Objective sleep measures in chronic fatigue syndrome patients: A systematic review and meta-analysis 2023, Mohamed et al

[Sly Saint]

Abstract
Patients with myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) often report disrupted and unrefreshing sleep in association with worsened fatigue symptoms. However, the nature and magnitude of sleep architecture alteration in ME/CFS is not known, with studies using objective sleep measures in ME/CFS generating contradictory results.

The current manuscript aimed to review and meta-analyse of case-control studies with objective sleep measures in ME/CSF. A search was conducted in PubMed, Scopus, Medline, Google Scholar, and Psychoinfo databases.

After review, 24 studies were included in the meta-analysis, including 20 studies with 801 adults (ME/CFS = 426; controls = 375), and 4 studies with 477 adolescents (ME/CFS = 242; controls = 235), who underwent objective measurement of sleep. Adult ME/CFS patients spend longer time in bed, longer sleep onset latency, longer awake time after sleep onset, decreased sleep efficiency, decreased stage 2 sleep, increased Stage 3, and longer rapid eye movement sleep latency. However, adolescent ME/CFS patients had longer time in bed, longer total sleep time, longer sleep onset latency, and reduced sleep efficiency.

The meta-analysis results demonstrate that sleep is altered in ME/CFS, with changes seeming to differ between adolescent and adults, and suggesting sympathetic and parasympathetic nervous system alterations in ME/CFS.

https://www.sciencedirect.com/science/article/abs/pii/S1087079223000278

 

[DokaGirl]

Abstract
Patients with myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) often report disrupted and unrefreshing sleep in association with worsened fatigue symptoms. However, the nature and magnitude of sleep architecture alteration in ME/CFS is not known, with studies using objective sleep measures in ME/CFS generating contradictory results.

The current manuscript aimed to review and meta-analyse of case-control studies with objective sleep measures in ME/CSF. A search was conducted in PubMed, Scopus, Medline, Google Scholar, and Psychoinfo databases.

After review, 24 studies were included in the meta-analysis, including 20 studies with 801 adults (ME/CFS = 426; controls = 375), and 4 studies with 477 adolescents (ME/CFS = 242; controls = 235), who underwent objective measurement of sleep. Adult ME/CFS patients spend longer time in bed, longer sleep onset latency, longer awake time after sleep onset, decreased sleep efficiency, decreased stage 2 sleep, increased Stage 3, and longer rapid eye movement sleep latency. However, adolescent ME/CFS patients had longer time in bed, longer total sleep time, longer sleep onset latency, and reduced sleep efficiency.

The meta-analysis results demonstrate that sleep is altered in ME/CFS, with changes seeming to differ between adolescent and adults, and suggesting sympathetic and parasympathetic nervous system alterations in ME/CFS.

https://www.sciencedirect.com/science/article/abs/pii/S1087079223000278

I wish that this level of understanding had been applied to my sleep study done quite some time ago.

My sleep study documented disordered sleep in at least 2 areas, but was basically shrugged off as not important. No mention of sympathetic or parasympathetic nervous system alterations, which could have suggested a notable dysfunction.

Perhaps with greater understanding, more is now being gleaned from sleep studies.

I hope pwME who have this test can receive a more thorough interpretation of their sleep rhythms.

 

[Mij]

My sleep study report from the hospital wasn't even sent to my doctor.

 

[DokaGirl]

The IOM/NAM includes sleep problems as an inclusion in its ME/CFS definition criteria. As does the CCC, and the ME-ICC.

Given these 24 studies, and 668 participants with ME, it seems to me that with these numbers, perhaps there is some promise here to follow these authors' hypothesis to prove sympathetic and parasympathetic nervous system alterations in ME.

 

[Sly Saint]

I'm guessing this commentary is on this paper but I'm not sure

Commentary on Mohamed et al.: Inter- and intra-sleep variability deserve further attention in myalgic encephalomyelitis/chronic fatigue syndrome

https://www.sciencedirect.com/science/article/abs/pii/S1087079223000680


there's no abstract and the pdf has no real info either other than its a preprint.

 

[SNT Gatchaman]

That commentary makes two points: 1. Are sleep disturbances a “one size fits all” ME/CFS? 2. Are sleep disturbances consistent over time and as the disease progresses? —

People with severe or very severe ME/CFS may be completely wheelchair-dependent and housebound for months or years. Previous studies identified several clinical differences in ME/CFS outcomes according to disease severity. Therefore, it is important to emphasize that sleep disturbance may also vary according to the severity of the illness. [Followed by discussion of different cytokine profiles in patients and immune-sleep cross-talk.]

In addition to inter-individual variability in sleep disturbances, the severity and frequency of sleep disturbance may also vary within a given patient and fluctuate over time. Abnormalities in the immune system are present at the onset of the disease but tend to diminish over time. They reappear in association with an increase in disease symptoms during post-exertional flare-ups, also known as 'crashes'. Sleep outcomes may therefore be affected by the disease stages [...] In addition, it's worth noting that patients may not show any obvious signs of the disease during a clinical polysomnographic assessment. However, if their symptoms are severe or worsening, they may not be able to participate in such assessments. [..] Finally, one or two nights of polysomnography do not allow us to see the “whole elephant” in a fluctuating disease such as ME/CFS. Therefore, attention to methods that allow ecological and longitudinal follow-up of sleep is essential to understand the whole picture.

 

[Sean]

I have done two sleep studies. Wired up to the wazoo with sensors, in a strange bed, trying to go to sleep according to their schedule, not my normal one. Etc.

I am not blind nor unsympathetic to the practical difficulties for clinicians/researchers involved in this kind of assessment.

But how they think they can get reliable real world data about people's sleep patterns in that setting escapes me.

 

[DokaGirl]

I have done two sleep studies. Wired up to the wazoo with sensors, in a strange bed, trying to go to sleep according to their schedule, not my normal one. Etc.

I am not blind nor unsympathetic to the practical difficulties for clinicians/researchers involved in this kind of assessment.

But how they think they can get reliable real world data about people's sleep patterns in that setting escapes me.

One of the most uncomfortable sleeps I've ever had was during my sleep study.

 

[RedFox]

I have done two sleep studies. Wired up to the wazoo with sensors, in a strange bed, trying to go to sleep according to their schedule, not my normal one. Etc.

I am not blind nor unsympathetic to the practical difficulties for clinicians/researchers involved in this kind of assessment.

But how they think they can get reliable real world data about people's sleep patterns in that setting escapes me.

When I got a sleep study I slept about 3 hours out of the whole night. I think the main cause was that the wires prevented me from tossing turning naturally. I move around a lot, often waking up in a different position than the one I fell asleep in, or finding pillows on the floor.

 

[Mij]

I eventually had to take trazadone b/c I was unable to fall asleep by 2 a.m and the tech told me the next morning that I 'slept just fine".

 

[rvallee]

One of the most uncomfortable sleeps I've ever had was during my sleep study.

Ironically, when I had mine, I had one of the best night's sleep of my life. Fell asleep like a brick, which almost never happens, and never woke up until morning. Totally unrepresentative of my usual sleep. Single points in time are a lousy method of research for something that can vary this much.

But given that the vast majority of sleep specialists are pulmonologists and most issues are sleep apnea or similar issues, it's mostly all they check.

I also had one of the most absurd medical appointments in my life, with a specialist who was retiring the next day, and was really confused as to why he had been assigned to me since the appointment was useless. Bad logistics, whatever.

 

[Sean]

But given that the vast majority of sleep specialists are pulmonologists and most issues are sleep apnea or similar issues,

That is what mine were for.

 

[bobbler]

That commentary makes two points: 1. Are sleep disturbances a “one size fits all” ME/CFS? 2. Are sleep disturbances consistent over time and as the disease progresses? —

This. All of this in the two quotes. I'm impressed someone seems to have 'got it'.

I do think also that there, just anecdotally from meeting others with ME over the years, does seem to be 'those that get significant sleep reversal' (and for me PEM is either a part of it/trigger or it is basically part of PEM, but it also happens as part of the 'overdo' when you become so tired you can't sleep when you would as you've gone through the wall) and those who don't really.

I say 'don't really' because if you are one of the former then it is a very different thing to when someone comes back and says it can get messed up a big, struggle with mornings when tired, or was fixed/trained out of/ameliorated by 'routines' - because one sure way mine was made worse, just like the GET 'pushing through' does it, was to think this sign of body being in acute ill-health could be 'helped' by hardship being laboured onto it, extending it, making yourself more tired than even that will 'in order to train it out' etc . SO there seems to be different phenomena that are rarely unpicked when people 'study' sleep

I'm impressed just to see someone note everyone isn't the same and that stages and severity and PEM affect this given historical things I've seen in the area. As well as their picking up on it needing to be more longitudinal and the methods issues of that not being possible unless there is a natural environment/you not being able to study those either more severe or ill at the time without such methods.