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Douleur et Analgésie

, 16:117 | Cite as

Douleur musculosquelettique, fibromyalgie et sommeil

  • Y. Dauvilliers
  • J. Touchon
Article

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.

Mots-clés

Fibromyalgie sommeil douleur polysomnographie anomalie alpha-delta 

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.

Key-words

Fibromyalgia sleep pain polysomnography alphadelta sleep 

Bibliographie

  1. 1.
    Affleck G., Urrows S., Tennen H., Higgins P. andAbeles M.: Sequential daily relations of sleep, pain intensity and attention to pain among women with fibromyalgia.Pain 68, 363–368, 1996.PubMedCrossRefGoogle Scholar
  2. 2.
    American College of Rheumatology. Criteria for the classification of fibromyalgia.Arthritis Rheumat. 33, (2) 160–172, 1990.CrossRefGoogle Scholar
  3. 3.
    ASDA, EEG arousals: Scoring rules and examples. A preliminary report from the Sleep Disorders Atlas Task Force of the American Sleep Disorders Association.Sleep 15, 174–184, 1992.Google Scholar
  4. 4.
    Bennett R.M., Clark S.R. andWalczyk J.: A randomized, double-blind, placebo-controlled study of growth hormone in the treatment of fibromyalgia.Am. J. Med. 104, 227–231, 1998.PubMedCrossRefGoogle Scholar
  5. 5.
    Bonner, M.H.:Sleep deprivation. Kryger M.H., Roth T., Dement W.C.: Principles and practice of sleep medicine. 3 ed. Philadelphia: W.B. Saunders, 2000, pp. 53–71. Notes: Chapter Num: 5.Google Scholar
  6. 6.
    Borbély A.A. andAchermann P.: Sleep homeostasis and models of sleep regulation. Kryger M.H., Roth T., Dement W.C.: Principles and practice of sleep medicine, 3rd ed. W.B. Saunders Co, pp. 377–399, 2000.Google Scholar
  7. 7.
    Boselli M., Parrino L., Smerieri A. andTerzano M.G.: Effect of age on EEG arousals in normal sleep.Sleep 21 (4), 351–357, 1998.PubMedGoogle Scholar
  8. 8.
    Branco J., Atalaia A. andPaiva T.: Sleep cycles and alpha-delta sleep in fibromyalgia syndrome.J. Rheumatol. 21, 1113–1117, 1994.PubMedGoogle Scholar
  9. 9.
    Brousseau M., Kato T., Mayer P., Manzini C., Guitard F. andMontplaisir J.: Effect of experimental innocuous and noxious stimuli on sleep for normal subjects. IASP Abstr. 10, 498-No. 1491-P39, 2002.Google Scholar
  10. 10.
    Carette S., Oakson G., Guimont C. andSteriade M.: Sleep electroencephalography and the clinical response to amitriptyline in patients with fibromyalgia.Arthritis Rheum.38, 1211–1217, 1995.PubMedCrossRefGoogle Scholar
  11. 11.
    Citera G., Arias M.A., Maldonado-Cocco J.A., Lazaro M.A., Rosemffet, M.G., Brusco L.I., Scheines E.J. andCardinalli D.P.: The effect of melatonin in patients with fibromyalgia: a pilot study. Clin Rheumatol.19, 9–13, 2000PubMedCrossRefGoogle Scholar
  12. 12.
    Crofford L.J.: Neuroendocrine abnormalities in fibromyalgia and related disorders. Am. J. Med. Sci.315, 359–366, 1998.PubMedCrossRefGoogle Scholar
  13. 13.
    Dauvilliers Y. andTouchon J.: Sleep in fibromyalgia: review of clinical and polysomnographic data.Neurophysiol. Clin, 31, 18–33, 2001.PubMedCrossRefGoogle Scholar
  14. 14.
    Donald F., Esdaile J., Kimoff J.R. andFitzcharles M.A.: Musculoskeletal complaints and fibromyalgia in patients attending a respiratory sleep disorders clinic. J. Rheumatol.23, 1612–1616, 1996PubMedGoogle Scholar
  15. 15.
    Drewes A.M., Nielsen K.D., Taagholt S.J., Bjerregard K., Svendsen L. andGade J: Sleep intensity in fibromyalgia: Focus on the microstructure of the sleep process.Br. J. Rheumatol.34, 629–635, 1995.PubMedCrossRefGoogle Scholar
  16. 16.
    Drewes A.M., Nielsen K.D., Arendt-Nielsen L., Birket-Smith L. and andHansen L.M. The effect of cutaneous and deep pain on the electroencephalogram during sleep: and experimental study. Sleep20, 632–640, 1997.PubMedGoogle Scholar
  17. 17.
    Evengard B., Nilsson C.G., Lindh G., Lindquist L., Eneroth P., Fredrikson S. et al.: Chronic fatigue syndrome differs from fibromyalgia No evidence for elevated subtance P levels in cerebrospinal fluid of patients with chronic fatigue syndrome.Pain 78, 153–155, 1998.PubMedCrossRefGoogle Scholar
  18. 18.
    Goldenberg D.L.: Fibromyalgie syndrome. An emerging but controversial conditial.JAMA 257, 2782–2787, 1987.PubMedCrossRefGoogle Scholar
  19. 19.
    Harding S.M.: Sleep in fibromyalgia patients: Subjective and objective finding.Am. J. Med. Sci, 315, 367–376, 1998.PubMedCrossRefGoogle Scholar
  20. 20.
    Hauri P. andHawkins D.R.: Alpha delta sleep.Electroencephalogr. Clin. Neurophysiol.34, 233–237, 1973.PubMedCrossRefGoogle Scholar
  21. 21.
    Home J.A. andShackell B.S.: Alpha-like EEG activity in non REM sleep and the fibromyalgia (fibrositis) syndrome.Electroencephalogr. Clin. Neurophysiol.79, 271–276, 1991.CrossRefGoogle Scholar
  22. 22.
    ICSD-International Classification of Sleep disorders: Diagnostic and coding manual. Diagnostic Classification Steering Committee, Thorpy M. J., chairman, American Sleep Disorders Association (eds.), Rdochester (Minnesota) 1990.Google Scholar
  23. 23.
    Khanounov I. andLevine I.: The effecct of phototherapy to clinical characteristics and sleep structure of patients with fibromyalgia syndrome.J. Sleep Res. P267, 1998.Google Scholar
  24. 24.
    Klerman E.B., Goldenberg D.L., Brown E.N., Maliszewski A.M. andAdler G.K.: Circadian rhythms of women with fibromyalgia.J. Clin. Endocrinol. Metab.86, 1034–1039, 2001.PubMedCrossRefGoogle Scholar
  25. 25.
    Landis C.A., Lentz M.J., Rothermel J., Riffle S.C., Chapman D., Buchwald D. andShaver J.L.: Decreased nocturnal levels of prolactin and growth hormone in women with fibremyalgia.J. Clin. Endocrinol. Metab.86, 1672–1678, 2001.PubMedCrossRefGoogle Scholar
  26. 26.
    Lavigne G.J., Zucconi M., Castronove C., Manzini C., Marchettini P. andSmirne S.: Sleep arousal response to experimental thermal stimulation during sleep in human subjects free of pain and sleep problems.Pain 84, 283–290, 2000.PubMedCrossRefGoogle Scholar
  27. 27.
    Leal-Cerro A., Povedano J., Astorga R., Gonzalez M., Silva H., Garcia-Pesquera F., Casanueva F.F. andDieguez C: The growth hormone (GH)-releasing hormone-GH-insulin-like growth factor-1 axis in patients with fibromyalgia syndrome.J. Clin. Endocrinol. Metab. 84, 3378–3381, 1999.PubMedCrossRefGoogle Scholar
  28. 28.
    Lentz M.J., Landis C.A., Rothermal J. andShaver J.L.: Effects of selective slow wave sleep disruption on musculoskeletal pain and fatigue in middle aged women.J. Rheumatol.26, 1586–1592, 1999.PubMedGoogle Scholar
  29. 29.
    Levine B., Roehrs T., Stepanski E., Zorick F. andRoth T: Fragmenting sleep diminishes its recuperative value.Sleep 10 (6) 590–599, 1987PubMedGoogle Scholar
  30. 30.
    Mahowald M.L. andMahowald M.W.: Nighttime sleep and daytime functioning (sleepiness and fatigue) in well-defined chronic rheumatic diseases.Sleep Medicine 1, 179–193, 2000.PubMedCrossRefGoogle Scholar
  31. 31.
    Martinez-Lavin L.J., Hermosillo A.G., Rosas M. andSoto M.E.: Circadian studies of autonomic nervous balance in patients with fibromyalgia: A heart rate variability analysis.Arthritis Rheum 41, 1966–1971, 1998.PubMedCrossRefGoogle Scholar
  32. 32.
    Mathur H. andDouglas N.J.: Frequency of EEG arousals from nocturnal sleep in normal subjects.Sleep 18 (5), 330–333, 1995.PubMedGoogle Scholar
  33. 33.
    May K.P., West S.G., Baker M.R. andEverett D.W.: Sleep apnea in male patients with the fibromyalgia syndrome.Am. J. Med.94, 505–508, 1993.PubMedCrossRefGoogle Scholar
  34. 34.
    Moldofsky H., Scarisbrick P., England F. andSmythe H.: Musculoskeletal symptoms end non REM sleep disturbance in patients with fibrositis syndrome and healthy subjects.Fsychosom. Med.37, 341–351, 1975.Google Scholar
  35. 35.
    Moldofsky H. andScarisbrick P.: Induction of neuroasthenic musculoskeletal pain syndrome by selective deep sleep stage deprivation.Psychosom. Med.38, 35–44, 1976.PubMedGoogle Scholar
  36. 36.
    Molony R.R., Mac Peek D.M., Schifiman P.L., Frank M., Neubauer J.A., Schwartzberg M. et al., Sleep, sleep apnea and the fibromyalgia syndrome.J Rheumatol.13, 797–800, 1986.PubMedGoogle Scholar
  37. 37.
    Morin C.M., Gibson D. andWade J.: Self-reported sleep and mood disturbance in chronic pain patients.Clin. J. Pain 14, 311–314, 1998.PubMedCrossRefGoogle Scholar
  38. 38.
    O'Malley P.G., Balden E., Tomkins G., Santoro J., Kroenke K. andJackson J.L.: Treatment of fibromyalgia with antidepressants: a meta-analysis.J. Gen. Intern. Med. 15, 659–666, 2000.PubMedCrossRefGoogle Scholar
  39. 39.
    Older S.A., Battafarano D.F., Danning C.L., Ward J.A., Grady E.P., Derman S. etaal.: The effects of delta wave sleep interruption on pain tresholds and fibromyalgia-like symptoms in healthy subjects; correlations with insulin-like growth factor 1.J. Rheumatol 25, 1180–1186, 1998.PubMedGoogle Scholar
  40. 40.
    Pivik R.T. andHartman K.: A reconceptualization of EEG alpha activity as an index of arousal during sleep: All alpha activity is not equal.Sleep Res. 4, 131–137, 1995.CrossRefGoogle Scholar
  41. 40.
    Rechtshaffen A andKales A.: A manual of standardized terminology, techniques, and scoring system for sleep stages of human subjects. Washington D.C.: Public Health Service Publication No. 204, U.S. Government Printing Office, 1968.Google Scholar
  42. 41.
    Roizenblatt S., Moldofsky H., Benedito-Silva A.A. andTufik S.: Alpha sleep characteristics in fibromyalgia.Arthritis Rheum. 44, 222–230, 2001.PubMedCrossRefGoogle Scholar
  43. 42.
    Sarzi-Puttini P., Rizzi M., Andreoli A., Panni B., Pecis M., Colombo S., Turiel M., Carrabba M. andSergi M.: Hypersomnolence in fibromyalgia syndrome.Clin. Exp. Rheumatol. 20, 69–72, 2002.PubMedGoogle Scholar
  44. 43.
    Schneider-Helmert D., Whitehouse I., Kumar A. andLijzenga C.: Insomnia and alpha sleep in chronic non-organic pain as compared to primary insomnia.Neuropsychobiology 43, 54–58, 2001.PubMedCrossRefGoogle Scholar
  45. 44.
    Scheuler W., Kubicki S., Marquardt J., Scholz G., Weiss K.H., Henkes H. et al.:The alpha-sleep pattern—Quantitative analysis and functional aspects.In: Koella W.P., Schulz H., Obala F., Visser P.: «Sleep 1986» Stuttgart-New-York, Gustav Fischer, 284–286, 1988.Google Scholar
  46. 45.
    Smythe H.: Referred pain and tender points.Am. J. Med. 81 (suppl. 3A), 90–104, 1986.PubMedCrossRefGoogle Scholar
  47. 46.
    Staedt J., Windt H., Hjak G., Stoppe G., Rudolph G., Ensink F.B.M., Hildebrandt J. andRuther E.: Cluster arousal analysis in chronic pain-disturbed sleep.J. Sleep Res. 2, 134–137, 1993.PubMedGoogle Scholar
  48. 47.
    Touchon J., Besset A., Billiard M., Simon L., Herisson C. andCadilhac J.: Fibrositis syndrome: polysomnographic and psychological aspects.In: Koella W.P., Schulz H., Obal F., Visser P.: «Sleep 1986». Stuttgart-New-York, Gustav Fischer, 297–298, 1988.Google Scholar
  49. 48.
    Wikner J., Hirsch U., Wetterberg L. andRojdmark S.: Fibromyalgia—a syndrome associated with decreased nocturnal melatonin secretion.Clin. Endocrinol. 49, 179–183, 1998.CrossRefGoogle Scholar
  50. 49.
    Wolfe F., Ross K., Anderson J., Russell I.J. andHebert L.: The prevalence and characteristics of fibromyalgia in the general population.Arthritis Rheum. 38, 19–28, 1995.PubMedCrossRefGoogle Scholar
  51. 50.
    Yunus M., Kalyan-Raman U., Masi A.T. andAldag J.C.: Electron microscopic studies of muscle biopsy in primary fibromyalgia syndrome. A controlled and clinded study.J. Rheumatol. 16 (1), 97–101, 1989.PubMedGoogle Scholar
  52. 51.
    Yunus M., Dailey J.W., Masi A.T. andJobe P.L.: Plasma tryptophan and other amino acide in primary fibromyalgia syndrome.Arthritis Rheum. 32, 4 (suppl.): B 118, 1989Google Scholar
  53. 52.
    Yunus M. andAldag J.C.: Restless legs syndrome and leg cramps in fibromyalgia syndrome: A controlled study.BMJ. 312, 1339–1339 1996.PubMedGoogle Scholar

Copyright information

© Springer-Verlag 2003

Authors and Affiliations

  1. 1.Service de Neurologie BHôpital Gui-de-ChauliacMontpellier cedex 5France
  2. 2.Inserm EMI 9930MontpellierFrance

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