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Circadian studies of autonomic nervous balance in patients with fibromyalgia (FM): a heart rate variability analysis

  [ 93 votes ]   [ Discuss This Article ]
By Martinez-Lavin M, Hermosillo AG, Rosas M, Soto ME • • November 6, 1998

OBJECTIVE: To determine the accumulated 24-hour cardiovascular
autonomic modulation and its circadian variations in patients
with fibromyalgia, by means of heart rate variability
METHODS: Thirty patients with fibromyalgia and 30
age- and sex-matched controls were studied prospectively.
Assessments included a 24-hour ambulatory recording of heart
rate variability, time-domain analysis of the accumulated
24-hour R-R interval variations, and power spectral analysis
to determine the sympatho/ vagal balance at different hours
(calculated as the power spectral density of the low-frequency
[0.04- 0.15-Hz] sympathetic band divided by the power of the
high-frequency [0.15-0.50-Hz] parasympathetic band).
Fibromyalgia patients had diminished accumulated 24-hour heart
rate variability, manifested by a decreased standard deviation
of all R-R intervals (mean +/- SD 126 +/- 35 ms, versus 150
+/- 33 ms in controls; P = 0.008) and a decreased ratio of
pairs of adjacent R-R intervals differing by >50 ms (mean +/-
SD 12.0 +/- 9.0% versus 20.1 +/- 18.0%; P = 0.031). Patients
lost the circadian variations of sympatho/vagal balance, with
nocturnal values significantly higher than those of controls
at time 0 (mean +/- SD 3.5 +/- 3.2 versus 1.2 +/- 1.0; P =
0.027) and at 3 hours (3.3 +/- 3.0 versus 1.6 +/- 1.4; P =
CONCLUSION: Individuals with fibromyalgia have
diminished 24-hour heart rate variability due to an increased
nocturnal predominance of the low-frequency band oscillations
consistent with an exaggerated sympathetic modulation of the
sinus node. This abnormal chronobiology could explain the
sleep disturbances and fatigue that occur in this syndrome.
Spectral analysis of heart rate variability may be a useful
test to identify fibromyalgia patients who have dysautonomia.

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