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BMJ Open 3:e002999 doi:10.1136/bmjopen-2013-002999
  • Patient-centred medicine
    • Research

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

  1. Jason G Ellis1
  1. 1Northumbria Centre for Sleep Research, Department of Psychology, Northumbria University, Newcastle, UK
  2. 2Institute for Ageing and Health, Newcastle University, Newcastle, UK
  3. 3Fatigue Service, VermoeidheidCentrum Nederland bv, Lelystad, The Netherlands
  1. Correspondence to Dr Jason G Ellis; Jason.ellis{at}northumbria.ac.uk
  • Received 5 April 2013
  • Revised 24 April 2013
  • Accepted 25 April 2013
  • Published 1 June 2013

Abstract

Objectives Despite 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.

Design A cross-sectional, single-site study.

Setting A fatigue clinic in the Netherlands.

Participants A consecutive series of 343 patients meeting the criteria for CFS, according to the Fukuda definition.

Measures Patients 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.

Results Of 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.

Conclusions The 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.

This is an open-access article distributed under the terms of the Creative Commons Attribution Non-commercial License, which permits use, distribution, and reproduction in any medium, provided the original work is properly cited, the use is non commercial and is otherwise in compliance with the license. See: http://creativecommons.org/licenses/by-nc/2.0/ and http://creativecommons.org/licenses/by-nc/2.0/legalcode.

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