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Douleur musculosquelettique, fibromyalgie et sommeil

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Résumé

La fibromyalgie est une entité clinique fréquente caractérisée principalement par des douleurs musculo-articulaires et le plus souvent accompagnées d'un sommeil de mauvaise qualité subjectivement vécu comme non réparateur. Une altération de la continuité du sommeil et des anomalies de son architecture ont été objectivées dans cette affection. Une diminution de l'efficacité du sommeil, une augmentation du nombre d'éveils, une diminution du sommeil lent profond et surtout une activité alpha anormale en sommeil lent profond (activité alphadelta) seraient caractéristiques bien que non spécifiques de cette affection. Ces données ont de plus éte confirmées par l'analyse spectrale de l'activité EEG au cours du sommeil en retrouvant une augmentation de la puissance des bandes à hautes fréquences ainsi qu'une diminution de celle à basses fréquences. La présence d'une activité alpha-delta, de micro-éveils et de complexes K-alpha, témoins d'une fragmentation du sommeil, correspondent à une possible intrusion de l'éveil dans le sommeil et peuvent ainsi contribuer à l'altération de la fonction restauratrice du sommeil et ainsi expliquer en partie la symptomatologie diurne de ces patients. Toutefois ces activités alpha anormales ne sont pas spécifiques et sont observées chez des sujets sains privés de sommeil lent profond. Cette fragmentation anormale du sommeil n'est pas à mettre en rapport avec un trouble primaire du sommeil comme le syndrome d'apnées du sommeil et le syndrome des mouvements périodiques des membres inférieurs, bien que ces dermières conditions sont souvent concomitantes. La pathogénie de la fibromyalgie demeure toujours incertaine. Toutefois l'altération du métabolisme de certaines substances dont la sérotonine, la mélatonine et l'hormone de croissance a pu être objectivée. Cette affection est fréquente et apparaît multifactorielle malgré l'existence d'un débat sur les causes de la fibromyalgie, l'implication de facteurs psychologiques (anxiété), environnementaux, génétiques, neurochimiques et de leurs impacts sur la qualité du sommeil. Enfin, il est probable que ceux-ci interviennent à diffèrents niveaux dans la genèse des symptômes de la fibromyalgie.

Summary

Fibromyalgia is a common chronic syndrome characterized by widespread pain, unrefreshed sleep, disturbed mood and fatigue. The complaints of sleep disturbances are correlated with polysomnographic features showing clear abnormalities in the continuity of sleep as well as in the sleep architecture. Sleep-recording abnormalities are characterized by a reduced sleep efficiency with increased number of awakenings, a reduced amount of slow wave sleep and an abnormal alpha wave intrusion in non rapid eye movement, termed alpha-delta sleep. These data were confirmed by spectral analysis of sleep showing an increased EEG power density in the higher frequency band and a reduced EEG power density in the lower frequency bands. Alpha intrusion during sleep can be of different patterns, alpha-delta sleep, high frequency of arousals and alpha-K complex, all indicators of fragmented sleep. The fibromyalgia symptoms may relate to a on-restorative sleep disorder associated with the alpha-EEG sleep anomalies. However, alpha-EEG sleep anomaly is non-specific for fibrositis and is also seen in normal controls during sleep stage 4 following sleep deprivation. Moreover, fibromyalgia patients may also experience primary sleep disorder such as sleep apnea or periodic leg movements, but these are based on different pathophysiology. The etiology of fibromyalgia, a common condition, is incompletely understood and the existence of a specific entity is still a matter of debate. However, several studies have found abnormal brain metabolism of substances such as serotonin, melatonin and growth hormone in fibromyalgia. Pain, poor sleep quality and anxiety may contribute to the clinical picture. Several factors such as psychological, environmental, genetic factor, neuroendocrine metabolism and altered sleep physiology are involved in the pathogenesis of fibromyalgia.

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Correspondence to Y. Dauvilliers.

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Dauvilliers, Y., Touchon, J. Douleur musculosquelettique, fibromyalgie et sommeil. Doul. et Analg. 16, 117 (2003). https://doi.org/10.1007/BF03007113

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Mots-clés

  • Fibromyalgie
  • sommeil
  • douleur
  • polysomnographie
  • anomalie alpha-delta

Key-words

  • Fibromyalgia
  • sleep
  • pain
  • polysomnography
  • alphadelta sleep