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Subjective Sleep Quality and Depressive Symptoms in Patients with the Chronic Fatigue Syndrome

  [ 136 votes ]   [ Discuss This Article ] • April 24, 2002

Journal: J of Chronic Fatigue Syndrome, Vol. 10(2) 2002, pp. 19-28

Authors: A. W. Graffelman, MD; A. Knuistingh Neven, MD, PhD; L. Nagelkerken, PhD; H. Petri, MD, PhD; M. P. Springer, MD, PhD

Affiliations: A. W. Graffelman, A. Knuistingh Neven, H. Petri, and M. P. Springer are affiliated with the Department of General Practice and Nursing Home Medicine, Leiden University Medical Centre, Leiden, The Netherlands. L. Nagelkerken is affiliated with the TNO-Prevention and Health Division of Immunological and Infectious Diseases, Leiden, The Netherlands. Address correspondence to: Mrs. A. W. Graffelman, MD, Department of General Practice and Nursing Home Medicine, Leiden University Medical Centre, P.O. Box 2088, 2301 CB Leiden, The Netherlands (E-mail: )


Objectives: To evaluate subjective quality of sleep and depressive symptoms of patients with chronic fatigue syndrome (CFS).

Methods: Adult patients, who met the criteria for CFS, were recruited by general practitioners in the Leiden area, The Netherlands. Age and sex-matched controls were recruited. Questionnaires were handed out to 59 patients and 56 controls.

Results: CFS patients had a significant higher mean score than controls on the Groningen Sleep Quality Score (GSQS) and the Zung-index, i.e., worse sleep and depression scores. In the multivariate logistic regression model, the GSQS had an OR of 1.35 per unit score (CI: 1.07-1.70), and the Zung-index had an OR of 1.21 per unit score (CI: 1.10-I .33).

Conclusions: In our study, CFS patients report more subjective sleep impairment and depressive symptoms than controls but these factors appear to be independent. The fact that only a minority of the CFS patients have depressive symptoms suggests it is unlikely that depression is the cause of CFS.

KEYWORDS. Chronic fatigue syndrome, depression, general practice, sleep


Chronic fatigue syndrome (CFS) is an illness of unknown origin, characterized by inordinate fatigue which has lasted for at least six months, resulting in impaired physical and mental functioning. A working case definition was agreed upon by the CDC, first published by Holmes et al. (1) and later revised by Fukuda et al. (2).

The prevalence of CFS varies from 0.37 to 3.0 per 1000 persons in different studies over the world (3-5). A recent study by Wessely et al. (6) in primary care gave a much higher prevalence. In The Netherlands, the reported prevalence of CFS is 1.1 per 1000 (7,8). The prevalence is higher in women than in men (3,7,8,9). The pathogenesis of CFS is still unknown, despite many studies which have investigated a wide variety of causes, ranging from infections to psychiatric disorders. Overt depression and insomnia are exclusion criteria for CFS. However, depressive symptoms and subjective impairment of sleep seem to occur frequently in patients with CFS (10,11).

Previous research has shown that CFS patients without depression can develop sleep disturbance whether it is objectively measured
(10,12,13) or subjectively reported (14,15). These are all secondary care studies and the relationship between sleep and depressive symptoms has not been explored in primary care CFS patients. The aim of the present study was to describe the subjective sleep quality and depressive symptoms of CFS patients compared to controls in a primary care setting.

© 2002 by The Haworth Press, Inc. All rights reserved.

[Copies of the complete article are available for a fee from The Haworth Document Delivery Service: 1-800-HAWORTH. E-mail address: Website: ]

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