Sleep and Sleep Complaints in Juvenile Fibromyalgia Syndrome

Clara Malattia; Lorenzo Chiarella; Miriam Sansone; Angela Pistorio; Claudio Lavarello; Manuela Carpaneto; Raffaele Ferri; Angelo Ravelli; Lino Nobili

doi:10.3899/jrheum.220720

Sleep and Sleep Complaints in Juvenile Fibromyalgia Syndrome

J Rheumatol. 2023 Jun;50(6):827-834. doi: 10.3899/jrheum.220720. Epub 2023 Jan 15.

Authors

Clara Malattia¹, Lorenzo Chiarella², Miriam Sansone², Angela Pistorio³, Claudio Lavarello⁴, Manuela Carpaneto⁵, Raffaele Ferri⁶, Angelo Ravelli⁷, Lino Nobili²

Affiliations

¹ C. Malattia, MD, PhD, Clinica Pediatrica e Reumatologia, IRCCS Istituto Giannina Gaslini, and Department of Neurosciences, Rehabilitation, Ophthalmology, Genetic and Maternal Infantile Sciences, University of Genoa, Genoa; claramalattia@gaslini.org.
² L. Chiarella, MD, M. Sansone, MD, L. Nobili, MD, Department of Neurosciences, Rehabilitation, Ophthalmology, Genetic and Maternal Infantile Sciences, University of Genoa, and Child Neuropsychiatry Unit, IRCCS Istituto Giannina Gaslini, Genoa.
³ A. Pistorio, MD, Direzione Scientifica, IRCCS Istituto Giannina Gaslini, Genoa.
⁴ C. Lavarello, MD, Clinica Pediatrica e Reumatologia, IRCCS Istituto Giannina Gaslini, Genoa.
⁵ M. Carpaneto, MD, SS Antonio e Biagio e Cesare Arrigo Hospital, Child Neuropsychiatry Unit, Alessandria.
⁶ R. Ferri, MD, Sleep Research Centre, Oasi Institute Research, IRCCS, Troina.
⁷ A. Ravelli, MD, Department of Neurosciences, Rehabilitation, Ophthalmology, Genetic and Maternal Infantile Sciences, University of Genoa, and Direzione Scientifica, IRCCS Istituto Giannina Gaslini, Genoa, Italy.

PMID: 36642430
DOI: 10.3899/jrheum.220720

Abstract

Objective: To investigate sleep quality in juvenile fibromyalgia syndrome (JFS) and its effect on the global burden of the disease.

Methods: Consecutive patients with JFS who performed full-night polysomnography (PSG) were included in this cross-sectional study. JFS-related symptoms, neuropsychiatric features, and sleep quality were assessed using self-report measures. PSG sleep parameters, including N3 distribution index, were obtained from patients and age-matched healthy controls.

Results: We included 25 patients (20 females, median age 15.7 yrs). Nonrestorative sleep was reported by 22 of 25 (88%) patients. Patients with JFS showed significantly longer sleep period time (P = 0.004) and increased wake after sleep onset (P = 0.03) compared to healthy peers. The N3 distribution index was significantly lower in patients than in the control group (P = 0.02). Subjective poor sleep quality was related to Widespread Pain Index (WPI; r _s -0.65), Symptom Severity Scale (r _s -0.64), depressive symptoms (r _s -0.58), fatigue (r _s -0.44), and symptom severity upon awakening (r _s -0.65). The N3 distribution index was correlated to depressive symptoms (r _s 0.41) and irritability (r_s 0.40). On multiple regression analysis, WPI was predicted by subjective sleep quality (β -0.32, P = 0.04), whereas depressive symptoms were predicted by subjective sleep measures (β -0.32, P = 0.04) and PSG parameters (N3 min: β -0.07, P = 0.03).

Conclusion: Sleep complaints are a key hallmark of JFS and have significant effect on relevant clinical domains of the disease, such as pain and depression.

Keywords: depression; fatigue; juvenile fibromyalgia; musculoskeletal pain; polysomnography; sleep.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Adolescent
Cross-Sectional Studies
Fatigue / diagnosis
Female
Fibromyalgia* / diagnosis
Humans
Pain / diagnosis
Sleep
Sleep Wake Disorders* / diagnosis
Sleep Wake Disorders* / etiology