Polysomnography in idiopathic muscle pain syndrome (fibrositis)

Silva, A. B.; Bertoríni, T. E.; Lemmi, H.

doi:10.1590/S0004-282X1991000400012

Abstracts

Muscle pain occurs in various neuromuscular disorders with characteristic physiological or biochemical abnormalities. There is, however, a group of patients in whom there is no clear physiological or structural basis for their pains. This syndrome has been called fibrositis or fibromyalgia. Sleep abnormalities have been reported in some of these patients, but have not been confirmed by others. We studied 8 patients with this disorder and found sleep abnormalities that were characterized by nocturnal myoclonus, alpha-delta sleep, and abnormalities compatible with depression. Polysomnography was, therefore, instrumental in helping direct the treatment of these patients. Therapeutic approaches aimed to correct the specific disorders were effective in improving the pain symptoms

Dor muscular ocorre em diversas doenças neuromusculares com anormalidades fisiológicas e bioquímicas características. Contudo, há um grupo de pacientes nos quais não são detectadas claramente bases fisiológicas ou estruturais que expliquem suas dores. A síndrome tem sido também chamada fibrosite ou fibromialgia. Anormalidades do sono têm sido relatadas em alguns desses pacientes, embora nem sempre confirmadlas. Estudamos 8 pacientes com esse quadro e encontramos anormalidades do sono caracterizadas por mioclono noturno, sono alfa-delta e anormalidades compatíveis a depressão. Asism, a polissonografia é método auxiliar útil no estabelecimento do modo de tratar desses pacientes. As medidas terapêuticas adotadas visavam a corrigir as desordens específicas encontradas, tendo sido eficazes para aliviar os sintomas de dor.

CONTENTS CONTEÚDO

A. B. Silva^I; T. E. Bertoríni^II; H. Lemmi^III

^ISleep Disorders Center, Baptist Memorial Hospital, Memphis, TN

^IIDepartment of Neurology, The University of Tennessee, Memphis, TN

^IIIDirector, Sleep Disorders Center. Presented at the American Neurolgical Association, Philadelphia, PA, USA, 1988.

SUMMARY

Muscle pain occurs in various neuromuscular disorders with characteristic physiological or biochemical abnormalities. There is, however, a group of patients in whom there is no clear physiological or structural basis for their pains. This syndrome has been called fibrositis or fibromyalgia. Sleep abnormalities have been reported in some of these patients, but have not been confirmed by others. We studied 8 patients with this disorder and found sleep abnormalities that were characterized by nocturnal myoclonus, alpha-delta sleep, and abnormalities compatible with depression. Polysomnography was, therefore, instrumental in helping direct the treatment of these patients. Therapeutic approaches aimed to correct the specific disorders were effective in improving the pain symptoms

RESUMO

Dor muscular ocorre em diversas doenças neuromusculares com anormalidades fisiológicas e bioquímicas características. Contudo, há um grupo de pacientes nos quais não são detectadas claramente bases fisiológicas ou estruturais que expliquem suas dores. A síndrome tem sido também chamada fibrosite ou fibromialgia. Anormalidades do sono têm sido relatadas em alguns desses pacientes, embora nem sempre confirmadlas. Estudamos 8 pacientes com esse quadro e encontramos anormalidades do sono caracterizadas por mioclono noturno, sono alfa-delta e anormalidades compatíveis a depressão. Asism, a polissonografia é método auxiliar útil no estabelecimento do modo de tratar desses pacientes. As medidas terapêuticas adotadas visavam a corrigir as desordens específicas encontradas, tendo sido eficazes para aliviar os sintomas de dor.

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Dr. Tulio E. Bertorini - The University of Tennessee, Department of Neurology - 956 Court Avenue, Room B 212 - Memphis, TN 38163 - USA.

1. Ahles TA, Yunus MB, Riley SD, Bradley JM, Masi AT. Psychological factors associated wita primary fibromyalgia syndrome. Arthritis Rheum 1984, 27:1101.
2. Akiskal HS, Lemmi H, Yerevanian B, King D, Belluomini J. The utility of the REM latency test in psychiatric diagnosis: a study of 81 depressed outpatients. Psychiat Res 1982, 7:101.
3. Bird HA. Sleep in rheumatic diseases. Intern Med Specialist 1987, 8:133.
4. Campbell SM, Clark S, Tindall EA, Forehand ME, Bennett RM. Clinical characteristics of fibrositis : I. A «blinded» control study of symptoms and tender points. Arthritis Rheum 1983, 26:817.
5. Coble P, Foster FG, Kupfer DJ. Electroencephalographic sleep diagnosis of primary depression. Arch Gen Psychiat 1976, 33:1124.
6. Golden H. Weber SM, Bergen D. Sleep studies in patients with fibrositis syndrome. Arthritis Rheum 1983, 26:S32.
7. Goldenberg D. Psychological studies in fibrositis. Am J Med 1986, 81:67.
8. Goldenberg DL. Fibromyalgia syndrome: an emerging but controversial condition. JAMA 1987, 257:2782.
9. Gupta MA, Moldofsky H. Dysthymic disorder and rheumatic pain modulation disorder (fibrositis syndrome) : a comparison of symptoms and sleep physiology. Can J Psychiat 1986, 31:608.
10. Hauri P. Hawkins DR. Alpha-delta sleep. Electroenceph Clin Neurophysiol 1973, 34:233.
11. Henriksson KG, Bengtsson A, Larsson J, Lindström F, Thornell L-E. Muscle biopsy findings of possible diagnostic importance in primary fibromyalgia (fibrositis, myofascial syndrome). Lancet 1982, 2:1396.
12. Hudson JI. Hudson MS, Pliner LF, Goldesberg DL, Pope HG Jr. Fibromyalgia and major affective disorder: a controlled phenomenology and family history study. Am J Psychiat 1985. 142:441.
13. Kalyan-Raman UP, Kalyan-Raman K. Tunis MB, Masi AT. Muscle pathology in primary fibromyalgia syndrome: a light microscopic, histochemical and ultrastructural study. J Rheumatol 1984, 11:808.
14. Kaplan H. Brooke MH. Histochemical study of muscle in rheumatoid diseases. Arthritis Rheum 1971, 14:168.
15. Kupfer DJ, Foster FG. EEG, sleep and depression. In Williams RL, Karacan I (eds) : Sleep Disorders: Diagnosis and Treatment. New York: John Wiley & Sons, 1978.
16. Moldofsky H. Sleep and musculoskeletal pain. Am J Med 1986, 81:85.
17. Moldofsky H, Lue FA. The relationship of alpha and delta EEG frequencies to pain and mood in fibrositis patients treated with chlorpromazine and L-tryptophan. Electroenceph Clin Neurophysiol 1980, 50:71.
18. Moldofsky H, Lue FA, Smythe HA. Alpha EEG sleep and morning symptoms in rheumatoid arthritis. J Rheumatol 1983, 10:373.
19 Moldofsky H, Scarisbrick P, England R, Smythe H. Musculoskeletal symptoms and non-REM sleep disturbance in patients with fibrositis syndrome and healthy subjects. Psychosom Med 1975, 37:341.
23, Moldofsky H, Tullis C, Lue FA, Quance G, Davidson BA. Sleep-related myoclonus in rheumatic pain modulation disorder (fibrositis syndrome) and in excessive daytime somnolence. Psychosom Med 1984, 46:145.
21. Payne TC. Leavit F, Garron DC, Katz RS, Golden HE, Glickman PB, Vanderplate C. Fibrositis and psychologic disturbance. Arthritis Rheum 1982, 25:213.
22. Rechshaffen A, Kales A (eds). A Manual of Standardized Terminology : Techniques and Scoring System for Sleep Stages of Human Subjects. Washington DC: NIH Publication #204, Superintendent of Documents, US Government Printing Office, 1968.
23. Roy P, Gutman L. Myalgias in muscle disease. Neurol Clin 1988, 6:621.
24. Saskin P, Moldofsky H, Lue FA. Sleep and posttraumatic rheumatic pain modulation disorder (fibrositis syndrome). Psychosom Med 1986, 48:319.
25. Yunus M, Masi AT, Calabro JJ, Miller KA, Feigenbaum SL. Primary fibromyalgia (fibrositis) : clinical study of 50 patients with matched normal controls. Semin Arthritis Rheum 1981, 11:151.