THU0481 SLEEP DISTURBANCES IN FIBROMYALGIA – AN AUSTRALIAN TERTIARY HOSPITAL EXPERIENCE
Authors: Kevin Su, Krishna Bajee Sriram, Parham Afrasyabi
Journal: Annals of the Rheumatic Diseases (2019)

<h3>Background</h3> Fibromyalgia (FM) is a central pain disorder with an estimated population prevalence of 2-7% and six times as common in women than men.<sup>1</sup>Obstructive sleep apnoea (OSA) is a structural sleep disorder, with an estimated incidence of 14% of males and 5% females. Incidence of OSA in FM has been variably reported but estimated at 25-81%.<sup>2</sup> Despite its frequency, the underlying nature of sleep disturbances haven't been consistently replicated. A 2017 meta-analysis found significant differences in sleep efficiency (SE), a measure of total time spent in REM (Rapid Eye movement) sleep, number of arousals and sleep quality.<sup>3</sup> Prados et al in 2013 showed women with FM have less severe sleep disturbance than males, suggesting a gender difference.<sup>4</sup> <h3>Objectives</h3> To identify the incidence of FM in a cohort referred to the respiratory department for diagnostic polysomnography (dPSG) at the Gold Coast University Hospital (GCUH), a tertiary referral centre in Australia. We aim to identify epidemiological, gender differences and sleep abnormalities in patients with FM and OSA. Methods: dPSG reports of 998 patients with 1053 studies at the GCUH from 2015 - 18 was audited. We included FM diagnosed by a rheumatologist from the general Rheumatology clinics of the same facility. Two control groups were formed, one with a random number generator. The second from manual matching of major OSA risk factors such as age, gender and Body mass index (BMI), with a two to one ratio for statistical power. All were subsequently subdivided into gender. Statistical analysis was performed with calculation of mean, standard deviation and T tests for significance as calculated by the computer software Stata. <h3>Results</h3> <h3>Conclusion</h3> Female predominance and 3% population incidence of FM was congruent with literature. We note the mean age was nearing expected upper limits for FM. Increased age as a risk factor for OSA may have led this selection bias. Unexpectedly, overall severity of OSA as per AHI and number of desaturating events as per ODI3 was less in FM. We hypothesise that this is due to a higher proportion of females in the FM group compared to males, confirmation would require a larger study cohort, a limitation of this study. It was beyond the scope of this study to explore concomitant medication use and comorbidities and its effect on sleep. Another significant finding was in males, where sleep efficiency (SE) was lower in both matched and random groups. Furthermore, when matched for age, gender and BMI, males FM have reduced total sleep time. Suggesting that males with FM may have additional impediments to good sleep efficiency which may not be readily recognised during clinical evaluation. Similarly to Prados et al, we found females with FM (fig. 3) had a trend for better sleep quality and less sleep disturbance. However, no domain reached statistical significance, which again reflects low study power. This study emphasises the contribution of OSA as a comorbidity for patients with FM and its effect on sleep quality. Importantly, also the differences in gender. <h3>References</h3> [1] Neumann L, Buskila D. Epidemiology of fibromyalgia. Curr Pain Headache Rep. 2003 Oct;7(5):362-8. [2] Ferré A. Chronic fatigue syndrome and sleep disorders: clinical associations and diagnostic difficulties. Neurologia. 2016 Feb 11. pii: S0213-4853(16)00010-4. [3] Wu YL, Chang LY, Lee HC, Fang SC, Tsai PS. Sleep disturbances in fibromyalgia: A meta-analysis of case-control studies. J Psychosom Res. 2017 May;96:89-97. [4] Prados G, Miró E, Martínez MP, Sánchez AI, López S, Sáez G. Fibromyalgia: gender differences and sleep-disordered breathing. Clin Exp Rheumatol. 2013 Nov-Dec;31(6 Suppl 79):S102-10. <h3>Acknowledgement</h3> Dr Jennifer Ng (Rheumatology) at the Gold Coast University Hospital <h3>Disclosure of Interests</h3> None declared