest city in South America, continues to grow, and this growth is dramatically effecting the environment and human health. The aim of this study was to estimate the point prevalence of chronic pain in São Paulo city dwellers and to explore the influence of aspects related to urbanicity.MethodsA two-stage cluster randomized sample included 1100 individuals of the city of Sao Paulo, representing the population proportionally in terms of gender, age and social classes in 2007. For this observational cross-sectional study, the household sample was interviewed using validated questionnaires for sociodemographic aspects, the Beck inventories for anxiety and depression, the WHOQoL-REF for quality of life, the Chalder Fatigue Scale. Musculoskeletal pain was defined as diffuse pain or pain located in the back, joints or limbs. Data regarding sleep complaints and polysomnography were obtained from the Epidemiologic Sleep Study conducted in São Paulo city in 2007.ResultsThe prevalence estimate of chronic musculoskeletal pain was approximately 27%, with a female/male ratio of approximately 2.6/1. The predictors were being in the age-range of 30–39 years, low socioeconomic and schooling levels, obesity, sedentarism, fatigue, non-restorative sleep, daytime sleepiness, poor sleep quality, poor life quality, anxiety and depression symptoms. Psychological wellbeing was the main discriminator between responders with chronic musculoskeletal pain and the controls, followed by depression for the participants with poor psychological wellbeing, and fatigue, for the remaining ones. Insomnia syndrome was the third-level discriminator for those with fatigue, whereas sleep quality for those without fatigue.ConclusionsMusculoskeletal pain was frequently reported by São Paulo city dwellers and its correlates with psychological and sleep aspects are suggestive of a response to urbanicity.

Trial Registration

ClinicalTrials.gov NCT00596713     

The Association between Daytime Napping and Cognitive Functioning in Chronic Fatigue Syndrome

Objectives

The precise relationship between sleep and physical and mental functioning in chronic fatigue syndrome (CFS) has not been examined directly, nor has the impact of daytime napping. This study aimed to examine self-reported sleep in patients with CFS and explore whether sleep quality and daytime napping, specific patient characteristics (gender, illness length) and levels of anxiety and depression, predicted daytime fatigue severity, levels of daytime sleepiness and cognitive functioning, all key dimensions of the illness experience.

Methods

118 adults meeting the 1994 CDC case criteria for CFS completed a standardised sleep diary over 14 days. Momentary functional assessments of fatigue, sleepiness, cognition and mood were completed by patients as part of usual care. Levels of daytime functioning and disability were quantified using symptom assessment tools, measuring fatigue (Chalder Fatigue Scale), sleepiness (Epworth Sleepiness Scale), cognitive functioning (Trail Making Test, Cognitive Failures Questionnaire), and mood (Hospital Anxiety and Depression Scale).

Results

Hierarchical Regressions demonstrated that a shorter time since diagnosis, higher depression and longer wake time after sleep onset predicted 23.4% of the variance in fatigue severity (p <.001). Being male, higher depression and more afternoon naps predicted 25.6% of the variance in objective cognitive dysfunction (p <.001). Higher anxiety and depression and morning napping predicted 32.2% of the variance in subjective cognitive dysfunction (p <.001). When patients were classified into groups of mild and moderate sleepiness, those with longer daytime naps, those who mainly napped in the afternoon, and those with higher levels of anxiety, were more likely to be in the moderately sleepy group.

Conclusions

Napping, particularly in the afternoon is associated with poorer cognitive functioning and more daytime sleepiness in CFS. These findings have clinical implications for symptom management strategies.     

The Amount of Diurnal Sleep,and Complaints of Fatigue and Poor Sleep,in Night-Working Women: The Effects of Having Children

This study deals with female industrial night workers. There is little scientific literature on this topic since, until recently, such shift systems have in most countries been restricted to men. The amount of diurnal sleep, as well as complaints about fatigue and poor sleep, were compared in women who were (n = 17) or were not (n = 26) caring for children. The women were engaged at an assembly line, working nights (22:00-06:00) from Monday to Friday. They filled out sleep logs for 10 consecutive weeks and were interviewed about complaints concerned with fatigue and poor sleep. A comparison of the diurnal sleeps taken between consecutive night shifts showed that the average total length of daily sleep, as well as the time of onset of the first sleep, did not differ between the groups; however, workers who had children tended to show, in comparison with their childless colleagues, more sleep episodes per day and a shorter first sleep. The total number of complaints about poor sleep and fatigue did not differ between the groups; nevertheless, workers with children complained more of difficulty in falling asleep, had a greater dissatisfaction with the amount of sleep on weekdays, and tended to show an increasing fatigue as the week progressed. We conclude that there are social pressures in women who care for children that are in addition to those that are a general consequence of night work. These results reinforce a need for the implementation of measures that organise child care, so helping a mother who wishes to work also outside the home.     

The Amount of Diurnal Sleep, and Complaints of Fatigue and Poor Sleep, in Night-Working Women: The Effects of Having Children

This study deals with female industrial night workers. There is little scientific literature on this topic since, until recently, such shift systems have in most countries been restricted to men. The amount of diurnal sleep, as well as complaints about fatigue and poor sleep, were compared in women who were (n = 17) or were not (n = 26) caring for children. The women were engaged at an assembly line, working nights (22:00-06:00) from Monday to Friday. They filled out sleep logs for 10 consecutive weeks and were interviewed about complaints concerned with fatigue and poor sleep. A comparison of the diurnal sleeps taken between consecutive night shifts showed that the average total length of daily sleep, as well as the time of onset of the first sleep, did not differ between the groups; however, workers who had children tended to show, in comparison with their childless colleagues, more sleep episodes per day and a shorter first sleep. The total number of complaints about poor sleep and fatigue did not differ between the groups; nevertheless, workers with children complained more of difficulty in falling asleep, had a greater dissatisfaction with the amount of sleep on weekdays, and tended to show an increasing fatigue as the week progressed. We conclude that there are social pressures in women who care for children that are in addition to those that are a general consequence of night work. These results reinforce a need for the implementation of measures that organise child care, so helping a mother who wishes to work also outside the home.     

Fatigue in Type 2 Diabetes: Impact on Quality of Life and Predictors

Fatigue is a persistent symptom, impacting quality of life (QoL) and functional status in people with type 2 diabetes, yet the symptom of fatigue has not been fully explored. The purpose of this study was to explore the relationship between fatigue, QoL functional status and to investigate the predictors of fatigue. These possible predictors included body mass index (BMI), Hemoglobin A1C (HbA1C), sleep quality, pain, number of complications from diabetes, years since diagnosis and depression. Forty-eight individuals with type 2 diabetes (22 females, 26 males; 59.66±7.24 years of age; 10.45 ±7.38 years since diagnosis) participated in the study. Fatigue was assessed by using Multidimensional Fatigue Inventory (MFI-20). Other outcomes included: QoL (Audit of Diabetes Dependent QoL), and functional status (6 minute walk test), BMI, HbA1c, sleep (Pittsburg sleep quality index, PSQI), pain (Visual Analog Scale), number of complications, years since diagnosis, and depression (Beck’s depression Inventory-2). The Pearson correlation analysis followed by multivariable linear regression model was used. Fatigue was negatively related to quality of life and functional status. Multivariable linear regression analysis revealed sleep, pain and BMI as the independent predictors of fatigue signaling the presence of physiological (sleep, pain, BMI) phenomenon that could undermine health outcomes.     

Effectiveness of enhanced cognitive behavior therapy for bulimia nervosa in Japan: a randomized controlled trial protocol

Although fatigue is a common and distressing symptom in cancer survivors, the mechanism of fatigue is not fully understood. Therefore, this study aims to investigate the relation between the fatigue and mindfulness of breast cancer survivors using anxiety, depression, pain, loneliness, and sleep disturbance as mediators. Path analysis was performed to examine direct and indirect associations between mindfulness and fatigue. Participants were breast cancer survivors who visited a breast surgery department at a university hospital in Japan for hormonal therapy or regular check-ups after treatment. The questionnaire measured cancer-related-fatigue, mindfulness, anxiety, depression, pain, loneliness, and sleep disturbance. Demographic and clinical characteristics were collected from medical records. Two-hundred and seventy-nine breast cancer survivors were registered, of which 259 answered the questionnaire. Ten respondents with incomplete questionnaire data were excluded, resulting in 249 participants for the analyses. Our final model fit the data well (goodness of fit index = .993; adjusted goodness of fit index = .966; comparative fit index = .999; root mean square error of approximation = .016). Mindfulness, anxiety, depression, pain, loneliness, and sleep disturbance were related to fatigue, and mindfulness had the most influence on fatigue (β = − .52). Mindfulness affected fatigue not only directly but also indirectly through anxiety, depression, pain, loneliness, and sleep disturbance. The study model helps to explain the process by which mindfulness affects fatigue. Our results suggest that mindfulness has both direct and indirect effects on the fatigue of breast cancer survivors and that mindfulness can be used to more effectively reduce their fatigue. It also suggests that health care professionals should be aware of factors such as anxiety, depression, pain, loneliness, and sleep disturbance in their care for fatigue of breast cancer survivors. This study was registered in the University Hospital Medical Information Network Clinical Trials Registry (UMIN number. 000027720) on June 12, 2017.     

Association between pro- and anti-inflammatory cytokine genes and a symptom cluster of pain, fatigue, sleep disturbance, and depression

Because multiple symptoms associated with "sickness behavior" have a negative impact on functional status and quality of life, increased information on the mechanisms that underlie inter-individual variability in this symptom experience is needed. The purposes of this study were to determine: if distinct classes of individuals could be identified based on their experience with pain, fatigue, sleep disturbance, and depression; if these classes differed on demographic and clinical characteristics; and if variations in pro- and anti- inflammatory cytokine genes were associated with latent class membership. Self-report measures of pain, fatigue, sleep disturbance, and depression were completed by 168 oncology outpatients and 85 family caregivers (FCs). Using latent class profile analysis (LCPA), three relatively distinct classes were identified: those who reported low depression and low pain (83%), those who reported high depression and low pain (4.7%), and those who reported high levels of all four symptoms (12.3%). The minor allele of IL4 rs2243248 was associated with membership in the "All high" class along with younger age, being White, being a patient (versus a FC), having a lower functional status score, and having a higher number of comorbid conditions. Findings suggest that LPCA can be used to differentiate distinct phenotypes based on a symptom cluster associated with sickness behavior. Identification of distinct phenotypes provides new evidence for the role of IL4 in the modulation of a sickness behavior symptom cluster in oncology patients and their FCs.     

Poor Sleep in Patients with Multiple Sclerosis

Background

Poor sleep is a frequent symptom in patients with multiple sclerosis (MS). Sleep may be influenced by MS-related symptoms and adverse effects from immunotherapy and symptomatic medications. We aimed to study the prevalence of poor sleep and the influence of socio-demographic and clinical factors on sleep quality in MS- patients.

Methods

A total of 90 MS patients and 108 sex-and age- matched controls were included in a questionnaire survey. Sleep complaints were evaluated by Pittsburgh Sleep Quality Index (PSQI) and a global PSQI score was used to separate good sleepers (≤5) from poor sleepers (>5). Excessive daytime sleepiness, the use of immunotherapy and antidepressant drugs, symptoms of pain, depression, fatigue and MS-specific health related quality of life were registered. Results were compared between patients and controls and between good and poor sleepers among MS patients.

Results

MS patients reported a higher mean global PSQI score than controls (8.6 vs. 6.3, p = 0.001), and 67.1% of the MS patients compared to 43.9% of the controls (p = 0.002) were poor sleepers. Pain (p = 0.02), fatigue (p = 0.001), depression (p = 0.01) and female gender (p = 0.04) were associated with sleep disturbance. Multivariate analyses showed that female gender (p = 0.02), use of immunotherapy (p = 005) and a high psychological burden of MS (p = 0.001) were associated with poor sleep among MS patients.

Conclusions

Poor sleep is common in patients with MS. Early identification and treatment of modifiable risk factors may improve sleep and quality of life in MS.     

Knee Pain and Low Back Pain Additively Disturb Sleep in the General Population: A Cross-Sectional Analysis of the Nagahama Study

Introduction

Association of knee and low back pain with sleep disturbance is poorly understood. We aimed to clarify the independent and combined effects of these orthopedic symptoms on sleep in a large-scale general population.

Methods

Cross-sectional data about sleep and knee/low back pain were collected for 9,611 community residents (53±14 years old) by a structured questionnaire. Sleep duration less than 6 h/d was defined as short sleep. Sleep quality and the presence of knee and low back pain were evaluated by dichotomous questions. Subjects who complained about knee or low back pains were graded by tertiles of a numerical response scale (NRS) score and a Roland-Morris disability questionnaire (RDQ) score respectively. Multivariate regression analyses were performed to determine the correlates of short sleep duration and poor sleep quality.

Results

Frequency of participants who complained of the orthopedic symptoms was as follows; knee pain, 29.0%; low back pain, 42.0% and both knee and low back pain 17.6%. Both knee and low back pain were significantly and independently associated with short sleep duration (knee pain: odds ratio (OR) = 1.19, p<0.01; low back pain: OR = 1.13, p = 0.01) and poor sleep quality (knee pain: OR = 1.22, p<0.01; low back pain; OR = 1.57, p<0.01). The group in the highest tertile of the NRS or RDQ score had the highest risk for short sleep duration and poor sleep quality except for the relationship between the highest tertile of the RDQ score and short sleep duration.(the highest tertile of the NRS: OR for short sleep duration = 1.31, p<0.01; OR for poor sleep quality = 1.47, p<0.01; the highest tertile of the RDQ: OR for short sleep duration = 1.11, p = 0.12; OR for poor sleep quality = 1.81, p<0.01) Further, coincident knee and low back pain raised the odds ratios for short sleep duration (either of knee or low back pain: OR = 1.10, p = 0.06; both knee and low back pain: OR = 1.40, p<0.01) and poor sleep quality (either of knee or low back pain: OR = 1.61, p<0.01; both knee and low back pain: OR = 2.17, p<0.01).

Conclusion

Knee and low back pains were independently associated with short sleep duration and poor sleep quality. Further, they additively increased the correlation with these sleep problems in the general population.     

THE VALIDITY OF THE FATIGUE AND RISK INDEX FOR PREDICTING IMPAIRMENTS OF HEALTH AND SAFETY UNDER DIFFERENT SHIFT SCHEDULES IN THE CONTEXT OF RISK ASSESSMENTS

In Germany, risk assessment of the working time arrangement is legally required, and within this context the authors assessed the usefulness of the fatigue and risk index (FRI) to predict any detrimental effects to health and safety. This assessment was made using data from two different surveys. Each contained records of working hours over a 4-wk period plus information on occupational accidents and health complaints. The independent variables drawn from the FRI parameters included the maxima, means, variances, and index factor scores. Phi-correlations between the FRI (dichotomized to the index of the reference system) and the incidence of an occupational accident were rather moderate, with a maximum correlation of .22 using the mean fatigue index (FI). Correlations between the two index factor scores and health complaints (sleep problems, stomach pain, eructation/heartburn) revealed the FI component, but not the risk index (RI) component, was related to those health complaints. Forward stepwise logistic regression analysis indicated the FI (but not the RI) predicted occupational accidents (FI_factor odds ratio [OR]?=?1.90, confidence interval [CI] 1.23–2.93). When using multiple regression analyses, the FI was able to predict sleep problems and other circadian related-problems, but the regression coefficients were moderate. In general, the results were not considered sufficient to justify a mandatory use of the FRI. (Author correspondence: jana.greubel@gawo-ev.de)     

Sleep/Wake Cycle Parameters and Sleep/Fatigue Complaints in Female Night Workers

Adaptation to shift-work is influenced by the way workers schedule their lives, including allocation of sleep episodes. Female workers (n = 29) engaged at an assembly line were studied as to individual differences in sleep parameters in order to verify whether those differences could be related to the manifestation of sleep and fatigue complaints. The sample was composed of women (20–40 y) working at night from Monday to Friday. Sleep data were based on daily sleep logs which were filled out by the workers for 10 consecutive weeks. In the analyses of sleep data both diurnal episodes between consecutive night shifts and noctural sleep episodes preceding working nights were taken into account. Worker's complaints were analyzed through questions extracted from an interview form encompassing questions on fatigue associated with the work schedule and on dissatisfaction with sleep on weekdays and weekends. The analysis of diurnal episodes showed no significant correlation between the total amount of sleep per day and the total number of complaints. Nevertheless, the latter was correlated to the length of the first sleep episode on a day, which usually began in the morning. As to sleep onset times, significant correlations were not detected concerning the first diurnal episodes. The analysis of nocturnal episodes did not reveal any significant correlation between sleep parameters and complaints. Results indicate that workers whose sleep onsets were allocated to the morning and were able to sleep for many consecutive hours, tended to show less complaints, suggesting that the temporal allocation of diurnal sleep and its length are relevant in the determination of how these workers perceive fatigue and sleep quality.     

Sleep Complaints and Polysomnographic Findings: A Study of Nuclear Power Plant Shift Workers

The literature widely recognizes that shift workers have more health complaints than the general population. The objective of this study was to describe the prevalence of sleep complaints and verify the polysomnographic (PSG) variables of shift workers in two Brazilian nuclear power plants. We carried out a subjective evaluation with a sleep questionnaire. Based on these results, the interviewees that reported sleep‐related complaints were referred for polysomnographic evaluation. Of the 327 volunteers initially evaluated by the sleep questionnaire, 113 (35%) reported sleep complaints; they were significantly older, had higher body mass index (BMI), and worked more years on shifts than those without sleep complaints. Of these 113, 90 met criteria for various sleep disorders: 30 (9%) showed obstructive sleep apnea (OSA), 18 (5.5%) showed limb movement, and 42 (13%) evidenced both sleep problems and had a significantly higher proportion of sleep stage 1 and arousals compared with the 23 shift workers that had no indices of sleep problems. The present study found that 90 (27.5%) of the evaluated participants met the PSG criteria of some type of clinical sleep disorder. This high proportion should be investigated for associations with other aspects of work, such as working hours, working schedule, years performing shift work, and access to health services. Due to the strong association between sleep disorders and the incidence of fatigue and sleepiness, the evaluation of the sleep patterns and complaints of shift workers is essential and should be considered to be one of the basic strategies of industry to prevent accidents.     

Sleep complaints and polysomnographic findings: a study of nuclear power plant shift workers

The literature widely recognizes that shift workers have more health complaints than the general population. The objective of this study was to describe the prevalence of sleep complaints and verify the polysomnographic (PSG) variables of shift workers in two Brazilian nuclear power plants. We carried out a subjective evaluation with a sleep questionnaire. Based on these results, the interviewees that reported sleep-related complaints were referred for polysomnographic evaluation. Of the 327 volunteers initially evaluated by the sleep questionnaire, 113 (35%) reported sleep complaints; they were significantly older, had higher body mass index (BMI), and worked more years on shifts than those without sleep complaints. Of these 113, 90 met criteria for various sleep disorders: 30 (9%) showed obstructive sleep apnea (OSA), 18 (5.5%) showed limb movement, and 42 (13%) evidenced both sleep problems and had a significantly higher proportion of sleep stage 1 and arousals compared with the 23 shift workers that had no indices of sleep problems. The present study found that 90 (27.5%) of the evaluated participants met the PSG criteria of some type of clinical sleep disorder. This high proportion should be investigated for associations with other aspects of work, such as working hours, working schedule, years performing shift work, and access to health services. Due to the strong association between sleep disorders and the incidence of fatigue and sleepiness, the evaluation of the sleep patterns and complaints of shift workers is essential and should be considered to be one of the basic strategies of industry to prevent accidents.     

Factors Influencing Sleep Disturbances among Spouse Caregivers of Cancer Patients in Northeast China

Background

In China, spouse caregivers of cancer patients (SCCPs) are involved in all aspects of patient care and experience psychological distress which could result in sleep disturbance and fatigue. However, few studies have explored the differences between SCCPs and the general population, or what factors affect SCCPs'' sleep. This study aims to (1) Compare the differences in sleep disturbances and fatigue severity between SCCPs and the age- and gender-matched general population, and (2) Identify selected personal characteristics, including coping style that affect sleep disturbances in SCCPs.

Methodology/Principal Findings

The Stress and Coping Model was used to guide this study. Participants were recruited from the northeast part of China and included 600 people from the general population and 300 SCCPs. Participants completed a socio-demographic form, Fatigue Scale-14, trait Coping Style Questionnaire, and Symptom Checklist-90.

Results

The majority of the participants were middle age, most of whom (78.7%) spent more than 8 hours each day taking care of their spouses. Compared to the general population, the SCCPs experienced significant sleep disturbances with a mean of 7.30 (SD = 1.27), and fatigue severity with a mean of 8.11 (SD = 3.25). Among the selected SCCPs'' personal characteristics, current poor health status (β = 0.14, P<0.001), having a spouse under mixed treatment (β = 0.13, p<0.001), and financial burden (β = 0.14, P<0.001) are the significant predictors for sleep disturbances. Positive coping is the predictor for fewer sleep disturbances (β = 0.27, P<0.001). Those who reported sleep disturbances also experienced higher physical and mental fatigue severity (P<0.001).

Conclusion

Intervention to improve coping style in SCCPs is needed. Further research is also needed to explore the other mediators and moderators that regulate sleep disturbance and health outcomes in the SCCPs.     

Sleep/Wake Cycle Parameters and Sleep/Fatigue Complaints in Female Night Workers

Adaptation to shift-work is influenced by the way workers schedule their lives, including allocation of sleep episodes. Female workers ( n = 29) engaged at an assembly line were studied as to individual differences in sleep parameters in order to verify whether those differences could be related to the manifestation of sleep and fatigue complaints. The sample was composed of women (20-40 y) working at night from Monday to Friday. Sleep data were based on daily sleep logs which were filled out by the workers for 10 consecutive weeks. In the analyses of sleep data both diurnal episodes between consecutive night shifts and noctural sleep episodes preceding working nights were taken into account. Worker's complaints were analyzed through questions extracted from an interview form encompassing questions on fatigue associated with the work schedule and on dissatisfaction with sleep on weekdays and weekends. The analysis of diurnal episodes showed no significant correlation between the total amount of sleep per day and the total number of complaints. Nevertheless, the latter was correlated to the length of the first sleep episode on a day, which usually began in the morning. As to sleep onset times, significant correlations were not detected concerning the first diurnal episodes. The analysis of nocturnal episodes did not reveal any significant correlation between sleep parameters and complaints. Results indicate that workers whose sleep onsets were allocated to the morning and were able to sleep for many consecutive hours, tended to show less complaints, suggesting that the temporal allocation of diurnal sleep and its length are relevant in the determination of how these workers perceive fatigue and sleep quality.     

Sleep disturbances are associated with increased pain,disease activity,depression, and anxiety in ankylosing spondylitis: a case-control study

Introduction

Literature data suggest that sleep disturbances are prevalent among patients with ankylosing spondylitis (AS) and have a close correlation with pain. Other studies indicate that sleep disturbances are constantly accompanied by depression and anxiety in AS, but their interrelations are poorly understood. This study was designed to evaluate sleep disturbances and their association with demographic variables, pain, disease-specific variables, functional status, covering depression and anxiety in AS patients.

Methods

The 314 patients with AS and age- and sex-matched controls took part in the study, completed a battery of questionnaires, and participated in long-term follow-up. Blood samples were taken to measure C-reactive protein (CRP) and the erythrocyte sedimentation rate (ESR). The association among sleep, pain, disease activity, functional status, depression, and anxiety were assessed by using Pearson/Spearman correlations and multiple regression analysis.

Results

The Pittsburgh Sleep Quality Index (PSQI) score of the Chinese version was significantly higher in the AS group than in the control group (P = 0.020). Of the 314 patients with AS, 184 (58.6%) had a high risk for sleep disturbances. The PSQI score was associated with age, years of education, ESR, CRP, overall assessment of health, pain, morning stiffness, Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), Bath Ankylosing Spondylitis Functional Index (BASFI), depression, and anxiety (all P < 0.001), but were not associated with disease duration, fingertip-to-floor distance, and Bath Ankylosing Spondylitis Metrology Index (BASMI) (P > 0.05). In hierarchic multiple regression analysis, the medical and psychological variables contributed significantly to the variance in sleep-disturbances scores, adding an additional 23.9% to the overall R² beyond that accounted for by demographic variables (R-square, 8.5%), resulting in a final R²of 42.6%. Multiple stepwise regression analysis revealed that anxiety was the maximal statistical contribution in predicting sleep disturbances (standardized coefficients, 0.287).

Conclusions

The prevalence of sleep disturbances in AS patients is higher than it is generally thought to be. Depression, anxiety, nocturnal pain, and total back pain are the major contributors of sleep disturbances in AS.     

应激与颞下颌关节紊乱病研究新进展

颞下颌关节紊乱病是慢性面部疼痛最常见的诱因,常常与躯体和心理主诉症状密切联系,包括疲劳,睡眠失调,焦虑和抑郁等。即使未发现任何能够合理解释疼痛原因的时候,健康专业人士也常常忽略疼痛感受的主观性。从严格的生物医学角度来讲,对疼痛的这种理解是不科学的。本文的主要目的是通过查阅近年来大量的研究文献资料,发现应激引起疼痛感觉的生物学途径以及导致颞下颌关节紊乱的原因。研究发现下丘脑-垂体-肾上腺轴、5-羟色胺和阿片样物质通路都与颌面部疼痛的发病密切相关,同时也提出了未来可能使用的治疗方法。同时,也希望本文能把与疼痛学科差别较大的口腔医学融入到需要多学科合作的颞下颌关节紊乱的诊断和治疗中,从科学角度提高对该病的临床诊疗效率。     

Beyond pain in fibromyalgia: insights into the symptom of fatigue

Fatigue is a disabling, multifaceted symptom that is highly prevalent and stubbornly persistent. Although fatigue is a frequent complaint among patients with fibromyalgia, it has not received the same attention as pain. Reasons for this include lack of standardized nomenclature to communicate about fatigue, lack of evidence-based guidelines for fatigue assessment, and a deficiency in effective treatment strategies. Fatigue does not occur in isolation; rather, it is present concurrently in varying severity with other fibromyalgia symptoms such as chronic widespread pain, unrefreshing sleep, anxiety, depression, cognitive difficulties, and so on. Survey-based and preliminary mechanistic studies indicate that multiple symptoms feed into fatigue and it may be associated with a variety of physiological mechanisms. Therefore, fatigue assessment in clinical and research settings must consider this multi-dimensionality. While no clinical trial to date has specifically targeted fatigue, randomized controlled trials, systematic reviews, and meta-analyses indicate that treatment modalities studied in the context of other fibromyalgia symptoms could also improve fatigue. The Outcome Measures in Rheumatology (OMERACT) Fibromyalgia Working Group and the Patient Reported Outcomes Measurement Information System (PROMIS) have been instrumental in propelling the study of fatigue in fibromyalgia to the forefront. The ongoing efforts by PROMIS to develop a brief fibromyalgia-specific fatigue measure for use in clinical and research settings will help define fatigue, allow for better assessment, and advance our understanding of fatigue.