Personal non-commercial use only

ABSTRACT. Objective. To determine the effects of bedtime very low dose (VLD) cyclobenzaprine (CBP) on symptoms and sleep physiology of patients with fibromyalgia (FM), unrefreshing sleep, and the α-nonREM sleep electroencephalographic (EEG) anomaly at screening. Methods. Of 37 patients with FM in the screened population, 36 were randomized and treated in this 8-week, double-blind, placebo-controlled, dose-escalating study of VLD CBP 1-4 mg at bedtime. We evaluated changes in subjective symptoms including pain, tenderness, fatigue, mood [Hospital Anxiety and Depression Scale (HAD)], and objective EEG sleep physiology (at screening, baseline, and Weeks 2, 4, and 8). Results. In the VLD CBP-treated group (n = 18) over 8 weeks, musculoskeletal pain and fatigue decreased, tenderness improved; total HAD score and the HAD depression subscore decreased; patient-rated and clinician-rated fatigue improved. In the placebo-treated group (n = 18), none of these outcome measures changed significantly. Compared to placebo at 8 weeks, VLD CBP significantly improved pain, tenderness, and the HAD Depression subscore. Analysis of cyclic alternating pattern (CAP) sleep EEG revealed that significantly more subjects in the VLD CBP group than the placebo group had increased nights of restorative sleep in which CAP A2+A3 /CAP A1+A2+A3 = CAP A2+A3(Norm) ≤ 33%. For VLD CBP-treated subjects, the increase in nights with CAP A2+A3(Norm) ≤ 33% was correlated to improvements in fatigue, total HAD score, and HAD depression score. Fibromyalgia syndrome (FM) is a common, chronic musculoskeletal pain disorder, diagnosed predominantly in women, that is characterized by widespread pain, increased sensitivity to pain (or tenderness) at multiple tender points, fatigue, unrefreshing sleep, and depressed mood 1 . Cyclobenzaprine (CBP) has been studied in FM in a number of randomized trials employing doses of 10-40 mg per day, with mixed result

Personal non-commercial use only

ABSTRACT. Objective. To determine the effects of bedtime very low dose (VLD) cyclobenzaprine (CBP) on symptoms and sleep physiology of patients with fibromyalgia (FM), unrefreshing sleep, and the a-nonREM sleep electroencephalographic (EEG) anomaly at screening. Methods. Of 37 patients with FM in the screened population, 36 were randomized and treated in this 8-week, double-blind, placebo-controlled, dose-escalating study of VLD CBP 1-4 mg at bedtime. We evaluated changes in subjective symptoms including pain, tenderness, fatigue, mood [Hospital Anxiety and Depression Scale (HAD)], and objective EEG sleep physiology (at screening, baseline, and Weeks 2, 4, and 8). Results. In the VLD CBP-treated group (n = 18) over 8 weeks, musculoskeletal pain and fatigue decreased, tenderness improved; total HAD score and the HAD depression subscore decreased; patient-rated and clinician-rated fatigue improved. In the placebo-treated group (n = 18), none of these outcome measures changed significantly. Compared to placebo at 8 weeks, VLD CBP significantly improved pain, tenderness, and the HAD Depression subscore. Analysis of cyclic alternating pattern (CAP) sleep EEG revealed that significantly more subjects in the VLD CBP group than the placebo group had increased nights of restorative sleep in which CAP A2+A3 /CAP A1+A2+A3 = CAP A2+A3(Norm) ≤ 33%. For VLD CBP-treated subjects, the increase in nights with CAP A2+A3(Norm) ≤ 33% was correlated to improvements in fatigue, total HAD score, and HAD depression score. Fibromyalgia syndrome (FM) is a common, chronic musculoskeletal pain disorder, diagnosed predominantly in women, that is characterized by widespread pain, increased sensitivity to pain (or tenderness) at multiple tender points, fatigue, unrefreshing sleep, and depressed mood 1 . Cyclobenzaprine (CBP) has been studied in FM in a number of randomized trials employing doses of 10-40 mg per day, with mixed result

Coexistência de transtornos respiratórios do sono e síndrome fibromiálgica Sleep disordered breathing concomitant with fibromyalgia syndrome

OBJETIVO: Identificar síndrome fibromiálgica em pacientes com transtornos respiratórios do sono. MÉTODOS: Foram estudados 50 pacientes que compareceram à Clínica do Sono com queixas de roncar no sono, apnéias e sonolência diurna. Confirmou-se o diagnóstico de transtornos respiratórios do sono através de polissonografia. Para se estabelecer o diagnóstico de síndrome fibromiálgica, submeteram-se os pacientes a avaliação de acordo com os critérios estabelecidos pelo American College of Rheumatology. RESULTADOS: Estudaram-se 50 pacientes, 32 do sexo masculino. A média (&plusmn; desvio-padrão) de idade do grupo foi de 50 &plusmn; 12 anos. A média do índice de massa corporal do grupo foi de 29,7 &plusmn; 5,6 kg/m². A média do índice de apnéias e hipopnéias do grupo foi de 36 &plusmn; 29 apnéias e hipopnéias /hora. Nove das 18 mulheres e 2 homens preencheram os critérios estabelecidos pelo American College of Rheumatology para o diagnóstico de síndrome fibromiálgica. CONCLUSÃO: Considerando-se que a prevalência de síndrome fibromiálgica na população geral é de 0,5% para homens e de 3,4% para mulheres, a fração de casos de fibromialgia mais de dez vezes maior nesta amostra reforça a hipótese de associação entre transtornos respiratórios do sono e síndrome fibromiálgica.<br>OBJECTIVE: To identify fibromyalgia syndrome in patients with sleep disordered breathing. METHOD: We studied 50 patients seeking treatment at a sleep disorder clinic for snoring, apnea and excessive daytime sleepiness. Sleep disordered breathing was diagnosed through the use of polysomnography. To diagnose fibromyalgia syndrome, patients were evaluated in accordance with the criteria established by the American College of Rheumatology. RESULTS: Of the 50 patients, 32 were male. The mean (&plusmn; standard deviation) age of the group was 50 &plusmn; 12 years. The mean body mass index was 29.7 &plusmn; 5.6 kg/m². The mean apnea-hypopnea index was 36 &plusmn; 29 attacks of apnea or hypopnea per hour of sleep. Of the 18 women and 32 men evaluated, 9 and 2, respectively, met the American College of Rheumatology criteria for fibromyalgia syndrome. CONCLUSION: Considering the fact that the prevalence of fibromyalgia syndrome in the general population is 0.5% for men and 3.4% for women, the more than ten-fold higher proportion of fibromyalgia cases seen in this sample supports the hypothesis that there is an association between sleep disordered breathing and fibromyalgia syndrome