Somatic syndromes, insomnia, anxiety, and stress among sleep disordered breathing patients, 2016, Amdo et al.

[nataliezzz]

Somatic syndromes, insomnia, anxiety, and stress among sleep disordered breathing patients
Tshering Amdo, Nadia Hasaneen, Morris S Gold, Avram R Gold
https://www.researchgate.net/public...ess_among_sleep_disordered_breathing_patients (PDF)

Objectives: We tested the hypothesis that the prevalence of somatic syndromes, anxiety, and insomnia among sleep disordered breathing (SDB) patients is correlated with their levels of somatic arousal, the symptoms of increased sympathetic nervous system tone under conditions of stress.

Methods: We administered the Body Sensation Questionnaire (BSQ; a 17-item questionnaire with increasing levels of somatic arousal scored 17-85) to 152 consecutive upper airway resistance syndrome (UARS) patients and 150 consecutive obstructive sleep apnea/hypopnea (OSA/H) patients. From medical records, we characterized each patient in terms of the presence of syndromes and symptoms into three categories: somatic syndromes (six syndromes), anxiety (anxiety disorders, nightmares, use of benzodiazepines), and insomnia (sleep onset, sleep maintenance, and use of hypnotics). For the pooled sample of SDB patients, we modeled the correlation of the BSQ score with the presence of each syndrome/symptom parameter within each of the three categories, with adjustment for male vs. female.

Results: Mean BSQ scores in females were significantly higher than those in males (32.5 ± 11.1 vs. 26.9 ± 8.2; mean ± SD). Increasing BSQ scores significantly correlated with increasing prevalence rates of somatic syndromes (p < 0.0001), of anxiety (p < 0.0001), and of insomnia (p ≤ 0.0001). In general, females had higher prevalence rates of somatic syndromes and symptoms of anxiety than males at any BSQ score while rates of insomnia were similar.

Conclusions: In patients with SDB, there is a strong association between the level of somatic arousal and the presence of stress-related disorders like somatic syndromes, anxiety, and insomnia.

 

[nataliezzz]

This study used the same clinical series of 302 UARS and OSA patients from the study below (see that thread for the BSQ also):

Somatic arousal and sleepiness/fatigue among patients with sleep-disordered breathing, 2016, Gold et al.

From the present study:

Six "somatic syndromes" were considered: headaches (excluding morning headaches), restless legs syndrome (RLS), temporomandibular joint (TMJ) syndrome, IBS, fibromyalgia, and CFS.

Three anxiety parameters were considered: presence of an anxiety disorder/symptom, nightmares, and taking benzodiazepines.

Four insomnia parameters were considered: (a) trouble falling asleep, (b) lying awake with intense thoughts, (c) waking up during the night, and (d) taking hypnotics. We consider (a) and (b) as reflecting sleep-onset insomnia whereas (c) reflects sleep-maintenance insomnia.

Each Stony Brook University Sleep Disorders Center patient assessed the frequency of 24 sleep-related complaints on a 4-point scale: 0 = never/rarely, 1 = 1×/week, 2 = 2–4×/week, and 3 = almost always. From each patient’s chart, the frequency of the following complaints was extracted:
(1) Experience restlessness or discomfort in the legs (restless legs syndrome; RLS)
(2) Have difficulty falling asleep (insomnia)
(3) Lie awake with intense thoughts (insomnia)
(4) Wake up during the night (insomnia)
(5) Experience nightmares (anxiety)

These complaints were dichotomized as 0/1 = absence and 2/3 = presence, so that the presence of each complaint meant it occurs more than once per week.

Presence of the following diagnoses/symptoms was extracted from the Sleep Disorders Center’s medical history questionnaire and standardized Sleep Medicine note (both sources make specific reference to the diagnoses/symptoms): chronic fatigue syndrome (CFS), fibromyalgia, IBS, TMJ syndrome, headaches (excluding morning headaches), and anxiety (an anxiety disorder or anxiety as a symptom in review of systems). From the medication list, we recorded whether or not benzodiazepines or hypnotics were used. The physician’s dictated consultation was also reviewed (when available).

We found that female sex raised the BSQ score by 5 to 6 points among SDB patients, raising the prevalence of somatic syndromes, anxiety, and insomnia among females. In addition, the prevalence rate of somatic syndromes and anxiety disorders was higher for females than for males at any BSQ score, magnifying the effect of the increased level of somatic arousal among females (Tables 2 and 4; Figs. 2 and 3). These disparities between the sexes are not explained by our findings.

In an earlier study of 75 consecutive SDB patients, Gold and associates found that a lower AHI predicted a higher prevalence of sleep-onset insomnia, headache, IBS, and alpha-delta sleep [26]. Patients with UARS had higher prevalence of these symptoms and signs compared to patients with severe OSA/H even when females and males were considered separately [26]. The implications of somatic arousal were not considered in that work. Therefore, to extend the original result, we investigated the relationship of AHI to the prevalence of somatic syndromes, anxiety, and insomnia, controlling for sex and BSQ score, in the supplement to this paper (ESM 2). For fibromyalgia, CFS, and IBS, we found a significant incremental negative correlation between AHI and syndrome prevalence beyond the impacts of sex and BSQ score. For other somatic syndromes, anxiety, and insomnia, the correlations were not significant after adjusting for sex and BSQ score. We did not capture the presence of alpha-delta sleep in this study.

Our supplemental findings suggest a modest incremental role for AHI as a determinant of the prevalence of somatic syndromes among SDB patients. Why UARS patients have higher rates of somatic syndromes compared to patients with severe OSA/H, even after adjustment for sex and BSQ score, remains uncertain.

 

[nataliezzz]

A few threads related to impact of treatment of OSA on restless legs syndrome (RLS):

• Treatment of Comorbid OSA by Upper Airway Stimulation Results in Resolution of Debilitating Symptoms of Restless Legs Syndrome, 2018, Myc et al.
• Outcome of restless legs severity after CPAP treatment in patients affected by the association of RLS and OSA, 2006, Delgado Rodrigues et al.
• ...the impact of OSA syndrome treatment in patients with previously diagnosed, clinically significant restless legs syndrome, 2017, Silva et al.

 

[Clio]

Any research treating "functional somatic syndromes" as an actual thing is unlikely to be good. Isn't half of this forum based on debunking this psychosomatic ideology?

 

[nataliezzz]

Any research treating "functional somatic syndromes" as an actual thing is unlikely to be good. Isn't half of this forum based on debunking this psychosomatic ideology?

I'm not really concerned with what "half of this forum" is doing, to be honest. I'm here creating an archive of the evidence related to obstructive sleep-disordered breathing (UARS/OSAS) and a variety of unexplained disorders to share with people who may be interested in reading about it and possibly researching it (especially sleep doctors, as they will be the ones who will ultimately have to be carrying out these studies) since many people find the Twitter/Bluesky thread format tiresome - if people here want to engage with it that's great, but it's not my primary goal.

Also, there is nothing psychosomatic about a physiological stress response to obstructive sleep-disordered breathing while people are unconscious.