1. The influence of depression symptoms and sleep quality on the functional level of FMS patients I. Bouloukaki1, L. Konstantara1, C. Mermigkis1, E. Markakis2, E. Mauroudi1, V. Moniaki1, S. Schiza1 1 Sleep Disorders Center, Department of Thoracic Medicine, University of Crete, Heraklion, Greece
BACKGROUND:
Fibromyalgia (FMS) symptoms are often associated with sleep disturbances and depression.
Although the underlying mechanism mediating depression and pain is not fully understood, a bidirectional relationship between pain and depression exists, with the symptoms of one worsening the other or making the other more likely to develop.
Table 2. Selected PSG variables of the total FMS sample and comparison between the groups.
N=22
BDI<10
BDI>10
P-Value
Diagnostic PSG
SE (%)
68.6 ± 9.7
67.3 ± 8.6
69.2 ± 10.8
0.68
WASO (min)
91.3 ± 31.4
99.1 ± 40.0
87.7 ± 27.4
0.44
NREM (%)
85.4 ± 17.8
75.3 ± 30.0
90.1 ± 4.1
0.06
SWS (%)
8.3 ± 6.5
5.8 ± 2.3
9.5 ± 7.5
0.23
REM (%)
10.4 ± 4.7
11.6 ± 6.0
9.9 ± 4.1
Sleep latency (min)
55.1 ± 51.4
65.6 ± 56.1
50.3 ± 50.2
0.53
REM latency (min)
228.8 ± 82.9
229.6 ± 68.0
228.5 ± 91.2
0.98
AHI
2.6 ± 2.2
2.6 ± 2.8
2.6 ± 1.9 AI
34.3 ± 11.8
30.9 ± 12.6
46.3± 12.0
0.02
ODI
2.6 ± 2.3
2.1 ± 2.6
2.8 ± 2.2
0.56
Mean SaO2 (%)
96.1 ± 1.2
96.3 ± 1.5
96.0 ± 1.1
0.62
Minimum SaO2 (%)
90.6 ± 3.1
90.1 ± 3.5
90.9 ± 2.9
AIM: To assess the influence of depression and sleep quality on the functional level of patients with FMS.
METHODS: 
Forty one patients were evaluated in the Sleep Disorders unit over 5 years meeting standard clinical criteria for FMS.
The diagnosis of fibromyalgia was made following the fibromyalgia diagnostic criteria of the American College of Rheumatology (ARA 2010 version).
All patients underwent polysomnography.
The Fibromyalgia Impact Questionnaire (FIQ) assessed participants’ severity of symptoms.
Depression level was assessed with Beck Depression Inventory (BDI).
Subjective daytime sleepiness was assesed by Epworth sleepiness scale (ESS).
Figure 1: Questionnaire scores by clinical depression symptoms
Questionnaires
Group 2
N=22
BDI<10
Ν=7
BDI>10
Ν=15
P-Value
FIQ
48.5 ± 24.7
41.2 ± 24.2
51.6± 25.3
0.45
BDI
15.9 ± 8.1
8.7 ± 1.4
17.7 ± 7.8
0.008
ESS
10.7 ± 5.2
12.0 ± 4.2
10.0 ± 5.7
0.42
RESULTS II:
A statistically significant correlation was found between FIQ scores and SE (%) (r=0.52, p=0.03), presence of diabetes (r=0.52, p=0.032) as well as Sleep latency (r=-0.61, p=0.009),
Furthermore, a statistically significant trend was noted between FIQ and BDI (r=044, p=0.07), WASO (r=0.44, p=0.07) and mean SaO2 (%) values (r = -0.46, p = 0.05).
RESULTS I:
Ninteen out of 41 patients were excluded due to the presence of Obstructive sleep apnea.
Fifteen of the patients (63.6%) with FMS assessed in this study reported to be clinically depressed according to the BDI (BDI>10).
Subgroup analysis was performed, according to BDI score.
Table 1. Baseline demographic characteristics of the total FMS sample and comparison in parameters between 2 groups.
CONCLUSIONS:
Symptom severity in FMS patients seems to be associated with depression and objective alterations in some variables of the sleep quality.
Furthermore, patients with both FMS and depression exhibited lesser consolidated sleep, suggesting more severe impairment in sleep quality.
Characteristics
N=22
BDI<10
Ν=7
BDI>10
Ν=15
P-Value
Age (years)
48.7 ± 11.5
49.1 ± 13.0
48.5 ± 11.2
0.91
Gender, male (%)
1 (4.7%)
1 (14.3%)
0.32
Menopause, n (%)
9 (40.9%)
7 (46.6%)
0.21
BMI (kg/m2)
26.3 ± 4.8
23.6 ± 1.7
27.6 ± 5.3
0.06
Current smokers, n (%)
4 (18.2%)
1 (14,3%)
3 (20%)
0.94
Comorbidities
Diabetes mellitus, n (%)
3 (13.6%)
2 (13.3%)
0.95
Hypertension, n (%)
4 (26.6%)
0.13
Hypothyroidism, n (%)
8 (36.4%)
2 (28.6%)
6 (40%)
0.60
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