Study urges further research into association of sleep disorders to pain perception and illness behavior in fibromyalgia syndrome

Fibromyalgia (FM) syndrome remains a distressing chronic pain condition marked by extensive suffering, mood swings, disrupted sleep, and persistent fatigue. In a recent publication in Open Access Rheumatology, findings emphasized the significance of deeper investigation into the connections among managed and unmanaged sleep disturbances, pain perception, somatization, and illness behavior in the health dynamics of those with FM.

The pilot study conducted by Dr. Meresh and colleagues at Loyola University Medical Center in Maywood, USA, enrolled subjects diagnosed with either isolated FM or FM coexisting with obstructive sleep apnea (OSA). Participants completed a battery of self-administered instruments, including the Short-Form McGill Pain Questionnaire (SF-MPQ), the Somatosensory Amplification Scale (SSAS), and the Illness Behavior Questionnaire (IBQ). The cohort comprised 25 FM patients, predominantly female (n=23), with a mean age of 57.48 years.

Among the subjects, 17 (68%) concurrently exhibited OSA, while 8 (32%) did not. Significantly lower scores were observed in patients with OSA compared to those without OSA for both the SF-MPQ Sensory sub-scale (P=0.03) and SF-MPQ overall scores (P=0.04). However, no significant differences were observed in SSAS overall scores or IBQ overall scores based on OSA diagnosis. Further correlations between IBQ dimensions, SSAS, and the mean number of diagnoses in FM and FM+OSA revealed specific trends in the problem list of SSAS: individuals with scores ≤30 had a mean of 29.5 diagnoses, whereas those with scores ≥30 exhibited a mean of 34.9 diagnoses.

Disrupted sleep patterns represent a prevalent manifestation in FM syndrome and constitute an integral criterion in the diagnostic framework established by the American College of Rheumatology. While routine assessments for sleep are not conducted for FMS evaluation, the implementation of polysomnography holds the potential to reveal latent sleep disturbances in this population. Studies conducted in general rheumatology practices indicated that a substantial cohort of women diagnosed with FM syndrome concurrently experiences sleep-disordered breathing. Moreover, for male individuals, FM syndrome may function as an indicative marker for the presence of obstructive sleep apnea (OSA).

The recent findings underscore the necessity for further exploration into the intricate interplay among managed and unmanaged sleep disturbances, pain perception, somatization, and illness behavior in individuals afflicted by fibromyalgia (FM). A deeper understanding of how obstructive sleep apnea (OSA) impacts pain perception in FM patients is crucial for enhancing their overall health with targeted treatments, potentially reducing the need for multiple medications for pain management.


Meresh ES, Xu S, Palomino A, Artin H, Padiyara J, Stasieluk C, et al. The Correlation of Pain, Psychological Aspects, and Sleep in Fibromyalgia: A Cross-Sectional Analysis. Open Access Rheumatol. 2023;15:237–46.