Sleep Monitoring Indicators Similar in OSA Patients With and Without Fibromyalgia

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A new meta-analysis found sleep monitoring indicators were similar in patients with obstructive sleep apnea-hypopnea syndrome (OSAHS) who had fibromyalgia and who did not.¹

“This systematic evaluation and meta-analysis provide unique information on the clinical correlates of [fibromyalgia] in patients with OSAHS,” wrote investigators, led by Jie He, from the Clinical Medical College of Chengdu Medical College in China.

OSAHS, characterized by apnea and decreased respiration and oxygen saturation levels, may lead to daytime sleepiness, fatigue, and inattention. Patients with this sleep disorder often have fibromyalgia, and the 2 conditions have similar symptoms, such as lack of concentration, depression, insomnia, mood swings, drowsiness, and lethargy.²

Most studies have evaluated the sleep quality of patients with fibromyalgia since there are no noticeable differences in sleep duration between patients with and without fibromyalgia.¹ This analysis sought to assess the differences in sleep monitoring indicators between patients with OSAHS who have fibromyalgia and those with OSAHS who do not.

The team analyzed the incidence of fibromyalgia in patients with OSAHS in 14 studies, pulled from the online databases of PubMed, EMBASE, Web of Science, CNKI, and Wanfang up to March 1, 2024. They also compared the sleep monitoring indicator markers in patients with and without fibromyalgia, which were AHI scores, minimum SaO2 level, mean saturation oxygen level, total sleep duration, efficiency, latency, rapid eye movement, N1, N2, N3, and Epworth sleepiness scale scores.

Inclusion criteria included cohort studies, cross-sectional studies, case-control studies, randomized controlled trials, and clinical fibromyalgia diagnosis criteria of fibromyalgia created by the American College of Rheumatology (ACR) in 1990, 2010, and 2017. Participants met the OSAHS diagnostic criteria if they had an apnea-hypopnea index [AHI] score of ≥ 5/h (adults) and ≥ 1/h (children).

In total, the study included 23,473 patients—4308 who tested positive and 19,169 who tested negative for fibromyalgia.

The analysis revealed 21% of patients with OSAHS experienced fibromyalgia (95% confidence interval [CI], 0.16 – 0.26; P < .001). Subgroup analyses adjusted for race, age, sex, body mass index (BMI), and diagnostic criteria for patients with OSAHS found females, as well as obese patients, have a greater risk of fibromyalgia.

Compared to males’ overall fibromyalgia incidence of 3%, females had a fibromyalgia incidence of 23% (95% CI, 0.11 – 0.35; P < .001). Another subgroup analysis showed a 25% incidence of OSAHS and positive fibromyalgia among patients with a mean BMI ≥ 30 (95% CI, 0.13 – 0.38; P < .001). Patients with a lower BMI (< 30) had an incidence of 18% OSAHS and positive fibromyalgia (95% CI, 0.12 – 0.25; P < .001).

No Differences Between Sleep Monitoring Indicators

However, when examining sleep monitoring indicators, investigators observed no distinct differences between patients with OSAHS with fibromyalgia and those without fibromyalgia:

• AHI score: 95% CI, −3.62 to 1.10; P = .296
• Total sleep time: 95% CI, −2.83 to 22.65; P = .128
• Sleep latency: 95% CI, −7.53 to 6.43; P = .878
• Sleep Efficiency: 95% CI, −0.56 to 3.45; P = .154
• REM: 95% CI, −23.39 to 9.50; P = .408
• Epworth Sleepiness Scale: 95% CI, −1.20 to 1.05, P = .893
• N1/N2/N3:
  • N1: 95% CI, −7.16 to 0.78, P = 0.054
  • N2: 95% CI, −3.96 to 2.67, P = 0.704
  • N3: 95% CI, −3.14 to 3.85, P = 0.844
• Mean SaO2 level: 95% CI, −0.43 to 2.71, P = 0.154

The analysis found patients with fibromyalgia had slightly lower minimum arterial oxygen saturation levels than those without (95% CI, −3.84 to 0.04, P = .045).

Ultimately, the study showed patients with OSAHS have a high incidence of fibromyalgia, but fibromyalgia has little effect on polysomnographic indicators of OSAHS.

“The current literature suggests that patients with OSAHS have a high incidence of [fibromyalgia] (21%), and [fibromyalgia] has little effect on polysomnographic indicators of OSAHS,” investigators wrote.

References

1. ^{He J, Chen M, Huang N, Wang B. Fibromyalgia in obstructive sleep apnea-hypopnea syndrome: a systematic review and meta-analysis. Front Physiol. 2024;15:1394865. Published 2024 May 20. doi:10.3389/fphys.2024.1394865}
2. ^{Fibromyalgia Pain & Sleep Apnea. Apnea Med. January 18, 2024. https://www.apneamed.org/blogs/info/fibromyalgia-pain-sleep-apnea. Accessed June 17, 2024.}