In women with fibromyalgia (FM), central nervous system (CNS) dysfunction in pain, mood, and sleep processes could be associated with changes in immune system indicators. The primary purpose of this ...study was to compare pain, psychological variables, subjective and objective sleep quality, lymphocyte phenotypes and activation markers, and natural killer activity (NKA) in midlife women with and without FM. A secondary purpose was to explore relationships among these variables in a step-wise regression. Subjects had pain pressure tender points assessed, completed a psychiatric interview and questionnaires (Beck Depression Inventory, SCL-90, Profile of Mood States, subjective sleep), and underwent polysomnograhic assessment for two consecutive nights. Lymphocyte phenotypes, activation markers, and NKA were assessed from blood drawn the morning after sleep laboratory night 2. Compared to controls, women with FM had lower pain thresholds, more psychological distress, higher depression scores, and reduced subjective and objective sleep quality. They also had fewer NK cells (
p<.009) and more NK cells that expressed the IL-2 receptor (
p<.04), but these differences were not statistically significant after correction for multiple comparisons. NKA was not statistically significantly lower in the women with FM compared to controls. In a multiple regression of age, tender point threshold, depression, psychological distress, and sleep efficiency, only the effect of group was significant (
F=5.479,
p<.03) on NKA. In conclusion, we found little evidence to support the hypothesis that pain, mood, and sleep symptoms are associated with changes in the enumeration of peripheral lymphocytes or function in FM.
Limited data are available on the relationship between self-reported sleep quality, fatigue, and behavioral sleep patterns in women with fibromyalgia (FM).
To compare self-reported sleep quality, ...fatigue, and behavioral sleep indicators obtained by actigraphy between women with FM and sedentary women without pain, and to examine relationships among these variables.
Twenty-three women with FM (M = 47.3, +/- 6.7 years) and 22 control women (M = 43.5, +/- 8.2 years) wore an actigraph on the nondominant wrist for 3 consecutive days at home. Each day women reported bedtimes, rise times, and ratings of sleep quality and fatigue in a diary. Self-reported sleep quality, fatigue, and indicators of sleep quality obtained from actigraphy (e.g., total sleep time, sleep efficiency, sleep latency, wake after sleep onset, and fragmentation index) were averaged. The Mann Whitney U test was used to assess group differences. Pearson Product Moment Correlation was used to evaluate relationships between sleep quality and fatigue, and among sleep quality, fatigue, and actigraphy sleep indicators.
Women with FM reported poorer sleep quality and more fatigue compared to controls (both p <.001). Actigraphy sleep indicators were not different between groups. In women with FM but not in controls, self-reported sleep quality was directly related to actigraphy indicators of total sleep time (r =.635, p <.01) and inversely related to sleep fragmentation (r = -.46, p <.05). Fatigue in women with FM was directly related to actigraphy indicators of wake after sleep onset (r =.57, p <.01), and inversely related to sleep efficiency (r = -.545, p <.01).
Self-reported sleep quality and fatigue are associated with behavioral indicators of sleep quality at home in women with FM. Actigraphy is a useful objective measure of improved sleep outcomes in intervention studies.
Using a telephone survey of 434 women who self-reported having and 198 women, who denied having fibromyalgia (FM) (aged 18-80 years), we compared women on self-reported number, major types, and ...effectiveness of currently taken conventional medications and herbs/supplements.
Ninety-three percent of women with FM reported taking at least one medication (1855 total, 499 types, on average 4.6 per person) compared with 56% of women without FM (269 total, 172 types, 1.4 per person on average). Half (n = 217) of the women with FM reported taking antidepressant drugs; more reported selective serotonin reuptake inhibitors (SSRI)-type with moderate effectiveness than tricyclic amines deemed to have strong effectiveness. Few were taking dual uptake inhibitors or the now approved pregabalin. Nearly 30% reported taking nonsteroidal anti-inflammatory drugs (NSAID), which have weak efficacy evidence. Less than 8% of controls reported taking either antidepressants or NSAID. Having FM was associated with these medications plus guaifenesen, anticonvulsants, muscle relaxants, narcotics, other analgesics, and benzodiazepines. Highest effectiveness scores were for opioid narcotics and guaifenesin. Forty-three percent of women with FM reported taking at least one herb/supplement compared with 23% of control women. The most common types were omega esterified fatty acids, glucosamine, and gingko. No particular type distinguished between the groups. Both groups tended to rate overall effectiveness lower for herbs/supplements than for conventional medications.
Substantial numbers of women with FM were taking pain medications that often lacked evidence for effectiveness. The variety of medications being taken by women with FM compared with women without FM indicates that there are few medications that consistently provide symptom alleviation for this condition.
Abstract Although aggressive medical treatment protocols have led to 80% five-year survival rates for most childhood cancer patients, many long-term survivors experience multiple troubling symptoms. ...Using data from 100 adult survivors of childhood cancers (ACC-survivors), we used latent variable mixture modeling to generate unique subgroups of survivors based on their experiences with a cluster of eight symptoms: lack of energy, worry, pain, difficulty sleeping, feeling irritable, feeling nervous, difficulty concentrating, and feeling sad (as measured by the Memorial Symptom Assessment Scale). We also examined factors that were likely to predict subgroup membership (chronic health conditions CHCs, health-promoting lifestyle, and demographic variables) and determined the extent to which satisfaction with quality of life (QoL) varied across the subgroups. The final mixture model included three subgroups of ACC-survivors: high symptoms (HS; n = 21), moderate symptoms (MS; n = 45), and low symptoms (LS; n = 34). ACC-survivors who reported at least one CHC were six times as likely to be classified in the HS subgroup as compared with the LS subgroup. Mean health-promoting lifestyle scores were lowest in the HS subgroup and highest in the LS subgroup. Differences in QoL among the subgroups were statistically significant, thus validating that the subgroups were characterized uniquely for identifying those symptoms with highest life impact. To our knowledge, we are the first to identify distinct subgroups of ACC-survivors differentiated by symptom cluster experience profiles. The findings warrant additional research to confirm the subgroup-specific symptom cluster experience profiles in larger studies of ACC-survivors.
To present the novel Symptom Cluster Experience Profile (SCEP) framework for guiding symptom research in adult survivors of childhood cancers and other subgroups at risk for high symptom burden.
...Empirically derived model of symptom cluster experience profiles, existing theoretical frameworks, and data-based literature on symptoms and quality of life in adult survivors of childhood cancers.
In a previous study, the authors generated a preliminary model to characterize subgroups of adult survivors of childhood cancers with high-risk symptom cluster profiles. The authors developed the SCEP framework, which depicts symptom cluster experiences as subgroup-specific profiles that are driven by multiple sets of risk and protective factors. The risk and protective factors may directly and indirectly contribute to or alleviate symptoms through their effects on systemic stress. Systemic stress instigates and sustains the symptom experience that, in turn, is expressed through negative diffusion into other components of quality of life, such as functional status, general health perceptions, and overall quality of life.
The SCEP framework is an initial approach to unbundle the complex heterogeneity that underlies the clustering of symptoms. By measuring a wide range of risk and protective factors in future studies of adult survivors of childhood cancers and other subgroups at risk for high symptom burden, further development and validation of the SCEP framework will occur.
The SCEP framework can be used to specify mechanisms underlying symptom cluster profiles and derive interventions targeted to high-risk symptom profiles. Findings from future studies can be translated to risk-based surveillance and symptom management clinical practice guidelines.
Women and sleep Shaver, Joan L F
The Nursing clinics of North America,
12/2002, Letnik:
37, Številka:
4
Journal Article
Recenzirano
Naturally fluctuating hormones (menstrual cycle, through pregnancy or menopausal transition) are not related to marked sleep disturbances in women. It is likely, however, that subsets of women will ...display a central nervous system vulnerability to hormonal fluctuations so that sleep disturbances manifest as a part of a complex of discomforting symptoms. Sleep is impacted directly through the circadian system or brain sleep regulation or through the development of concurrent functional changes and symptoms. Women are susceptible to sleep-related disorders that are also common in men, such as primary insomnia and SBD although the contributing factors and manifestations may not be the same.
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