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

Edwin S Meresh,1 Hewa Artin,2 Cara Joyce,3 Steven Birch,4 David Daniels,1 Jack H Owens,1 Alvaro J La Rosa,1 Murali S Rao,1 Angelos Halaris11Department of Psychiatry, Loyola University Medical Center, Maywood, IL 60153, USA; 2Loyola Stritch School of Medicine, Maywood, IL 60153, USA; 3Biostatistics Core, Clinical Research Office, Loyola University Medical Center, Maywood, IL 60153, USA; 4Informatics and Systems Development, Loyola University Medical Center, Maywood, IL 60153, USABackground: 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: fibromyalgia, obstructive sleep apnea, co-morbidity, sleep, rheumatology, psychiatry