Impact of sleep disturbances and autonomic dysfunction on the quality of life of patients with fibromyalgia

Ruchi Singh; Nirendra Kumar Rai; Aakarsh Rastogi; Chiranjeevi Endukuru; Ankur Joshi; Sudhanshu Shekhar Mishra

doi:10.1515/jbcpp-2020-0007

Article

Impact of sleep disturbances and autonomic dysfunction on the quality of life of patients with fibromyalgia

Ruchi Singh , Nirendra Kumar Rai , Aakarsh Rastogi , Chiranjeevi Endukuru , Ankur Joshi and Sudhanshu Shekhar Mishra

Published/Copyright: February 9, 2021

Published by

Become an author with De Gruyter Brill

Submit Manuscript Author Information Explore this Subject

From the journal Journal of Basic and Clinical Physiology and Pharmacology Volume 32 Issue 6

Abstract

Objectives

Fibromyalgia, a painful musculoskeletal disorder is associated with sleep disturbances as well as autonomic dysfunction. Pathophysiology of fibromyalgia is yet not clear and neuroanatomical proximity of sleep and autonomic centre prompts probable involvement of the two impacting the quality of life of fibromyalgia patients. Present study was done with the objective to explore the extent of sleep disturbances and/or autonomic dysfunction in fibromyalgia and asses their impact on quality of life of fibromyalgia patients.

Method and materials

Thirty consecutive fibromyalgia patients (diagnosed by ACR 2010) from out-patient department and 30 age-gender matched controls were enrolled after the ethical clearance. All participants were evaluated for: (1) sleep using Pittsburgh sleep quality index and medical outcomes study sleep scale-12 Revised, (2) Quality of life by 36 item short-form health survey-36v2TM and revised fibromyalgia impact questionnaire (only patients). Autonomic functions of patients were evaluated by standard cardiovascular autonomic function tests by Ewing’s battery and heart rate variability (5-min) measurement.

Results

Fibromyalgia patients had increased sleep disturbances compared to controls (39.46 ± 11, 59.61 ± 2.31; p=0.0001) and very poor sleep quality (13.63 ± 4.15, 3.03 ± 1.56; p=0.0001) as well as quality of life (p=0.0001) which further deteriorated with increasing severity of fibromyalgia. Twelve patients had autonomic dysfunction but it was neither associated with sleep disturbances nor with quality of life.

Conclusions

Mild to moderate grade fibromyalgia patients have significant sleep disturbance, poor sleep quality which remarkably impacts their quality of life. Autonomic dysfunction is not an early feature of disease. The study suggests that full spectrum of sleep disturbances and sleep quality should be explored in fibromyalgia syndrome (FMS) patients.

Keywords: autonomic dysfunction; fibromyalgia; heart rate variability; quality of life; sleep quality

Corresponding author: Ruchi Singh, MBBS, MD, Department of Physiology, All India Institute of Medical Sciences, Bhopal, India, Phone: +91 7773010095, E-mail: ruchi.physiology@aiimsbhopal.edu.in

Acknowledgements

This research was an ICMR-STS selected study. The authors acknowledge the ICMR India for this scheme which created interest in starting and completion of the study by the authors.

Research funding: It was a non funded research study
Author contributions: All authors have accepted responsibility for the entire content of this manuscript and approved its submission.
Competing interests: Authors state no conflict of interest.
Informed consent: Informed consent was obtained from all individuals included in this study.
Ethical approval: The study was conducted after the due approval by the institutions ethical committee.

References

1. Bennett, RM, Jones, J, Turk, DC, Russell, IJ, Matallana, L. An internet survey of 2,596 people with fibromyalgia. BMC Musculoskelet Disord 2007;8:27. https://doi.org/10.1186/1471-2474-8-27.Search in Google Scholar

2. Queiroz, LP. Worldwide epidemiology of fibromyalgia. Curr Pain Headache Rep 2013;17:356. https://doi.org/10.1007/s11916-013-0356-5.Search in Google Scholar

3. Berger, A, Dukes, E, Martin, S, Edelsberg, J, Oster, G. Characteristics and healthcare costs of patients with fibromyalgia syndrome. Int J Clin Pract 2007;61:1498–508. https://doi.org/10.1111/j.1742-1241.2007.01480.x.Search in Google Scholar

4. Bradley, LA. Pathophysiology of fibromyalgia. Am J Med. 2009;122:S22–30. https://doi.org/10.1016/j.amjmed.2009.09.008.Search in Google Scholar

5. Junior, MH, Goldenfum, MA, Siena, CA. Fibromyalgia: clinical and occupational aspects. Rev Assoc Med Bras (English Ed) 2012;58:358–65. https://doi.org/10.1016/s2255-4823(12)70208-4.Search in Google Scholar

6. Kleinman, L, Mannix, S, Arnold, LM, Burbridge, C, Howard, K, McQuarrie, K, et al.. Assessment of sleep in patients with fibromyalgia: qualitative development of the fibromyalgia sleep diary. Health Qual Life Outcome 2014;12:111. https://doi.org/10.1186/s12955-014-0111-6.Search in Google Scholar PubMed PubMed Central

7. Wagner, JS, DiBonaventura, MD, Chandran, AB, Cappelleri, JC. The association of sleep difficulties with health-related quality of life among patients with fibromyalgia. BMC Musculoskelet Disord 2012;13:199. https://doi.org/10.1186/1471-2474-13-199.Search in Google Scholar PubMed PubMed Central

8. Calandra-Buonaura, G, Provini, F, Guaraldi, P, Plazzi, G, Cortelli, P. Cardiovascular autonomic dysfunctions and sleep disorders. Sleep Med Rev 2016;26:43–56. https://doi.org/10.1016/j.smrv.2015.05.005.Search in Google Scholar PubMed

9. Miglis, MG. Autonomic dysfunction in primary sleep disorders. Sleep Med 2016;19:40–9. https://doi.org/10.1016/j.sleep.2015.10.001.Search in Google Scholar PubMed

10. Martinez-Lavin, M. The autonomic nervous system and fibromyalgia. J Muscoskel Pain 2002;10:221–8. https://doi.org/10.1300/j094v10n01_18.Search in Google Scholar

11. Cohen, H, Neumann, L, Kotler, M, Buskila, D. Autonomic nervous system derangement in fibromyalgia syndrome and related disorders. Isr Med Assoc J 2001;3:755–60.Search in Google Scholar

12. Elam, M, Johansson, G, Wallin, BG. Do patients with primary fibromyalgia have an altered muscle sympathetic nerve activity?. Pain 1992;48:371–5. https://doi.org/10.1016/0304-3959(92)90086-q.Search in Google Scholar

13. Cohen, H, Neumann, L, Alhosshle, A, Kotler, M, Abu-Shakra, M, Buskila, D. Abnormal sympathovagal balance in men with fibromyalgia. J Rheumatol 2001;28:581–9.Search in Google Scholar

14. Vincent, A, Whipple, MO, Low, PA, Joyner, M, Hoskin, TL. Patients with fibromyalgia have significant autonomic symptoms but modest autonomic dysfunction. PM&R 2016;8:425–35. https://doi.org/10.1016/j.pmrj.2015.08.008.Search in Google Scholar

15. Yunus, MB. The prevalence of fibromyalgia in other chronic pain conditions. Pain Res Treat 2012;2012:584573. https://doi.org/10.1155/2012/584573.Search in Google Scholar

16. Assumpção, A, Pagano, T, Matsutani, LA, Ferreira, EA, Pereira, CA, Marques, AP. Quality of life and discriminating power of two questionnaires in fibromyalgia patients: fibromyalgia impact questionnaire and medical outcomes study 36-item short-form health survey. Braz J Phys Ther 2010;14:284–9. https://doi.org/10.1590/s1413-35552010005000015.Search in Google Scholar

17. Kwiatek, R. Treatment of fibromyalgia. Aust Prescr 2017;40:179. https://doi.org/10.18773/austprescr.2017.056.Search in Google Scholar

18. Wolfe, F, Clauw, DJ, Fitzcharles, MA, Goldenberg, DL, Katz, RS, Mease, P, et al.. The American College of Rheumatology preliminary diagnostic criteria for fibromyalgia and measurement of symptom severity. Arthritis Care Res 2010;62:600–10. https://doi.org/10.1002/acr.20140.Search in Google Scholar

19. Buysse, DJ, Reynolds, CFIII, Monk, TH, Berman, SR, Kupfer, DJ. The Pittsburgh Sleep Quality Index: a new instrument for psychiatric practice and research. Psychiatr Res 1989;28:193–213. https://doi.org/10.1016/0165-1781(89)90047-4.Search in Google Scholar

20. Manzar, MD, Moiz, JA, Zannat, W, Spence, DW, Pandi-Perumal, SR, BaHammam, AS, et al.. Validity of the Pittsburgh sleep quality index in Indian university students. Oman Med J 2015;30:193. https://doi.org/10.5001/omj.2015.41.Search in Google Scholar PubMed PubMed Central

21. Hays, RD, Stewart, AL. Sleep measures. In: Stewart, AL,Ware, JE, editors. Measuring functioning and well-being: the Medical Outcomes Study Approach. Durham (NC): Duke University Press; 1992:p. 235–59.10.7249/CB361Search in Google Scholar

22. Martin, S, Chandran, A, Zografos, L, Zlateva, G. Evaluation of the impact of fibromyalgia on patients’ sleep and the content validity of two sleep scales. Health Qual Life Outcome 2009;7:64. https://doi.org/10.1186/1477-7525-7-64.Search in Google Scholar PubMed PubMed Central

23. Sadosky, A, Dukes, E, Evans, C. Reliability of a 1-week recall period for the Medical Outcomes Study Sleep Scale (MOS-SS) in patients with fibromyalgia. Health Qual Life Outcome 2009;7:12. https://doi.org/10.1186/1477-7525-7-12.Search in Google Scholar PubMed PubMed Central

24. Bennett, RM, Friend, R, Jones, KD, Ward, R, Han, BK, Ross, RL. Revised Fibromyalgia Impact Questionnaire (FIQR): validation & psychometric properties. Arthritis Res Ther 2009;11:R120. https://doi.org/10.1186/ar2783.Search in Google Scholar PubMed PubMed Central

25. Burckhardt, CS, Clark, SR, Bennett, RM. The fibromyalgia impact questionnaire: development and validation. J Rheumatol 1991;18:728–33.Search in Google Scholar

26. Salaffi, F, Di Carlo, M, Arcà, S, Galeazzi, M. Categorisation of disease severity states in fibromyalgia: a first step to support decision-making in health care policy. Clin Exp Rheumatol 2018;36:1074–81.Search in Google Scholar

27. Ware, JE, Kosinski, M, Bjorner, JB, Turner‐Bowker, DM, Gandek, B, Maruish, ME. User’s manual for the SF-36v2 Health Survey, 2nd ed. Lincoln. RI: QualityMetric Incorporated; 2007.Search in Google Scholar

28. Ware, JE, Kosinski, M, Dewey, JE. How to score version 2 of the SF-36 health survey (standard & acute forms). QualityMetric Incorporated; 2000.Search in Google Scholar

29. Malik, M, Camm, AJ, Bigger, JT, Breithardt, G, Cerutti, S, Cohen, RJ, et al.. Heart rate variability. Standards of measurement, physiological interpretation, and clinical use. Eur Heart J 1996;17:354–81. https://doi.org/10.1093/oxfordjournals.eurheartj.a014868.Search in Google Scholar

30. Sharma, RK, Deepak, KK, Bijlani, RL, Rao, PS. Short-term physical training alters cardiovascular autonomic response amplitude and latencies. Indian J Physiol Pharmacol 2004;48:165–73.Search in Google Scholar

31. Ewing, DJ, Martyn, CN, Young, RJ, Clarke, BF. The value of cardiovascular autonomic function tests: 10 years experience in diabetes. Diabetes Care 1985;8:491–8. https://doi.org/10.2337/diacare.8.5.491.Search in Google Scholar PubMed

32. Lentz, MJ, Landis, CA, Rothermel, JS, Shaver, JL. Effects of selective slow wave sleep disruption on musculoskeletal pain and fatigue in middle aged women. J Rheumatol 1999;26:1586–92.Search in Google Scholar

33. Generaal, E, Vogelzangs, N, Penninx, BW, Dekker, J. Insomnia, sleep duration, depressive symptoms, and the onset of chronic multisite musculoskeletal pain. Sleep 2017;40. https://doi.org/10.1093/sleep/zsw030.Search in Google Scholar PubMed

34. Mundal, I, Gråwe, RW, Bjørngaard, JH, Linaker, OM, Fors, EA. Psychosocial factors and risk of chronic widespread pain: an 11-year follow-up study—the HUNT study. Pain 2014;155:1555–61. https://doi.org/10.1016/j.pain.2014.04.033.Search in Google Scholar PubMed

35. Bigatti, SM, Hernandez, AM, Cronan, TA, Rand, KL. Sleep disturbances in fibromyalgia syndrome: relationship to pain and depression. Arthritis Care Res 2008;59:961–7. https://doi.org/10.1002/art.23828.Search in Google Scholar PubMed PubMed Central

36. Liedberg, GM, Björk, M, Börsbo, B. Self-reported nonrestorative sleep in fibromyalgia–relationship to impairments of body functions, personal function factors, and quality of life. J Pain Res 2015;8:499. https://doi.org/10.2147/JPR.S86611.Search in Google Scholar PubMed PubMed Central

37. Mork, PJ, Nilsen, TI. Sleep problems and risk of fibromyalgia: longitudinal data on an adult female population in Norway. Arthritis Rheum 2012;64:281–4. https://doi.org/10.1002/art.33346.Search in Google Scholar PubMed

38. Lautenbacher, S, Kundermann, B, Krieg, JC. Sleep deprivation and pain perception. Sleep Med Rev 2006;10:357–69. https://doi.org/10.1016/j.smrv.2005.08.001.Search in Google Scholar PubMed

39. Rizzi, M, Radovanovic, D, Santus, P, Airoldi, A, Frassanito, F, Vanni, S, et al.. OP0006 Influence of autonomic nervous system dysfunction in the genesis of sleep disorders in fibromyalgia patients.Search in Google Scholar

40. Whoqol Group. The World Health Organization quality of life assessment (WHOQOL): position paper from the World Health Organization. Soc Sci Med 1995;41:1403–9.10.1016/0277-9536(95)00112-KSearch in Google Scholar

41. Strömbeck, B, Ekdahl, C, Manthorpe, R, Wikström, I, Jacobsson, L. Health-related quality of life in primary Sjögren’s syndrome, rheumatoid arthritis and fibromyalgia compared to normal population data using SF-36. Scand J Rheumatol 2000;29:20–8.10.1080/030097400750001761Search in Google Scholar PubMed

42. Di Venere, D, Corsalini, M, Stefanachi, G, Tafuri, S, De Tommaso, M, Cervinara, F, et al.. Quality of life in fibromyalgia patients with craniomandibular disorders. Open Dent J 2015;9:9. https://doi.org/10.2174/1874210601509010009.Search in Google Scholar PubMed PubMed Central

43. Jansson-Fröjmark, M, Boersma, K. Bidirectionality between pain and insomnia symptoms: a prospective study. Br J Health Psychol 2012;17:420–31.10.1111/j.2044-8287.2011.02045.xSearch in Google Scholar PubMed

44. O’Brien, EM, Waxenberg, LB, Atchison, JW, Gremillion, HA, Staud, RM, McCrae, CS, et al.. Intraindividual variability in daily sleep and pain ratings among chronic pain patients: bidirectional association and the role of negative mood. Clin J Pain 2011;27:425–33. https://doi.org/10.1097/AJP.0b013e318208c8e4.Search in Google Scholar PubMed

45. Hamilton, NA, Pressman, M, Lillis, T, Atchley, R, Karlson, C, Stevens, N. Evaluating evidence for the role of sleep in fibromyalgia: a test of the sleep and pain diathesis model. Cognit Ther Res 2012;36:806–14. https://doi.org/10.1007/s10608-011-9421-8.Search in Google Scholar PubMed PubMed Central

46. Miró, E, Martínez, MP, Sánchez, AI, Prados, G, Medina, A. When is pain related to emotional distress and daily functioning in fibromyalgia syndrome? The mediating roles of self-efficacy and sleep quality. Br J Health Psychol 2011;16:799–814. https://doi.org/10.1111/j.2044-8287.2011.02016.x.Search in Google Scholar PubMed

47. Staud, R. Heart rate variability as a biomarker of fibromyalgia syndrome. Future Rheumatol 2008;3:475. https://doi.org/10.2217/17460816.3.5.475.Search in Google Scholar PubMed PubMed Central

48. Kulshreshtha, P, Gupta, R, Yadav, RK, Bijlani, RL, Deepak, KK. A comprehensive study of autonomic dysfunction in the fibromyalgia patients. Clin Auton Res 2012a;22:117–22. https://doi.org/10.1007/s10286-011-0150-6.Search in Google Scholar PubMed

49. Lerma, C, Martinez, A, Ruiz, N, Vargas, A, Infante, O, Martinez-Lavin, M. Nocturnal heart rate variability parameters as potential fibromyalgia biomarker: correlation with symptoms severity. Arthritis Res Ther 2011;6:R185. https://doi.org/10.1186/ar3513.Search in Google Scholar PubMed PubMed Central

Received: 2020-01-22

Accepted: 2020-09-10

Published Online: 2021-02-09

You are currently not able to access this content.

Articles in the same Issue

https://doi.org/10.1515/jbcpp-2020-0007

Keywords for this article

autonomic dysfunction; fibromyalgia; heart rate variability; quality of life; sleep quality