{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,22]],"date-time":"2026-03-22T09:34:45Z","timestamp":1774172085388,"version":"3.50.1"},"reference-count":59,"publisher":"The Journal of Rheumatology","issue":"9","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J Rheumatol"],"published-print":{"date-parts":[[2009,9]]},"abstract":"<jats:sec><jats:title>Objective.<\/jats:title><jats:p>Patients with fibromyalgia syndrome (FM) complain of inadequate sleep, which could contribute to common symptoms including sleepiness, fatigue, or pain. However, measures that consistently and objectively distinguish FM patients remain elusive.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods.<\/jats:title><jats:p>Fifteen women with FM and 15 age- and gender-matched controls underwent 3 nights of polysomnography; Multiple Sleep Latency Tests to assess sleepiness; testing of auditory arousal thresholds during non-REM stage 2 and stage 4 sleep; overnight assessment of urinary free cortisol; and analysis of 24-hour heart rate variability.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results.<\/jats:title><jats:p>On the second night of polysomnography, women with FM in comparison to controls showed more stage shifts (p = 0.04) but did not differ significantly on any other standard polysomnographic measure or on the Multiple Sleep Latency Tests. Alpha EEG power during deep non-REM sleep, alone or as a proportion of alpha power during remaining sleep stages, also failed to distinguish the groups, as did auditory arousal thresholds. Urinary free cortisol did not differ between FM and control subjects in a consistent manner. However, decreased short-term heart rate variability (HRV) and especially ratio-based HRV among FM subjects suggested diminished parasympathetic and increased sympathetic activity, respectively. Other HRV measures suggested decreased complexity of HRV among the FM subjects.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion.<\/jats:title><jats:p>Standard measures of sleep, a gold-standard measure of sleepiness, quantified alpha-delta EEG power, auditory arousal thresholds, and urinary free cortisol largely failed to distinguish FM and control subjects. However, HRV analyses showed more promise, as they suggested both increased sympathetic activity and decreased complexity of autonomic nervous system function in FM.<\/jats:p><\/jats:sec>","DOI":"10.3899\/jrheum.090051","type":"journal-article","created":{"date-parts":[[2009,8,15]],"date-time":"2009-08-15T01:26:01Z","timestamp":1250299561000},"page":"2009-2016","source":"Crossref","is-referenced-by-count":55,"title":["Objective Measures of Disordered Sleep in Fibromyalgia"],"prefix":"10.3899","volume":"36","author":[{"given":"RONALD D.","family":"CHERVIN","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"MIHAELA","family":"TEODORESCU","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"RAMESH","family":"KUSHWAHA","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"ANDREA M.","family":"DELINE","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"CHRISTINE B.","family":"BRUCKSCH","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"CHRISTINE","family":"RIBBENS-GRIMM","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"DEBORAH L.","family":"RUZICKA","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"PHYLLIS K.","family":"STEIN","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"DANIEL J.","family":"CLAUW","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"LESLIE J.","family":"CROFFORD","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"2262","published-online":{"date-parts":[[2009,8,14]]},"reference":[{"key":"2018112909211602000_36.9.2009.1","doi-asserted-by":"publisher","DOI":"10.1097\/00006842-197507000-00008"},{"key":"2018112909211602000_36.9.2009.2","doi-asserted-by":"crossref","unstructured":"Moldofsky H MacFarlane JG . Fibromylagia and chronic fatigue syndromes. In: Kryger MH Roth T Dement WC , editors Principles and Practice of Sleep Medicine. Philadelphia: Elsevier Saunders, 2005:1225\u201336.","DOI":"10.1016\/B0-72-160797-7\/50111-7"},{"key":"2018112909211602000_36.9.2009.3","doi-asserted-by":"crossref","first-page":"1211","DOI":"10.1002\/art.1780380906","article-title":"Sleep electroencephalography and the clinical-response to amitriptyline in patients with fibromyalgia","volume":"38","author":"Carette","year":"1995","journal-title":"Arthritis Rheum"},{"key":"2018112909211602000_36.9.2009.4","doi-asserted-by":"publisher","DOI":"10.1016\/S1389-9457(00)00028-9"},{"key":"2018112909211602000_36.9.2009.5","first-page":"69","article-title":"Hypersomnolence in fibromyalgia syndrome","volume":"20","author":"Sarzi-Puttini","year":"2002","journal-title":"Clin Exp Rheumatol"},{"key":"2018112909211602000_36.9.2009.6","doi-asserted-by":"publisher","DOI":"10.1002\/1529-0131(200101)44:1<222::AID-ANR29>3.0.CO;2-K"},{"key":"2018112909211602000_36.9.2009.7","doi-asserted-by":"publisher","DOI":"10.1016\/0002-9343(93)90085-4"},{"key":"2018112909211602000_36.9.2009.8","doi-asserted-by":"publisher","DOI":"10.1016\/S0002-9343(96)00067-8"},{"key":"2018112909211602000_36.9.2009.9","doi-asserted-by":"publisher","DOI":"10.1016\/S0889-857X(01)00012-6"},{"key":"2018112909211602000_36.9.2009.10","doi-asserted-by":"publisher","DOI":"10.1034\/j.1399-3003.1999.14a34.x"},{"key":"2018112909211602000_36.9.2009.11","doi-asserted-by":"publisher","DOI":"10.1136\/ard.51.1.108"},{"key":"2018112909211602000_36.9.2009.12","doi-asserted-by":"publisher","DOI":"10.1002\/1529-0131(199811)41:11<1966::AID-ART11>3.0.CO;2-O"},{"issue":"Suppl","key":"2018112909211602000_36.9.2009.13","first-page":"A724","article-title":"Heart rate variability during sleep in women with fibromyalgia","volume":"27","author":"McMillan","year":"2004","journal-title":"Sleep"},{"key":"2018112909211602000_36.9.2009.14","doi-asserted-by":"publisher","DOI":"10.1002\/art.1780371105"},{"key":"2018112909211602000_36.9.2009.15","doi-asserted-by":"publisher","DOI":"10.1016\/S0002-9343(99)00074-1"},{"key":"2018112909211602000_36.9.2009.16","doi-asserted-by":"publisher","DOI":"10.1002\/art.21372"},{"key":"2018112909211602000_36.9.2009.17","first-page":"469","article-title":"Altered reactivity of the hypothalamic-pituitary-adrenal axis in the primary fibromyalgia syndrome","volume":"20","author":"Griep","year":"1993","journal-title":"J Rheumatol"},{"key":"2018112909211602000_36.9.2009.18","doi-asserted-by":"crossref","first-page":"483","DOI":"10.1111\/j.1749-6632.2002.tb04251.x","article-title":"Blunted ACTH and cortisol responses to systemic injection of corticotropin-releasing hormone (CRH) in fibromyalgia role of somatostatin and CRH-binding protein","volume":"966","author":"Riedel","year":"2002","journal-title":"Ann N Y Acad Sci"},{"key":"2018112909211602000_36.9.2009.19","first-page":"1586","article-title":"Effects of selective slow wave sleep disruption on musculoskeletal pain and fatigue in middle aged women","volume":"26","author":"Lentz","year":"1999","journal-title":"J Rheumatol"},{"issue":"Suppl","key":"2018112909211602000_36.9.2009.20","first-page":"A298","article-title":"Do polysomnographic findings explain sleepiness or pain in fibromyalgia syndrome?","volume":"28","author":"Chervin","year":"2005","journal-title":"Sleep"},{"issue":"Suppl","key":"2018112909211602000_36.9.2009.21","first-page":"A353","article-title":"Sleep stage dynamics distinguish fibromyalgia patients from controls","volume":"30","author":"Burns","year":"2007","journal-title":"Sleep"},{"key":"2018112909211602000_36.9.2009.22","doi-asserted-by":"publisher","DOI":"10.1016\/j.sleep.2007.10.022"},{"key":"2018112909211602000_36.9.2009.23","doi-asserted-by":"crossref","first-page":"681","DOI":"10.1016\/S0889-857X(21)00895-4","article-title":"Fibromyalgia","volume":"16","author":"Wolfe","year":"1990","journal-title":"Rheum Dis Clin N Am"},{"key":"2018112909211602000_36.9.2009.24","doi-asserted-by":"publisher","DOI":"10.1016\/S0924-9338(97)83297-X"},{"key":"2018112909211602000_36.9.2009.25","doi-asserted-by":"crossref","first-page":"317","DOI":"10.1016\/0304-3959(87)91074-8","article-title":"The short form McGill Pain Questionnaire","volume":"30","author":"Melzack","year":"1987","journal-title":"Pain"},{"key":"2018112909211602000_36.9.2009.26","doi-asserted-by":"publisher","DOI":"10.1016\/0304-3959(88)90138-8"},{"key":"2018112909211602000_36.9.2009.27","doi-asserted-by":"publisher","DOI":"10.1002\/art.21407"},{"key":"2018112909211602000_36.9.2009.28","doi-asserted-by":"publisher","DOI":"10.1016\/0304-3959(78)90021-0"},{"key":"2018112909211602000_36.9.2009.29","doi-asserted-by":"publisher","DOI":"10.1016\/0304-3959(80)90050-0"},{"key":"2018112909211602000_36.9.2009.30","doi-asserted-by":"publisher","DOI":"10.1177\/014662167700100306"},{"key":"2018112909211602000_36.9.2009.31","doi-asserted-by":"crossref","first-page":"519","DOI":"10.1093\/sleep\/9.4.519","article-title":"Guidelines for the multiple sleep latency test (MSLT): a standard measure of sleepiness","volume":"9","author":"Carskadon","year":"1986","journal-title":"Sleep"},{"key":"2018112909211602000_36.9.2009.32","first-page":"150","article-title":"The development and use of the Stanford Sleepiness Scale (SSS)","volume":"9","author":"Hoddes","year":"1972","journal-title":"Psychophysiology"},{"key":"2018112909211602000_36.9.2009.33","unstructured":"Rechtschaffen A Kales A . A manual of standardized terminology, techniques and scoring system for sleep stages of human subjects. Los Angeles: Brain Information Service\/Brain Research Institute, UCLA; 1968."},{"key":"2018112909211602000_36.9.2009.34","doi-asserted-by":"crossref","first-page":"173","DOI":"10.1093\/sleep\/15.2.173","article-title":"EEG arousals: scoring rules and examples","volume":"15","year":"1992","journal-title":"Sleep"},{"key":"2018112909211602000_36.9.2009.35","doi-asserted-by":"crossref","first-page":"290","DOI":"10.1093\/sleep\/19.4.290","article-title":"Auditory awakening threshold in sleepy and alert individuals","volume":"19","author":"Rosenthal","year":"1996","journal-title":"Sleep"},{"key":"2018112909211602000_36.9.2009.36","first-page":"H151","article-title":"Assessment of autonomic function in humans by heart-rate spectral-analysis","volume":"248","author":"Pomeranz","year":"1985","journal-title":"Am J Physiol"},{"key":"2018112909211602000_36.9.2009.37","doi-asserted-by":"publisher","DOI":"10.1136\/hrt.71.1.1"},{"key":"2018112909211602000_36.9.2009.38","doi-asserted-by":"crossref","first-page":"140","DOI":"10.1161\/01.HYP.24.1.140","article-title":"Importance of appropriate spectral methodology to assess heart-rate-variability in the frequency-domain","volume":"24","author":"Malliani","year":"1994","journal-title":"Hypertension"},{"key":"2018112909211602000_36.9.2009.39","doi-asserted-by":"publisher","DOI":"10.1111\/j.1540-8167.1994.tb01164.x"},{"key":"2018112909211602000_36.9.2009.40","doi-asserted-by":"publisher","DOI":"10.1016\/0002-9149(94)90617-3"},{"key":"2018112909211602000_36.9.2009.41","first-page":"56","article-title":"Efficient estimation of the heart period power spectrum and application to diurnal-variation in autonomic tone","volume":"82","author":"Rottman","year":"1990","journal-title":"Circulation"},{"key":"2018112909211602000_36.9.2009.42","first-page":"H867","article-title":"Hemodynamic regulation \u2014 investigation by spectral-analysis","volume":"249","author":"Akselrod","year":"1985","journal-title":"Am J Physiol"},{"key":"2018112909211602000_36.9.2009.43","first-page":"1043","article-title":"Heart rate variability: standards of measurement, physiological interpretation and clinical use","volume":"81","year":"1996","journal-title":"Circulation"},{"key":"2018112909211602000_36.9.2009.44","doi-asserted-by":"publisher","DOI":"10.1063\/1.166141"},{"key":"2018112909211602000_36.9.2009.45","first-page":"R1078","article-title":"Age-related alterations in the fractal scaling of cardiac interbeat interval dynamics","volume":"271","author":"Iyengar","year":"1996","journal-title":"Am J Physiol"},{"key":"2018112909211602000_36.9.2009.46","doi-asserted-by":"publisher","DOI":"10.1002\/1529-0131(199910)42:10<2189::AID-ANR21>3.0.CO;2-V"},{"key":"2018112909211602000_36.9.2009.47","first-page":"701","article-title":"Assessment of the ear and otoacoustic emission findings in fibromyalgia syndrome","volume":"23","author":"Yilmaz","year":"2005","journal-title":"Clin Exp Rheumatol"},{"key":"2018112909211602000_36.9.2009.48","doi-asserted-by":"publisher","DOI":"10.1016\/j.jpain.2007.12.006"},{"key":"2018112909211602000_36.9.2009.49","first-page":"1070","article-title":"The effects of sodium oxybate on clinical symptoms and sleep patterns in patients with fibromyalgia","volume":"30","author":"Scharf","year":"2003","journal-title":"J Rheumatol"},{"key":"2018112909211602000_36.9.2009.50","doi-asserted-by":"publisher","DOI":"10.1016\/j.sleep.2005.03.014"},{"key":"2018112909211602000_36.9.2009.51","doi-asserted-by":"publisher","DOI":"10.1152\/japplphysiol.01095.2002"},{"key":"2018112909211602000_36.9.2009.52","doi-asserted-by":"crossref","first-page":"755","DOI":"10.1093\/sleep\/30.6.755","article-title":"The significance of the sympathetic nervous system in the pathophysiology of periodic leg movements in sleep","volume":"30","author":"Guggisberg","year":"2007","journal-title":"Sleep"},{"key":"2018112909211602000_36.9.2009.53","doi-asserted-by":"publisher","DOI":"10.1002\/art.20687"},{"key":"2018112909211602000_36.9.2009.54","doi-asserted-by":"publisher","DOI":"10.1007\/s00296-005-0007-1"},{"key":"2018112909211602000_36.9.2009.55","doi-asserted-by":"publisher","DOI":"10.1016\/j.semarthrit.2007.04.003"},{"key":"2018112909211602000_36.9.2009.56","doi-asserted-by":"publisher","DOI":"10.1016\/S0049-0172(00)80008-6"},{"key":"2018112909211602000_36.9.2009.57","doi-asserted-by":"publisher","DOI":"10.1002\/(SICI)1097-4598(199906)22:6<678::AID-MUS4>3.0.CO;2-P"},{"key":"2018112909211602000_36.9.2009.58","doi-asserted-by":"publisher","DOI":"10.1176\/appi.psy.45.2.129"},{"key":"2018112909211602000_36.9.2009.59","doi-asserted-by":"publisher","DOI":"10.1038\/sj.npp.1300146"}],"container-title":["The Journal of Rheumatology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.3899\/jrheum.090051","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2021,10,9]],"date-time":"2021-10-09T18:01:34Z","timestamp":1633802494000},"score":1,"resource":{"primary":{"URL":"http:\/\/www.jrheum.org\/lookup\/doi\/10.3899\/jrheum.090051"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2009,8,14]]},"references-count":59,"journal-issue":{"issue":"9","published-online":{"date-parts":[[2009,9,8]]},"published-print":{"date-parts":[[2009,9]]}},"alternative-id":["10.3899\/jrheum.090051"],"URL":"https:\/\/doi.org\/10.3899\/jrheum.090051","relation":{},"ISSN":["0315-162X","1499-2752"],"issn-type":[{"value":"0315-162X","type":"print"},{"value":"1499-2752","type":"electronic"}],"subject":[],"published":{"date-parts":[[2009,8,14]]}}}