Fibromyalgia and sleep-disordered breathing: the missing link
© BioMed Central Ltd 2008
Published: 25 November 2008
Recently, Martinez-Lavin  proposed a model of sympathetically maintained neuropathic pain syndrome that has the merit of scrutinizing possible mechanisms behind the central sensitization model . Eisinger , in an editorial comment, raises the issue of heterogeneity permeating Martinez-Lavin's proposition. Since it is difficult to establish a traumatic trigger event in all cases, Eisinger considers multicausality as more reasonable than a single post-traumatic etiology for all cases. Félix and Fontenele  further explored this venue, speculating that the orthostatic intolerance symptoms seen in the majority of fibromyalgia patients are a consequence of sympathetic hyperactivity. The idea that a COMT val-158-met polymorphism may cause higher cathecolamine levels has been explored . Loevinger and colleagues  have shown that the metabolic syndrome is more common in individuals with fibromyalgia who also have higher body mass index, blood pressure, and waist-to-hip ratio than controls.
Interestingly, elevated body mass index, blood pressure, and waist-to-hip ratio are associated with sleep-disordered breathing. We recently reported in a study that 50% of the women with obstructive sleep apnea syndrome or upper airway resistance syndrome had chronic pain and more than 11 tender points when pressed with 4 kgf/cm2 . Guille-minault and colleagues  reported orthostatic intolerance in patients with upper airway resistance syndrome. We believe that the authors investigating this theme should discuss the possibility of sleep-disordered breathing being the missing link between fibromyalgia, pain, disturbed sleep, alpha-delta sleep, hypotension, sympathetic hyperactivity, and metabolic syndrome.
We are conducting investigations into whether exposition to the typical stress of sleep-disordered breathing – with repeated arousal episodes and hypoxemia – has fibromyalgia as a possible outcome. Our preliminary results underline the need to consider and further explore this hypothesis.
- Martinez-Lavin M: Biology and therapy of fibromyalgia: Stress, the stress response system, and fibromyalgia. Arthritis Res Ther. 2007, 9: 216-10.1186/ar2146.PubMed CentralView ArticlePubMed
- Staud R: Biology and therapy of fibromyalgia: pain in fibromyalgia syndrome. Arthritis Res Ther. 2006, 8: 208-10.1186/ar1950.PubMed CentralView ArticlePubMed
- Eisinger J: Dysautonomia, fibromyalgia and reflex dystrophy. Arthritis Res Ther. 2007, 9: 105-10.1186/ar2212.PubMed CentralView ArticlePubMed
- Félix FHC, Fontenele JB: Is fibromyalgia a cardiovascular disease? A comment on Martinez-Lavin's review 'Stress, the stress response system, and fibromyalgia'. Arthritis Res Ther. 2007, 9: 404-10.1186/ar2296.PubMed CentralView ArticlePubMed
- Vargas-Alarcón G, Fragoso JM, Cruz-Robles D, Vargas A, Vargas A, Lao-Villadóniga JI, García-Fructuoso F, Ramos-Kuri M, Hernández F, Springall R, Bojalil R, Vallejo M, Martínez-Lavín M: Catechol-O-methyltransferase gene haplotypes in Mexican and Spanish patients with fibromyalgia. Arthritis Res Ther. 2007, 9: R110-10.1186/ar2316.PubMed CentralView ArticlePubMed
- Loevinger BL, Muller D, Alonso C, Coe CL: Metabolic syndrome in women with chronic pain. Metabol Clin Exp. 2007, 56: 87-93.View Article
- Germanowicz D, Lumertz MS, Martinez D, Margarites AF: Coexistência de transtornos respiratórios do sono e síndrome fibromiálgica. J Bras Pneumol. 2006, 32: 333-338.PubMed
- Guilleminault C, Faul JL, Stoohs R: Sleep-disordered breathing and hypotension. Am J Respir Crit Care Med. 2001, 164: 1242-1247.View ArticlePubMed