Obstructive sleep apnea co-morbidity in patients with fibromyalgia: a single-center retrospective analysis and literature review

Edwin S Meresh, Hewa Artin, Cara Joyce, Steven Birch, David Daniels, Jack H Owens, Alvaro J La Rosa, Murali S Rao, Angelos Halaris, Edwin S Meresh, Hewa Artin, Cara Joyce, Steven Birch, David Daniels, Jack H Owens, Alvaro J La Rosa, Murali S Rao, Angelos Halaris

Abstract

Background: Fibromyalgia (FM) is a chronic medical condition characterized by widespread pain, sleep disturbance, and cognitive dysfunction. Sleep disorders are thought to play a prominent role in the etiology and symptomatic management of FM, specifically obstructive sleep apnea (OSA). In order to provide collaborative care, we need a better understanding of any overlapping presentation of FM and OSA. We conducted a site-wide review of patients from 2012-2016 to identify FM patients diagnosed with OSA. Methods: Charts were reviewed in patients aged 18 and above from 2012-2016 using ICD codes from a clinical data repository. Intersection of patients with a diagnosis of FM and OSA in clinics of psychiatry, sleep, rheumatology, and other outpatient clinics was compared. Polysomnography order patterns for FM patients were investigated. Results: Co-morbidity was highest in the sleep clinic (85.8%) compared to psychiatry (42.0%), rheumatology (18.7%), and other outpatient clinics (3.6%) (p<0.001). In the rheumatology and other outpatient clinics, 93.5% and 96% of patients respectively, had no polysomnography ordered. Pairwise comparison of co-morbidity in clinics: sleep vs psychiatry, sleep vs rheumatology, sleep vs other clinics, psychiatry vs rheumatology, psychiatry vs other clinics, and rheumatology vs other clinics were statistically significant after applying a Sidak adjustment to the p-values (all p<0.001). Conclusion: Our analysis suggests that there could be a correlation between FM and OSA, and referral to sleep studies is recommended in the management of patients with FM. The varying prevalence of FM patients with co-morbid OSA in sleep clinics when compared to other outpatient clinics suggests a discrepancy in the identification of FM patients with OSA. When properly screened, OSA co-morbidity has the potential to be higher in other outpatient clinics.

Keywords: co-morbidity; fibromyalgia; obstructive sleep apnea; psychiatry; rheumatology; sleep.

Conflict of interest statement

The authors report no conflicts of interest in this work.

Figures

Figure 1
Figure 1
Percentage of patients with fibromyalgia and obstructive sleep apnea in psychiatry, sleep, rheumatology, and all other outpatient clinics. Abbreviations: FM, fibromyalgia; OSA, obstructive sleep apnea.
https://www.ncbi.nlm.nih.gov/pmc/articles/instance/6500898/bin/OARRR-11-103-g0001.jpg

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