Category: Symptoms

Sleep disturbances and fatigue in women with fibromyalgia and chronic fatigue syndrome

Abstract:

OBJECTIVE: To determine the relationship between sleep disturbances and fatigue in women with fibromyalgia (FM) and those with chronic fatigue syndrome (CFS) and to assess whether any differences existed between the two groups.

DESIGN: Descriptive comparative.

SETTING: Community program on chronic fatigue syndrome and related disorders.

PARTICIPANTS: Sixty-three women who attended the program; 13 had CFS, and 50 had FM.

MAIN OUTCOME MEASURES: A moderately strong relationship between fatigue and sleepiness was found (r = .63, p < .01). Trouble staying asleep was the highest rated sleep disturbance, and fatigue was the most common subjective feeling reported. Women with CFS reported significantly more trouble staying asleep than women with FM, t(61) = 1.81, p < .03.

CONCLUSIONS: Data from this study support that women with FM and CFS encounter problems sleeping. Clinicians are encouraged to assess women with FM and CFS for their quality of sleep rather than amount of sleep. Researchers are encouraged to continue study of sleep disturbances in women with FM and CFS to improve understanding of the disturbances and to test the effectiveness of sleep interventions.

 

Source: Schaefer KM. Sleep disturbances and fatigue in women with fibromyalgia and chronic fatigue syndrome. J Obstet Gynecol Neonatal Nurs. 1995 Mar-Apr;24(3):229-33. http://www.ncbi.nlm.nih.gov/pubmed/7782955

 

Serum levels of carnitine in chronic fatigue syndrome: clinical correlates

Abstract:

Carnitine is essential for mitochondrial energy production. Disturbance in mitochondrial function may contribute to or cause the fatigue seen in chronic fatigue syndrome (CFS) patients. One previous investigation has reported decreased acylcarnitine levels in 38 CFS patients.

We investigated 35 CFS patients (27 females and 8 males); our results indicate that CFS patients have statistically significantly lower serum total carnitine, free carnitine and acylcarnitine levels, not only lower acylcarnitine levels as previously reported. We also found a statistically significant correlation between serum levels of total and free carnitine and clinical symptomatology. Higher serum carnitine levels correlated with better functional capacity.

These findings may be indicative of mitochondrial dysfunction, which may contribute to or cause symptoms of fatigue in CFS patients.

 

Source: Plioplys AV, Plioplys S. Serum levels of carnitine in chronic fatigue syndrome: clinical correlates. Neuropsychobiology. 1995;32(3):132-8. http://www.ncbi.nlm.nih.gov/pubmed/8544970

 

Sleep, neuroimmune and neuroendocrine functions in fibromyalgia and chronic fatigue syndrome

Abstract:

The justification for disordered chronobiology for fibromyalgia and chronic fatigue syndrome (CFS) is based on the following evidence: The studies on disordered sleep physiology and the symptoms of fibromyalgia and CFS; the experimental studies that draw a link between interleukin-1 (IL-1), immune-neuroendocrine-thermal systems and the sleep-wake cycle; studies and preliminary data of the inter-relationships of sleep-wakefulness, IL-1, and aspects of peripheral immune and neuroendocrine functions in healthy men and in women during differing phases of the menstrual cycle; and the observations of alterations in the immune-neuroendocrine functions of patients with fibromyalgia and CFS (Moldofsky, 1993b, d). Time series analyses of measures of the circadian pattern of the sleep-wake behavioural system, immune, neuroendocrine and temperature functions in patients with fibromyalgia and CFS should determine whether alterations of aspects of the neuro-immune-endocrine systems that accompany disordered sleep physiology result in nonrestorative sleep, pain, fatigue, cognitive and mood symptoms in patients with fibromyalgia and CFS.

 

Source: Moldofsky H. Sleep, neuroimmune and neuroendocrine functions in fibromyalgia and chronic fatigue syndrome. Adv Neuroimmunol. 1995;5(1):39-56. http://www.ncbi.nlm.nih.gov/pubmed/7795892

 

Vestibular function test anomalies in patients with chronic fatigue syndrome

Abstract:

Chronic fatigue syndrome (CFS) is distinguished by the new onset of debilitating fatigue that lasts at least 6 months, concomitant with other symptoms to be described later. Many CFS patients complain of disequilibrium, yet the exact type of the balance dysfunction and its function and its location (peripheral vs. central) have not been described.

Herein we report results of vestibular function testing performed on 11 CFS patients. These results revealed no predominant pattern of abnormalities. Patients typically performed below average in dynamic posturography testing, with a significant number of falls in the tests requiring subjects to depend heavily on the vestibular system. One patient had abnormal caloric testing, while 3 had abnormally low earth vertical axis rotation (EVA) gains at the higher frequencies tested.

As a group, the average gain of EVA was significantly lower than normals in the 0.1 – 1.0 Hz range (p < 0.05). In earth horizontal axis rotation, the CFS group had a higher than normal bias value for the optokinetic (OKN) and eyes open in the dark conditions (p < 0.05), but had normal scores during visual vestibular reflex testing. Five of the 11 subjects had an abnormal OKN bias build up over the course of the run, equal to or actually exceeding the 60 degrees/s target velocity by as much as 14 degrees/s.

Altogether, these results are more suggestive of central nervous system deficits than of peripheral vestibular disfunction.

 

Source: Ash-Bernal R, Wall C 3rd, Komaroff AL, Bell D, Oas JG, Payman RN, Fagioli LR. Vestibular function test anomalies in patients with chronic fatigue syndrome. Acta Otolaryngol. 1995 Jan;115(1):9-17. http://www.ncbi.nlm.nih.gov/pubmed/7762393

 

Comparison of patients with chronic fatigue syndrome, fibromyalgia, and multiple chemical sensitivities

Abstract:

BACKGROUND: Chronic fatigue syndrome (CFS), fibromyalgia (FM), and multiple chemical sensitivities (MCS) are conditions associated with fatigue and a variety of other symptoms that appear to share many clinical and demographic features. Our objectives were to describe the similarities and differences among patients with CFS, FM, and MCS. Additional objectives were to determine how frequently patients with MCS and FM met the criteria for CFS and if they differed in their health locus of control.

METHODS: Demographic, clinical, and psychosocial measures were prospectively collected in 90 patients, 30 each with CFS, FM, and MCS. Patients were recruited from a university-based referral clinic devoted to the evaluation and treatment of chronic fatigue and three private practices. Variables included demographic features, symptoms characteristic of each condition, psychological complaints, a measure of health locus of control, and information on health care use.

RESULTS: Overall, the three patient groups were remarkably similar in demographic characteristics and the presence of specific symptoms. Patients with CFS and FM frequently reported symptoms compatible with MCS. Likewise, 70% of patients with FM and 30% of those with MCS met the criteria for CFS. Health care use was substantial among patients with CFS, FM, and MCS, with an average of 22.1, 39.7, and 23.3 visits, respectively, to a medical provider during the prior year. Health locus of control did not differ among the three populations.

CONCLUSIONS: In general, demographic and clinical factors and health locus of control do not clearly distinguish patients with CFS, FM, and MCS. Symptoms typical of each disorder are prevalent in the other two conditions.

Comment in: Chronic fatigue, fibromyalgia, and chemical sensitivity: overlapping disorders. [Arch Intern Med. 1995]

 

Source: Buchwald D, Garrity D. Comparison of patients with chronic fatigue syndrome, fibromyalgia, and multiple chemical sensitivities. Arch Intern Med. 1994 Sep 26;154(18):2049-53. http://www.ncbi.nlm.nih.gov/pubmed/8092909

 

Gender differences in patients with chronic fatigue syndrome

Abstract:

OBJECTIVE: To determine whether there are differences between men and women patients who have chronic fatigue syndrome (CFS) and, if so, to ascertain whether a gender-related pattern exists.

DESIGN: A descriptive study of demographic, clinical, and psychosocial measures, the results of which were prospectively collected for patients who had CFS.

SETTING: A university-based referral clinic devoted to the evaluation and management of chronic fatigue.

PATIENTS: 348 CFS patients who had undergone complete medical evaluations.

MEASURES: Clinical variables included symptoms, physical examination findings, and laboratory results. Psychosocial assessment consisted of a structured psychiatric interview, the Medical Outcomes Study Short-form General Health Survey to assess functional status, the General Health Questionnaire to ascertain psychological distress, the Multidimensional Health Locus of Control, and measures of attribution, social support, and coping.

MAIN RESULTS: Overall, few gender-related differences were identified. Women had a higher frequency of tender or enlarged lymph nodes (60% versus 33%, p < or = 0.01) and fibromyalgia (36% versus 12%, p < or = 0.001) and lower scores on the physical functioning subscale of the Medical Outcomes Study Short-form General Health Survey (37.6 versus 52.2, p < 0.01); men more often had pharyngeal inflammation (42% versus 22%, p < or = 0.001) and reported a higher lifetime prevalence of alcoholism (20% versus 9%, p < or = 0.01).

CONCLUSIONS: In general, demographic, clinical, and psychosocial factors do not distinguish men from women CFS patients.

 

Source: Buchwald D, Pearlman T, Kith P, Schmaling K. Gender differences in patients with chronic fatigue syndrome. J Gen Intern Med. 1994 Jul;9(7):397-401. http://www.ncbi.nlm.nih.gov/pubmed/7931750

 

Alpha-delta sleep in patients with a chief complaint of chronic fatigue

Abstract:

Our prospective, standardized cohort study was designed to assess the presence of alpha wave intrusions during non-rapid eye movement sleep (alpha-delta sleep) and its relationship to fibromyalgia, major depression, and chronic fatigue syndrome (CFS) in patients with a chief complaint of chronic fatigue.

The study group comprised 30 consecutive patients seen at a university hospital referral clinic for evaluation of chronic fatigue. All patients had nocturnal polysomnography, dolorimetric tender point assessment for fibromyalgia, a comprehensive history, physical, and laboratory evaluation, and a structured psychiatric interview. Alpha-delta sleep was identified in 8 of the 30 patients (26%), major depression in 20 (67%), CFS in 15 (50%), and fibromyalgia in 4 (13%). Ten of the 30 patients (33%) had a primary sleep disorder (sleep apnea, periodic limb movements, or narcolepsy).

Alpha-delta sleep was not significantly correlated with fibromyalgia, CFS, major depression, or primary sleep disorders, but was significantly more common among patients who had chronic fatigue without major depression. We conclude that primary sleep disorders are relatively common among patients with chronic fatigue and must be diligently sought and treated. Alpha-delta sleep is not a marker of fibromyalgia or CFS, but may contribute to the illness of nondepressed patients with these conditions.

Comment in: Sleep disorders and chronic fatigue. [South Med J. 1994]

 

Source: Manu P, Lane TJ, Matthews DA, Castriotta RJ, Watson RK, Abeles M. Alpha-delta sleep in patients with a chief complaint of chronic fatigue. South Med J. 1994 Apr;87(4):465-70. http://www.ncbi.nlm.nih.gov/pubmed/8153772

 

The ocular signs and symptoms of chronic fatigue syndrome

Abstract:

BACKGROUND: Chronic Fatigue syndrome (CFS) is a relatively newly defined clinical entity that affects multiple systems including the ocular system. These effects have not been well documented.

METHODS: 25 consecutive CFS patients were evaluated and the ocular signs and symptoms were described.

RESULTS: Significant ocular symptoms were present in all 25 patients. The most common clinical findings were abnormalities of the preocular tear film and ocular surface (19 patients) and reduced accommodation for age (18 patients).

CONCLUSIONS: CFS affects the ocular system in many ways. Eye care practitioners should pay particular attention to accommodative needs, ocular surface disease and tear film dysfunction when examining these patients. Further research into the pathophysiology of these ocular findings may lead to a better understanding of the pathophysiology of CFS.

 

Source: Caffery BE, Josephson JE, Samek MJ. The ocular signs and symptoms of chronic fatigue syndrome. J Am Optom Assoc. 1994 Mar;65(3):187-91. http://www.ncbi.nlm.nih.gov/pubmed/8201170

 

Single fibre EMG studies in chronic fatigue syndrome: a reappraisal

Abstract:

Single fibre EMG studies were carried out on the right extensor digitorum communis muscle in 30 subjects with chronic fatigue syndrome and in 30 age and sex matched controls. Abnormal jitter was seen in five patients with chronic fatigue syndrome. Slight but significant differences between the mean consecutive differences in the remainder of the chronic fatigue subjects and the control subjects were recorded. Overall the differences were so minor that it seems unlikely that a disturbance of neuromuscular function as reflected by jitter measurement has a pathogenetic role. It is suggested that the increased jitter seen may be explained by the effects of the variability of motor unit firing rates on the myogenic component of the jitter.

Comment in: Single fibre EMG studies in chronic fatigue syndrome: a reappraisal. [J Neurol Neurosurg Psychiatry. 1994]

 

Source: Roberts L, Byrne E. Single fibre EMG studies in chronic fatigue syndrome: a reappraisal. J Neurol Neurosurg Psychiatry. 1994 Mar;57(3):375-6. http://www.ncbi.nlm.nih.gov/pubmed/8158191

You can read the full article here: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1072834/pdf/jnnpsyc00033-0119.pdf

 

Chronic fatigue syndrome: a novel disorder with cutaneous manifestations

Abstract:

Persistent and disabling fatigue associated with low-grade fever and other constitutional symptoms, without any known disorder that accounts for it, is recognized as chronic fatigue syndrome (CFS). Skin lesions occur in 10-35% of patients, but their description is inaccurate. Recurrent aphthous stomatitis or persistent Epstein-Barr virus (EBV)-related erythema multiforme have also been reported. Patients may be diagnosed as having CFS only when they fulfill at least 2 major and 8 minor criteria. Major criteria are the presence of debilitating fatigue persisting or recurring for at least 6 months and the absence of any other medical disorder that may explain it. Although different viral or nonviral etiologies have been documented, evidence implicating EBV is gaining support.

 

Source: Rebora A, Drago F. Chronic fatigue syndrome: a novel disorder with cutaneous manifestations. Dermatology. 1994;188(1):3-5. http://www.ncbi.nlm.nih.gov/pubmed/8305753