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VOLUME 36, ISSUE 04

SLEEP AND PAIN IN ADOLESCENTS WITH FIBROMYALGIA
Relationship between Sleep and Pain in Adolescents with Juvenile Primary Fibromyalgia Syndrome

http://dx.doi.org/10.5665/sleep.2534

Margaret N. Olsen, BA1; David D. Sherry, MD1,2; Kathleen Boyne, MA3,4; Rebecca McCue, BA5; Paul R. Gallagher, MA6; Lee J. Brooks, MD2,3

1Division of Rheumatology, The Children's Hospital of Philadelphia, Philadelphia, PA; 2Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA; 3Division of Pediatric Pulmonology and Sleep Medicine, The Children's Hospital of Philadelphia, Philadelphia, PA; 4College of Medicine, University of Illinois, Chicago, IL; 5Department of Anesthesia, Stanford University School of Medicine, Palo Alto, CA; 6Biostatistics Core of the Clinical and Translational Research Center (CTRC), The Children's Hospital of Philadelphia, Philadelphia, PA



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Study Objectives:

To investigate sleep quality in adolescents with juvenile primary fibromyalgia syndrome (JPFS) and determine whether sleep abnormalities, including alpha-delta sleep (ADS), correlate with pain intensity. We hypothesized that successful treatment for pain with exercise therapy would reduce ADS and improve sleep quality.

Design:

Single-center preintervention and postintervention (mean = 5.7 ± 1.0 weeks; range = 4.0-7.3 weeks) observational study.

Patients:

Ten female adolescents (mean age = 16.2 ± 0.65 SD yr) who met criteria for JPFS and completed treatment.

Interventions:

Multidisciplinary pain treatment, including intensive exercise therapy.

Measurements and Results:

Pain and disability were measured by a pain visual analog scale (VAS) and the Functional Disability Inventory. Subjective sleep measures included a sleep VAS, an energy VAS, and the School Sleep Habits Survey. Objective sleep measures included actigraphy, polysomnography (PSG), and the Multiple Sleep Latency Test. Baseline PSG was compared with that of healthy age- and sex-matched control patients. At baseline, patients had poorer sleep efficiency, more arousals/awakenings, and more ADS (70.3% of total slow wave sleep [SWS] versus 21.9% SWS, P = 0.002) than controls. ADS was unrelated to pain, disability, or subjective sleep difficulty. After treatment, pain decreased (P = 0.000) and subjective sleep quality improved (P = 0.008). Objective sleep quality, including the amount of ADS, did not change.

Conclusions:

Although perceived sleep quality improved in adolescents with JPFS after treatment, objective measures did not. Our findings do not suggest exercise therapy for pain improves sleep by reducing ADS, nor do they support causal relationships between ADS and chronic pain or subjective sleep quality.

Citation:

Olsen MN; Sherry DD; Boyne K; McCue R; Gallagher PR; Brooks LJ. Relationship between sleep and pain in adolescents with juvenile primary fibromyalgia syndrome. SLEEP 2013;36(4):509-516.

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