Inspiratory Airflow Dynamics During Sleep in Women with Fibromyalgia, 2004, Gold et al.

[nataliezzz]

Inspiratory Airflow Dynamics During Sleep in Women with Fibromyalgia
Avram R Gold, Francis Dipalo, Morris S Gold, Joan Broderick
https://www.researchgate.net/publication/8541375_Inspiratory_Airflow_Dynamics_During_Sleep_in_Women_with_Fibromyalgia (PDF Available)

Study objectives: To determine whether women with fibromyalgia have inspiratory airflow dynamics during sleep similar to those of women with upper-airway resistance syndrome (UARS).

Design: A descriptive study of consecutive female patients with fibromyalgia.

Setting: An academic sleep disorders center.

Patients or participants: Twenty-eight women with fibromyalgia diagnosed by rheumatologists using established criteria. Fourteen of the women gave a history of snoring, while 4 claimed to snore 'occasionally' and 10 denied snoring. The comparison group comprised 11 women with UARS matched for age and obesity.

Interventions: Eighteen of the 28 women with fibromyalgia and all of the women with UARS had a full-night polysomnogram. All participants had a nasal continuous positive airway pressure (CPAP) study with quantitative monitoring of inspiratory airflow and effort between atmospheric pressure and therapeutic CPAP. Fourteen patients with fibromyalgia and all patients with UARS had a successful determination of pharyngeal critical pressure.

Measurements and results: Twenty-seven of 28 women with fibromyalgia had sleep-disordered breathing. One of the 27 had obstructive sleep apnea hypopnea while 26 had milder inspiratory airflow limitation with arousals. One patient had no apnea or hypopnea or inspiratory airflow limitation during sleep. While the patients were sleeping at atmospheric pressure, apnea-hypopnea index, arousal index, the prevalence of flow-limited breaths, and maximal inspiratory flow were similar between groups. The pharyngeal critical pressure of the patients with fibromyalgia was -6.5 +/- 3.5 cmH2O (mean +/- SD) compared to -5.8 +/- 3.5 cmH2O for patients with UARS (P = .62). Treatment of 14 consecutive patients with nasal CPAP resulted in an improvement in functional symptoms ranging from 23% to 47%, assessed by a validated questionnaire.

Conclusion: Inspiratory airflow limitation is a common inspiratory airflow pattern during sleep in women with fibromyalgia. Our findings are compatible with the hypothesis that inspiratory flow limitation during sleep plays a role in the development of the functional somatic syndromes.

 

[nataliezzz]

For all 28 subjects, the diagnosis of fibromyalgia was made by a board-certified rheumatologist using American College of Rheumatology criteria.

16 subjects were consecutive female patients with fibromyalgia referred to Stony Brook University Sleep Disorders Center with complaints of disturbed sleep and fatigue or sleepiness ("our referring physicians learn[ed] that complaints of sleep-onset insomnia and fatigue or tiredness, even in the absence of snoring, are reasons to evaluate a patient for sleep-disordered breathing.")

The 12 remaining subjects were consecutive participants in an unrelated fibromyalgia treatment study administered by one of the authors (Joan Broderick).

Of the 28 patients, 12 snored loudly/heavily, 2 snored mildly, 4 snored occasionally, and 10 denied snoring. The 14 patients who denied snoring or snored occasionally were equally distributed between the referral group and the treatment-study group. All 10 patients who denied snoring had inspiratory flow limitation during sleep.

Pcrit (pharyngeal critical closing pressure) - considered the gold standard for evaluating upper airway collapsibility - was attempted in all 28 fibromyalgia patients and successfully obtained in 14.

The UARS comparison subjects ("normals" were adults without habitual snoring and daytime sleepiness/fatigue and an AHI <5):

In order to compare the inspiratory airflow-dynamics data and Pcrit values of the women with fibromyalgia to those of a sample of women with UARS, we examined the data obtained in our previous study of inspiratory airflow dynamics during sleep and Pcrit in UARS patients (Figure 1b).8 Because our UARS patient sample in that study (17 men and 5 women) did not provide a large enough sample of women with UARS, we extracted the data from the 5 women with UARS who had participated in our previous study and added data on inspiratory airflow dynamics from the next 6 consecutively studied women with UARS in whom Pcrit values were obtained. This provided a dataset from a sample of 11 women with UARS with which to compare our data from the women with fibromyalgia. As in our previous studies of UARS patients,8,9 we diagnosed UARS in patients with a complaint of daytime fatigue or sleepiness who did not meet diagnostic criteria for OSAH, narcolepsy, or periodic limb movement disorder and whose complaint of fatigue or sleepiness was associated with inspiratory flow limitation while breathing at atmospheric pressure during a nasal CPAP titration study (described below).