Obstructive sleep apnea syndrome as an uncommon cause of fibromyalgia: a case report, 2007, Sepici et al.

[nataliezzz]

Obstructive sleep apnea syndrome as an uncommon cause of fibromyalgia: a case report
Vesile Sepici, Aliye Tosun, Oğuz Köktürk
https://link.springer.com/article/10.1007/s00296-007-0375-9
Sci-Hub link: https://sci-hub.st/10.1007/s00296-007-0375-9

Abstract
Fibromyalgia syndrome (FMS) is characterized by chronic widespread musculoskeletal pain, stiffness and tenderness at multiple points. Sleep disturbances are common in FMS and patients usually complain about nonrestorative sleep. Obstructive sleep apnea syndrome (OSAS) is characterized by repetitive pharyngeal collapse during sleep. Recurrent arousals from sleep occurs to restore pharyngeal patency in OSAS and this results in increased sympathetic activity and fragmentation of sleep. Sleep disturbances may lead to musculoskeletal pain and some studies suggest a relation between OSAS and FMS. Since OSAS is strongly associated with increased risk of myocardial infarction, cerebrovascular accidents and congestive heart failure, its diagnosis and treatment are of particular importance. Herein we present a female patient with diagnosis of FMS for 10 years who had complaints of morning fatigue, restless sleep, sleepiness during day and snoring besides musculoskeletal symptoms. Severe OSAS was diagnosed after polysomnographic analysis and FMS symptoms were totally improved with nasal continuous positive airway pressure treatment.

 

[nataliezzz]

A 55-year-old female was presented with history of widespread musculoskeletal pain for 10 years and had a diagnosis of FMS. Her pain was unresponsive to nonsteroidal anti-inflammatory drugs and also to antidepressant drugs prescribed by several physicians. Physical therapy also did not relieve her pain. She also complained about morning fatigue, restless sleep, and sleepiness during day even sleeping more than 8 h and snoring at night. She had a previous medical history of hypertension for 5 years.

On physical examination, neck and lower back movements were painful and slightly limited in all directions and paravertebral muscles were tender. On digital palpation, 14 tender points were detected and tenderness was not present in control points. Neurological examination was normal. Laboratory studies including erythrocyte sedimentation rate, C-reactive protein, complete blood count, biochemical tests and thyroid function tests were in normal ranges. Cervical and lumbosacral spine radiographs showed minimal degenerative changes. Body-mass index was 25.6 kg/m2. Patient was fulfilling the ACR criteria for FMS.

She underwent PSG analysis, which revealed severe obstructive type sleep apnea syndrome with AHI of 41.8. Subsequently, treatment with nasal continuous positive airway pressure (CPAP) was started. Upon CPAP treatment, FMS symptoms were totally improved. Four weeks later, on the follow-up visit, control PSG analysis was re-performed and revealed significant improvement with a decrease of AHI from 41.8 to 2.8. Patient is under follow-up and free of symptoms for 2 years.

To conclude, we assume that OSAS was the leading cause of FMS in our patient. Morning fatigue, daytime sleepiness, restless sleep and snoring complaints disappeared and FMS symptoms were totally improved with the CPAP therapy. Therefore, it may be useful to evaluate the
relation between SA and FMS in female patients with further studies. Treatment of underlying SA not only will provide the treatment for FMS, but also more importantly prevent the troublesome outcomes of the disease.