Tag: sleep

The effect of comorbid medical diagnoses on disturbed sleep in chronic fatigue syndrome

Abstract:

Background: Chronic fatigue syndrome [CFS] may occur alone or with fibromyalgia. This has led some to believe the two occur along a common illness spectrum. Evaluating whether this is the case is important as differences in burden or severity of CFS with fibromyalgia (FM) would suggest different underlying pathophysiological processes.

Objective: To determine if Insomnia Severity Index [ISI] scores differ between patients with CFS and those with CFS plus FM. In addition, we aim to determine if insomnia severity is impacted by other comorbid medically unexplained diagnoses.

Methods: 247 patients with CFS completed the ISI and the Centers for Epidemiological Study – Depression. Patient groups were stratified on CFS severity and the presence of FM. A secondary analysis was conducted to evaluate insomnia severity related to the number of comorbid medically unexplained diagnoses including, FM, multiple chemical sensitivity and/or irritable bowel syndrome.

Results: When controlling for depressed mood, ISI did not differ significantly across patient groups defined by CFS severity and FM status. However, independent of mood, ISI was sensitive to multiple diagnoses showing a significant increasing trend from CFS alone to CFS plus one, two or three comorbid diagnoses.

Conclusion: Although CFS severity and FM status do not impact insomnia severity, increased illness burden as manifested by multiple medically unexplained diagnoses does appear to influence insomnia. In contrast to our earlier studies, this study did not find that a comorbid diagnosis of FM in patients with CFS is related to a worse outcome in the variable of interest.

Source: Aaron J. Stegner, Michelle Blate & Benjamin H. Natelson (2024) The effect of comorbid medical diagnoses on disturbed sleep in chronic fatigue syndrome, Fatigue: Biomedicine, Health & Behavior, DOI: 10.1080/21641846.2024.2322915 https://www.tandfonline.com/doi/full/10.1080/21641846.2024.2322915

Impact of sleep disruption on cognitive function in patients with postacute sequelae of SARS-CoV-2 infection: initial findings from a Neuro-COVID-19 clinic

Abstract:

Introduction: Fatigue, brain fog, and sleep disturbance are among the most common symptoms of postacute sequelae of SARS-CoV-2 infection (PASC). We sought to determine the impact of sleep disruption on cognition and quality of life in patients with neurologic manifestations of PASC (Neuro-PASC).
Methods: Thirty-nine patients were recruited from Neuro-COVID-19 clinic. Mean age was 48.1 years, 71.8% were female, and 82% were never hospitalized for COVID-19. Patients were evaluated via clinical assessment, quality-of-life measures in domains of cognitive function, fatigue, sleep disturbance, anxiety, and depression, NIH Toolbox cognitive tests, and 7 days of wrist actigraphy.
Results: The median number of neurologic symptoms attributed to PASC was 6, with brain fog being the most common in 89.7%. Regarding non-neurologic symptoms, 94.9% complained of fatigue and 74.4% of insomnia. Patients reported significant impairment in all quality-of-life domains and performed worse in a task of attention compared to a normative US population. Actigraphy showed Neuro-PASC patients had lower sleep efficiency, longer sleep latency (both p < 0.001), and later sleep midpoint (p = 0.039) compared to 71 age-matched healthy controls with no PASC history. Self-reported cognitive symptoms correlated with the severity of fatigue (p < 0.001), anxiety (p = 0.05), and depression (p < 0.01). Objective evidence of sleep disruption measured by wakefulness after sleep onset, sleep efficiency, and latency were associated with decreased performance in attention and processing speed.
Conclusion: Prospective studies including larger populations of patients are needed to fully determine the interplay of sleep disruption on the cognitive function and quality of life of patients with PASC.

Source: Kathryn J Reid, Louis T Ingram, Millenia Jimenez, Zachary S Orban, Sabra M Abbott, Daniela Grimaldi, Kristen L Knutson, Phyllis C Zee, Igor J Koralnik, Mathew B Maas, Impact of sleep disruption on cognitive function in patients with postacute sequelae of SARS-CoV-2 infection: initial findings from a Neuro-COVID-19 clinic, SLEEP Advances, Volume 5, Issue 1, 2024, zpae002, https://doi.org/10.1093/sleepadvances/zpae002 https://academic.oup.com/sleepadvances/article/5/1/zpae002/7517273 (Full text)

Sleep Issues Amongst People With ME – A Conversation with Professor Dorothy Bruck

by Bronc

Just before Xmas 2010 I was overcome by a bout of Swine Flu. After the holiday, which was a complete blur due to sickness, I went back to work in January feeling very weak. Over the course of the next 8 months, up until my diagnosis of ME, I was afflicted by a bewildering variety of symptoms which caused a great deal of physical and mental suffering. The symptoms which affected me the most in some respects were the unrefreshing sleep and acute insomnia which made me fear that I would lose my job. I was working over 50 hours a week in a very stressful and physically demanding job which I increasingly struggled to keep onto partly due to the lack of sleep/unrefreshing sleep. I noticed a considerable decline in my ability to do some of the basics of my job as I struggled to concentrate and felt increasingly unable to keep up with the very demanding target driven regime at work. Trying to teach a class of 30 teenagers can be hard work at the best of times but when you’re getting 4 hours of unrefreshing sleep it can be a nightmare. Once I received my diagnosis of ME one of the first things I asked my GP for was a course of sleeping tablets to help me overcome the worst of the insomnia.

Since my diagnosis unrefreshing sleep and insomnia have been my constant companions. Sadly, none of the health professionals and scientists I’ve spoken to over the years have been able to offer much insight as to what is causing this and what might help treat it.

There is lack of research into this important aspect of ME. As we all know sleep is the foundation stone of good health for anyone. Those of us who live with dysfunctional sleep all the time it can be very debilitating and have a considerable knock on effect on the other symptoms of our illness.

I recently spoke with Professor Dorothy Bruck about her insights into some of the sleep issues which affect people with ME.

Emeritus Professor Bruck’s main area of research interest and expertise is sleep and sleep health. She has been thinking about, and working with, many aspects of sleep for about 40 years. Professor Bruck has had a long academic career at Victoria University in Melbourne, with particular expertise in sleep/wake behaviour, mental health, chronic fatigue syndrome, waking thresholds and human behaviour in emergencies. She has an international research reputation, with over 120 peer-reviewed full-length publications, $2.5 million in competitive grant income, dozens of invited international and national professional speaking engagements, and numerous awards. Professor Bruck’s research has been regularly featured in the media, including Time Magazine and New Scientist. Apart from her academic work Professor Bruck has worked as a sleep psychologist and most recently she was Chair of the Sleep Health Foundation (Australia). She is now semi-retired and lives in the Far South of Tasmania, Australia.

Q1. How did you get involved in the field of M.E. research?

I have been a sleep researcher since undertaking my Honours degree in 1978, with a particular interest in disorders of excessive daytime sleepiness such as narcolepsy.  In 2010 my teenage son was diagnosed with ME/CFS, which left him bed and recliner bound for about 10 of the next 15 years. Remarkably he has now improved sufficiently to hold a job with flexible hours.  While he was very sick I met ME/CFS clinicians and researchers in Melbourne and we managed to obtain funding for a series of studies focussing on sleep and gut microbes.  We have since published this research with Melinda Jackson and Amy Wallis as the first authors.

Q2. In October 2021 the National Institute for Clinical Excellence in the UK issued a new guideline for the treatment and care of people with M.E. This guideline recognised that for a diagnosis of M.E. to be made people had to suffer from four key symptoms. Unrefreshing sleep or non-restorative sleep is recognised as one of the core symptoms of the illness. The sleep disturbance experienced by pwME can be broken down into two categories: disturbed sleep patterns and unrefreshing sleep. Despite this, there is remarkably little research being conducted into this core symptom of the illness. Amongst the limited studies that have been done into this issue there appears to be no consensus as to what is causing the sleep dysfunction among pwME. How would you explain the sleep dysfunction experienced by pwME?

I think the dichotomy between disturbed sleep patterns and unrefreshing sleep is quite useful, keeping in mind however, that a pwME/CFS may have both.  Neither are unique to ME/CFS.

Disturbed sleep patterns (where the person is unable to sleep when they want to) may arise from co-morbidities with ME/CFS, such as sleep apnea, insomnia and circadian rhythm disorders. Sometimes the latter two disorders may begin with, or be perpetuated by, behavioural changes in sleep/wake behaviours that lead to disturbed sleep.

  • For example, the fatigue associated with ME/CFS may lead to irregular sleep patterns where the person sleeps episodically (i.e. naps) across the 24 hour period and the circadian (24 hour) rhythm becomes confused. The person’s sleep quality suffers because they are no longer getting their main sleep period in a single block at the time the body clock expects it. A different pattern that we may see in ME./CFS is Delayed Sleep Phase Disorder, where the person is very much an ‘evening’ type, going to bed late and getting up late. People who get insufficient outdoor light during the daytime are particularly susceptible to this.  Sometimes their body clock begins to ‘free run’ and each night they may go to bed later than the previous night, so their ‘day’ may be 25 hours instead of 24 hours.
  • Behavioural changes that may precipitate insomnia include decreased sleep drive (or sleep pressure) arising from reduced activity, significant napping during the day, reduced exposure to daytime light, worry at night about the consequences of having ME/CFS, and/or longer time in bed trying to sleep than the actual sleep duration that person may need. For example, due to boredom and/or feelings of fatigue, turning lights off from 9pm to 8am each night (i.e. 11 hours trying to sleep) when the person may only need 8 hours of actual sleep.  Best if lights-out time equals sleep time required.  The research shows quite clearly that treatment with Cognitive Behavioural Therapy for Insomnia can provide significant improvements in people whose sleep has been impaired by such behavioural factors and online programs are available.

On the other hand, disturbed sleep patterns in pwME/CFS may arise, not from behavioural factors, but from factors associated with ME/CFS itself, such as impaired melatonin secretion or other imbalances in the many hormonal or metabolic or neurological factors that we are only now beginning to understand affect sleep patterns.  Such imbalances may, in fact lead to either disturbed sleep patterns or unrefreshing sleep.

Unrefreshing sleep occurs across the population, both in people with a range of clinical conditions and sometimes in people with no diagnosed medical problem.  It is usually described by self-report. It is likely to be a very heterogenous phenomenon. A study by El-Mekkawy Leqaa et al (2022) noted a significant change in delta wave power (deep sleep) in the temporal brain region in those with unrefreshing sleep arising from sleep apnea, compared to controls. In our review of sleep patterns in ME/CFS (Jackson and Bruck, 2012) we concluded that technological advances in the assessment/monitoring of sleep may lead to further understanding of how the micro-structure of sleep may differ between those with self-reported unrefreshing sleep compared to quality sleep.

Q3. Anecdotal evidence from some pwME and a few research studies suggest that the sleep disturbance that people experience can have a significant impact on their cognitive abilities. How prevalent is this? What may be causing the sleep disturbance to impact people’s cognitive function?

Any ongoing sleep disturbance will affect a person’s cognitive abilities. Attention, concentration, memory and reaction time may all be affected in some way depending on (a) their overall health (physical and/or mental) and (b) individual differences in how poor sleep quality affects an individual.  It seems reasonable to think that a pwME/CFS that includes the symptom of brain fog would be affected by the cognitive impairments we associate with poor sleep in an additive way.

Q.4 Is there any evidence that non-restorative sleep is impacting other symptoms which pwME experience such as pain?

I believe that ANY ongoing poor quality sleep, whether it is unrestorative sleep or disturbed sleep will affect a range of ME/CFS symptoms, possibly all.  Pain and brain fog are likely to be particularly affected.

With regard to pain we know that sleep loss increases the experience of pain.  Krause et al (2019) showed that acute sleep deprivation amplifies pain reactivity within the human primary somatosensory cortex, lowers pain thresholds and that ‘even modest nightly changes in sleep quality within an individual determine consequential day-to-day changes in experienced pain’.

Q5. Having a clearer understanding about the pathophysiology of non-restorative sleep in pwME may lead to better treatment options for patients. Are you aware of any clinical trials which are exploring treatment issues for non-restorative sleep in pwME?

Unfortunately not.

Q6. Many people with M.E. report that there is a direct link between the degree of their non-restorative sleep and the depth of the fatigue they experience the next day. What research has been done into this particular issue and what were their findings?

To my knowledge this issue has not yet been investigated in pwME/CFS.  However, cognitive fatigue as measured on a range of working memory tests (Benkirane et al, 2022) found that the main effect of sleep fragmentation was to increase subjectively reported fatigue rather than reduce cognitive test performance.  This study, using healthy participants, highlights the difficulties in objectively measuring fatigue, as many people can rally their mental resources for short-term testing in a research setting.  This may have little to do with how fatigue is experienced in real-life settings.

Q7. What further research is required to investigate the causes of non-restorative sleep and the impact this has on cognitive function, fatigue and pain in pwME?

There are so many unanswered questions.  The first step for any such research is to have a standard definition of non-restorative sleep.  Is it a certain level of sleep fragmentation? Sleep disruption? Lower EEG delta power? Subjective report in the light of an otherwise normal sleep diary?  Is reported non-restorative sleep the same for someone with sleep apnea, vivid dreaming or ME/CFS?

Acupoint massage at Shenque (CV 8) for chronic fatigue syndrome: a randomized controlled trial

Abstract:

in English, Chinese

Objectives: To observe the clinical efficacy of acupoint massage at Shenque (CV 8) for chronic fatigue syndrome (CFS).

Methods: A total of 71 patients with CFS were randomized into an observation group (36 cases, 2 cases were eliminated, 3 cases dropped out) and a control group (35 cases). Using a specially made massage instrument, acupoint massage was adopted at the the five points of Shenque (CV 8), i.e. the center and the upper, lower, left, and right parts of the inner wall. The manipulation was given 10 min a time, once every 2 days, 3 times a week for 4 weeks continuously. No intervention was delivered in the control group. Before and after treatment, the scores of fatigue scale-14 (FS-14) and Pittsburgh sleep quality index (PSQI) were observed, and the clinical efficacy was evaluated in the both groups.

Results: After treatment, the physical fatigue and mental fatigue scores, as well as the total score of FS-14 were decreased compared with those before treatment in the observation group (P<0.001); the above scores in the observation group were lower than those in the control group (P<0.001). After treatment, excepted for the sleep time and hypnotic scores, the remaining item scores and the total score of PSQI were decreased compared with those before treatment in the observation group (P<0.05); the each item score and the total score of PSQI were lower than those in the control group (P<0.05). The total effective rate in the observation group was superior to that in the control group (P<0.01).

Conclusions: Acupoint massage at Shenque (CV 8) can effectively improve the fatigue state and sleep quality in patients with chronic fatigue syndrome.

Source: Li Z, Ji R, Yan C, Chen Y, Cao Z, Wang J. Acupoint massage at Shenque (CV 8) for chronic fatigue syndrome: a randomized controlled trial. Zhongguo Zhen Jiu. 2023 Jan 12;44(1):67-70. English, Chinese. doi: 10.13703/j.0255-2930.20230307-0002. PMID: 38191162. https://pubmed.ncbi.nlm.nih.gov/38191162/

Objective sleep measures in chronic fatigue syndrome patients: A systematic review and meta-analysis

Abstract:

Patients with myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) often report disrupted and unrefreshing sleep in association with worsened fatigue symptoms. However, the nature and magnitude of sleep architecture alteration in ME/CFS is not known, with studies using objective sleep measures in ME/CFS generating contradictory results.

The current manuscript aimed to review and meta-analyse of case-control studies with objective sleep measures in ME/CSF. A search was conducted in PubMed, Scopus, Medline, Google Scholar, and Psychoinfo databases.

After review, 24 studies were included in the meta-analysis, including 20 studies with 801 adults (ME/CFS = 426; controls = 375), and 4 studies with 477 adolescents (ME/CFS = 242; controls = 235), who underwent objective measurement of sleep.

Adult ME/CFS patients spend longer time in bed, longer sleep onset latency, longer awake time after sleep onset, decreased sleep efficiency, decreased stage 2 sleep, increased Stage 3, and longer rapid eye movement sleep latency.

However, adolescent ME/CFS patients had longer time in bed, longer total sleep time, longer sleep onset latency, and reduced sleep efficiency.

The meta-analysis results demonstrate that sleep is altered in ME/CFS, with changes seeming to differ between adolescent and adults, and suggesting sympathetic and parasympathetic nervous system alterations in ME/CFS.

Source: Abdalla Z. Mohamed, Thu Andersen, Sanja Radovic, Peter Del Fante, Richard Kwiatek, Vince Calhoun, Sandeep Bhuta, Daniel F. Hermens, Jim Lagopoulos, Zack Shan. Objective sleep measures in chronic fatigue syndrome patients: A systematic review and meta-analysis. Sleep Medicine Reviews, 2023, 101771.  https://www.sciencedirect.com/science/article/abs/pii/S1087079223000278

Persistent short nighttime sleep duration is associated with a greater post-COVID risk in fully mRNA-vaccinated individuals

Abstract:

Short nighttime sleep duration impairs the immune response to virus vaccination, and long nighttime sleep duration is associated with poor health status. Thus, we hypothesized that short (<6 h) and long (>9 h) nighttime sleepers have a higher post-COVID risk than normal nighttime sleepers, despite two doses of mRNA vaccine (which has previously been linked to lower odds of long-lasting COVID-19 symptoms). Post-COVID was defined as experiencing at least one core COVID-19 symptom for at least three months (e.g., shortness of breath).

Multivariate logistic regression adjusting for age, sex, BMI, and other factors showed in 9717 respondents (age span 18-99) that two mRNA vaccinations lowered the risk of suffering from post-COVID by about 21% (p < 0.001). When restricting the analysis to double-vaccinated respondents (n = 5918), short and long sleepers exhibited a greater post-COVID risk than normal sleepers (adjusted OR [95%-CI], 1.56 [1.29, 1.88] and 1.87 [1.32, 2.66], respectively). Among respondents with persistent sleep duration patterns during the pandemic compared to before the pandemic, short but not long sleep duration was significantly associated with the post-COVID risk (adjusted OR [95%-CI], 1.59 [1.24, 2.03] and 1.18 [0.70, 1.97], respectively). No significant association between sleep duration and post-COVID symptoms was observed in those reporting positive SARS-CoV-2 test results (n = 538).

Our findings suggest that two mRNA vaccinations against SARS-CoV-2 are associated with a lower post-COVID risk. However, this protection may be less pronounced among those sleeping less than 6 h per night. Our findings warrant replication in cohorts with individuals with confirmed SARS-CoV-2 infection.

Source: Xue P, Merikanto I, Chung F, Morin CM, Espie C, Bjorvatn B, Cedernaes J, Landtblom AM, Penzel T, De Gennaro L, Holzinger B, Matsui K, Hrubos-Strøm H, Korman M, Leger D, Mota-Rolim S, Bolstad CJ, Nadorff M, Plazzi G, Reis C, Chan RNY, Wing YK, Yordanova J, Bjelajac AK, Inoue Y, Partinen M, Dauvilliers Y, Benedict C. Persistent short nighttime sleep duration is associated with a greater post-COVID risk in fully mRNA-vaccinated individuals. Transl Psychiatry. 2023 Feb 1;13(1):32. doi: 10.1038/s41398-023-02334-4. PMID: 36726008; PMCID: PMC9890416. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9890416/ (Full text)

Sleep symptoms are essential features of long-COVID – Comparing healthy controls with COVID-19 cases of different severity in the international COVID sleep study (ICOSS-II)

Abstract:

Many people report suffering from post-acute sequelae of COVID-19 or “long-COVID”, but there are still open questions on what actually constitutes long-COVID and how prevalent it is. The current definition of post-acute sequelae of COVID-19 is based on voting using the Delphi-method by the WHO post-COVID-19 working group. It emphasizes long-lasting fatigue, shortness of breath and cognitive dysfunction as the core symptoms of post-acute sequelae of COVID-19.

In this international survey study consisting of 13,628 subjects aged 18-99 years from 16 countries of Asia, Europe, North America and South America (May-Dec 2021), we show that post-acute sequelae of COVID-19 symptoms were more prevalent amongst the more severe COVID-19 cases, i.e. those requiring hospitalisation for COVID-19. We also found that long-lasting sleep symptoms are at the core of post-acute sequelae of COVID-19 and associate with the COVID-19 severity when COVID-19 cases are compared with COVID-negative cases.

Specifically, fatigue (61.3%), insomnia symptoms (49.6%) and excessive daytime sleepiness (35.8%) were highly prevalent amongst respondents reporting long-lasting symptoms after hospitalisation for COVID-19. Understanding the importance of sleep-related symptoms in post-acute sequelae of COVID-19 has a clinical relevance when diagnosing and treating long-COVID.

Source: Merikanto I, Dauvilliers Y, Chung F, Wing YK, de Gennaro L, Holzinger B, Bjorvatn B, Morin CM, Penzel T, Benedict C, Koscec Bjelajac A, Chan NY, Espie CA, Hrubos-Strøm H, Inoue Y, Korman M, Landtblom AM, Léger D, Matsui K, Mota-Rolim S, Nadorff MR, Plazzi G, Reis C, Yordanova J, Partinen M. Sleep symptoms are essential features of long-COVID – Comparing healthy controls with COVID-19 cases of different severity in the international COVID sleep study (ICOSS-II). J Sleep Res. 2022 Oct 8:e13754. doi: 10.1111/jsr.13754. Epub ahead of print. PMID: 36208038. https://onlinelibrary.wiley.com/doi/10.1111/jsr.13754 (Full text)

An international study of post-COVID sleep health

Abstract:

Objectives: COVID-19 has infected millions of people worldwide, with growing evidence that individuals with a history of infection may continue to show persistent post-COVID symptoms (long COVID). The aim of this study was to investigate sleep health in an international sample of individuals who reported previously testing positive for COVID-19.

Design: Cross-sectional.

Setting: Online survey distributed online between March and June 2021.

Participants: A total of 1001 individuals who reported a positive diagnosis of COVID-19 across different geographical regions, including North and South America, Sub-Saharan Africa, and Europe.

Measurements: Self-reported sleep health, using the Regulatory Satisfaction Alertness Timing Efficiency Duration scale, as recalled before a COVID-19 diagnosis and also reported currently.

Results: Individuals reported worse overall current sleep health, with lower ratings across the 6 dimensions of sleep health (sleep regularity, satisfaction, alertness, timing, efficiency, and duration) compared to their ratings as recalled before COVID-19 infection. Greater severity of COVID-19 symptoms was the strongest predictor of poor current sleep health (P < .001), independent of demographics, presence of a pre-existing chronic health condition, and time since infection. Poor current sleep health was associated with poorer current quality of life (P < .001).

Conclusions: Poor current sleep health is evident in individuals with a history of COVID-19, particularly those with more severe symptoms at the time of their COVID-19 infection and is associated with a poorer quality of life. Clinicians and researchers should assess sleep health in COVID-19 patients and investigate long-term associations with their mental and physical health, as well as potential benefits of improving sleep in this population.

Source: Alzueta E, Perrin PB, Yuksel D, Ramos-Usuga D, Kiss O, Iacovides S, de Zambotti M, Cortes M, Olabarrieta-Landa L, Arango-Lasprilla JC, Baker FC. An international study of post-COVID sleep health. Sleep Health. 2022 Sep 23:S2352-7218(22)00112-7. doi: 10.1016/j.sleh.2022.06.011. Epub ahead of print. PMID: 36163137; PMCID: PMC9501615. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9501615/ (Full text)

Assessing sleep and pain among adults with myalgic encephalomyelitis/chronic fatigue syndrome: psychometric evaluation of the PROMIS® sleep and pain short forms

Abstract:

Purpose: To evaluate the psychometric properties of the patient-reported outcome measurement information system® (PROMIS) short forms for assessing sleep disturbance, sleep-related impairment, pain interference, and pain behavior, among adults with myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS).

Methods: Data came from the Multi-Site ME/CFS study conducted between 2012 and 2020 at seven ME/CFS specialty clinics across the USA. Baseline and follow-up data from ME/CFS and healthy control (HC) groups were used to examine ceiling/floor effects, internal consistency reliability, differential item functioning (DIF), known-groups validity, and responsiveness.

Results: A total of 945 participants completed the baseline assessment (602 ME/CFS and 338 HC) and 441 ME/CFS also completed the follow-up. The baseline mean T-scores of PROMIS sleep and pain measures ranged from 57.68 to 62.40, about one standard deviation above the national norm (T-score = 50). All four measures showed high internal consistency (ω = 0.92 to 0.97) and no substantial floor/ceiling effects. No DIF was detected by age or sex. Known-groups comparisons among ME/CFS groups with low, medium, and high functional impairment showed significant small-sized differences in scores (η2 = 0.01 to 0.05) for the two sleep measures and small-to-medium-sized differences (η2 = 0.01 to 0.15) for the two pain measures. ME/CFS participants had significantly worse scores than HC (η2 = 0.35 to 0.45) for all four measures. Given the non-interventional nature of the study, responsiveness was evaluated as sensitivity to change over time and the pain interference measure showed an acceptable sensitivity.

Conclusion: The PROMIS sleep and pain measures demonstrated satisfactory psychometric properties supporting their use in ME/CFS research and clinical practice.

Source: Yang M, Keller S, Lin JS. Assessing sleep and pain among adults with myalgic encephalomyelitis/chronic fatigue syndrome: psychometric evaluation of the PROMIS® sleep and pain short forms. Qual Life Res. 2022 Jul 27. doi: 10.1007/s11136-022-03199-8. Epub ahead of print. PMID: 35896905.  https://pubmed.ncbi.nlm.nih.gov/35896905/

Associations Between Psychological and Immunological Variables in Chronic Fatigue Syndrome/Myalgic Encephalomyelitis: A Systematic Review

Abstract:

Background: Little emphasis has been given to the fact that various psychological processes and behaviors in chronic fatigue syndrome/myalgic encephalomyelitis (CFS/ME) have neural correlates that affect-and are affected by-the immune system. The aim of this paper is to provide a systematic review of the literature on cross-sectional and longitudinal associations between psychological and immunological variables/changes in CFS/ME.

Methods: The systematic literature search was conducted on Dec 10, 2020 using PubMed. Original research studies investigating associations between a predefined set of psychological and immunological variables in CFS/ME were included. Specifically, the review was focused on studies examining the following psychological variables: executive function, emotion regulation, interpersonal function, sleep, mental health, anxiety, depression, and/or other psychiatric symptoms. In terms of immunological variables, studies investigating interleukin (IL)-1, IL-2, IL-4, IL-6, tumor necrosis factor (TNF), CD4+, and/or CD8+ were included. Besides original research papers, other potentially relevant papers (e.g., literature reviews) were carefully read and reference lists were checked in order to identify any additional relevant studies. Available data was summarized in text and tables.

Results: The literature search identified 897 potentially relevant papers. Ultimately, 14 studies (807 participants in total) were included in the review of which only two were longitudinal in nature. The review indicated that executive function is associated with IL-1 and IL-6, and interpersonal function is associated with IL-6 and TNF-α. Further, the available data suggested that emotion regulation is associated with IL-2 and sleep is associated with IL-1, IL-6, TNF-α, and IL-2. Interestingly, poorer emotion regulation, interpersonal function, and sleep have all been found to be associated with higher cytokine levels. Executive function has shown both positive and negative relationships with cytokines and among these psychological constructs, it is also the only one that has been found to be associated with CD4+ and CD8+ counts/percentages.

Conclusions: Correlations exist between psychological and immunological variables in CFS/ME. However, there are few consistent findings and there is almost a complete lack of longitudinal studies. This review points to a gap in existing CFS/ME research and hopefully, it will inspire to the generation of innovative, psychoneuroimmunological hypotheses within the CFS/ME research field.

Source: Raanes EFW, Stiles TC. Associations Between Psychological and Immunological Variables in Chronic Fatigue Syndrome/Myalgic Encephalomyelitis: A Systematic Review. Front Psychiatry. 2021 Nov 23;12:716320. doi: 10.3389/fpsyt.2021.716320. PMID: 34887782; PMCID: PMC8650213.  https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8650213/  (Full text)