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VOLUME 34, ISSUE 05

SLEEP-WAKE BEHAVIOR IN CHRONIC FATIGUE SYNDROME
Sleep-Wake Behavior in Chronic Fatigue Syndrome

Khairunnessa Rahman, BMedSci (Hons)1; Alexander Burton, PhD1; Sally Galbraith, PhD2; Andrew Lloyd, MD3; Ute Vollmer-Conna, PhD1

1School of Psychiatry, University of NSW, Sydney, Australia; 2School of Mathematics and Statistics, University of NSW, Sydney, Australia; 3Inflammation and Infection Research Centre, School of Medical Sciences, University of NSW, Sydney, Australia



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Study Objectives:

Disturbances of the internal biological clock manifest as fatigue, poor concentration, and sleep disturbances—symptoms reminiscent of chronic fatigue syndrome (CFS) and suggestive of a role for circadian rhythm disturbance in CFS. We examined circadian patterns of activity, sleep, and cortisol secretion in patients with CFS.

Design:

Case-control study, 5-day behavioral observation.

Setting:

Natural setting/home environment

Participants:

15 patients with CFS and 15 healthy subjects of similar age, sex, body mass index (BMI), and activity levels.

Interventions:

N/A

Measurements:

Self-report questionnaires were used to obtain medical history and demographic information and to assess health behaviors, somatic and psychological symptoms, and sleep quality. An actiwatch accelerometer recorded activity and sleep patterns over 5 days with concurrent activity and symptom logs. Diurnal salivary cortisol secretion was measured. Additionally, overnight heart rate monitoring and pain sensitivity assessment was undertaken.

Results:

Ratings of symptoms, disability, sleep disturbance, and pain sensitivity were greater in patients with CFS. No between-group differences were found in the pattern or amount of sleep, activity, or cortisol secretion. Afternoon activity levels significantly increased evening fatigue in patients but not control subjects. Low nocturnal heart rate variability was identified as a biological correlate of unrefreshing sleep.

Conclusions:

We found no evidence of circadian rhythm disturbance in CFS. However, the role of autonomic activity in the experience of unrefreshing sleep warrants further assessment. The activity symptom-relationship modelled here is of clinical significance in the approach to activity and symptom management in the treatment of CFS.

Citation:

Rahman K; Burton A; Galbraith S; Lloyd A; Vollmer-Conna U. Sleep-wake behavior in chronic fatigue syndrome. SLEEP 2011;34(5):671-678.

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