More on CFS and sleep.
Patients with chronic fatigue syndrome (CFS) present a disordered
sleep pattern and frequently undergo polysomnography to exclude a
primary sleep disorder. These studies have shown reduced sleep
efficiency, a reduction of deep sleep, prolonged sleep initiation, and
alpha-wave intrusion during deep sleep. Deregulation of the 2-5A
synthetase/RNase L antiviral pathway and a potential acquired
channelopathy are also found in a subset of CFS patients and could lead
to sleep disturbances. This study compiles a large sleep study database
of CFS patients and correlates these data with a limited number of
immune parameters because it has been thought that RNase L could be
associated with these sleep disturbances. Forty-eight patients
fulfilling CDCP criteria for CFS underwent extensive medical evaluation,
routine laboratory testing, and a structured psychiatric interview.
Subjects then completed a complaint checklist, and a two-night
polysomnographic investigation and RNase L analysis was performed. CFS
patients experienced a prolonged sleep latency, showed a low sleep
efficiency index, and had a low percentage of slow wave sleep. The
present alpha into delta sleep intrusion correlated with anxiety; no
correlations appeared, however, between alpha-delta sleep and
immunologic parameters, including RNase L.
Van Hoof E, De Becker P, Lapp C, et al. Defining the occurrence and
influence of alpha-delta sleep in chronic fatigue syndrome. Am I Med
Sci. 2007 Feb; 333(2):78-84.
COMMENT: The main findings were validation of sleep latency
problems and other sleep disturbances already previously suggested;
alpha-delta intrusion appeared to be associated with anxiety, and
elevated RNase L did not correlate with alpha-delta sleep intrusion.
This introduces one more factor into the mosaic of factors in CFS: that
of a not-infrequent association with an immediately prior viral
infection. Deregulation of one of the antiviral pathways is the
evidence. Again, sleep issues are an integral part of the mosaic.
Improving sleep, in my experience, makes life more tolerable for these
patients, but does not cure the syndrome.