Are there sleep-specific phenotypes in patients with chronic fatigue syndrome? A cross-sectional polysomnography analysis

Abstract

ObjectivesDespite sleep disturbances being a central complaint in patients with chronic fatigue syndrome (CFS), evidence of objective sleep abnormalities from over 30 studies is inconsistent. The present study aimed to identify whether sleep-specific phenotypes exist in CFS and explore objective characteristics that could differentiate phenotypes, while also being relevant to routine clinical practice.DesignA cross-sectional, single-site study.SettingA fatigue clinic in the Netherlands.ParticipantsA consecutive series of 343 patients meeting the criteria for CFS, according to the Fukuda definition.MeasuresPatients underwent a single night of polysomnography (all-night recording of EEG, electromyography, electrooculography, ECG and respiration) that was hand-scored by a researcher blind to diagnosis and patient history.ResultsOf the 343 patients, 104 (30.3%) were identified with a Primary Sleep Disorder explaining their diagnosis. A hierarchical cluster analysis on the remaining 239 patients resulted in four sleep phenotypes being identified at saturation. Of the 239 patients, 89.1% met quantitative criteria for at least one objective sleep problem. A one-way analysis of variance confirmed distinct sleep profiles for each sleep phenotype. Relatively longer sleep onset latencies, longer Rapid Eye Movement (REM) latencies and smaller percentages of both stage 2 and REM characterised the first phenotype. The second phenotype was characterised by more frequent arousals per hour. The third phenotype was characterised by a longer Total Sleep Time, shorter REM Latencies, and a higher percentage of REM and lower percentage of wake time. The final phenotype had the shortest Total Sleep Time and the highest percentage of wake time and wake after sleep onset.ConclusionsThe results highlight the need to routinely screen for Primary Sleep Disorders in clinical practice and tailor sleep interventions, based on phenotype, to patients presenting with CFS. The results are discussed in terms of matching patients’ self-reported sleep to these phenotypes in clinical practice.

Chronic fatigue syndrome (CFS) symptom-based phenotypes in two clinical cohorts of adult patients in the UK and The Netherlands

“…Some of the specific factors used in our study and earlier studies, e.g. pain, may warrant more detailed phenotypic analysis, as has been done for sleep abnormalities (Gotts et al, 2013). Associations of symptom-based phenotypes with 'other' comorbidities, such as postural orthostatic tachycardia syndrome (Lewis et al, 2013), also need to be explored.…”

Sleep Disturbances in Pediatric Chronic Fatigue Syndrome: A Review of Current Research

“…The possibility that pediatric CFS may not be associated with a unitary sleep profile is alluded to by Ohinata and colleagues 17 and proposed in the adult CFS literature. 21 It is worth considering that sleep in pediatric CFS may in fact be heterogeneous and a number of sleep phenotypes may explain the varying symptomatology. Therefore, future research that further characterizes the possible heterogeneity of sleep in CFS will be useful.…”

Poor sleep quality is associated with greater circulating pro-inflammatory cytokines and severity and frequency of chronic fatigue syndrome/myalgic encephalomyelitis (CFS/ME) symptoms in women

“…Recent research has identified subjective and objective accounts of poor sleep quality in CFS/ME—possibly identifying different sleep phenotypes (e.g. hypersomnia, insomnia-like phenotypes) (Gotts et al, 2013, Mariman, Vogelaers, 2013). Other studies found that CFS/ME patients report poor sleep, even while demonstrating otherwise normal sleep by polysomnography, as compared to healthy age-and gender-matched controls (Maes et al, 2012a, Neu et al, 2007).…”