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Are there sleep-specific phenotypes in patients with chronic fatigue syndrome? A cross-sectional polysomnography analysis

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By Zoe M Gotts et al. • • June 16, 2013

Editor's Comment: This is the first study to categorize different types of sleep disturbance in a large group of patients with CFS/ME. The researchers identified four basic groups: those who had difficulty falling asleep, those with frequent arousals, those with hypersomnia (more sleep time), and those with very short sleep time and frequent arousals. Because sleep is regulated by the central nervous system, identifiying types of sleep disorders in people with CFS/ME may help pinpoint different subsets of people with distinct brain anomalies.

The full study can be read HERE.

By Zoe M Gotts et al.


Objectives:Despite sleep disturbances being a central complaint in patients with chronic fatigue syndrome (CFS), evidence of objective sleep abnormalities from over 30 studies is inconsistent. The present study aimed to identify whether sleep-specific phenotypes exist in CFS and explore objective characteristics that could differentiate phenotypes, while also being relevant to routine clinical practice.

Design: A cross-sectional, single-site study.

Setting: A fatigue clinic in the Netherlands.

Participants: A consecutive series of 343 patients meeting the criteria for CFS, according to the Fukuda definition.

Measures: Patients underwent a single night of polysomnography (all-night recording of EEG, electromyography, electrooculography, ECG and respiration) that was hand-scored by a researcher blind to diagnosis and patient history.

Results: Of the 343 patients, 104 (30.3%) were identified with a Primary Sleep Disorder explaining their diagnosis. A hierarchical cluster analysis on the remaining 239 patients resulted in four sleep phenotypes being identified at saturation. Of the 239 patients, 89.1% met quantitative criteria for at least one objective sleep problem. A one-way analysis of variance confirmed distinct sleep profiles for each sleep phenotype. Relatively longer sleep onset latencies, longer Rapid Eye Movement (REM) latencies and smaller percentages of both stage 2 and REM characterised the first phenotype. The second phenotype was characterised by more frequent arousals per hour. The third phenotype was characterised by a longer Total Sleep Time, shorter REM Latencies, and a higher percentage of REM and lower percentage of wake time. The final phenotype had the shortest Total Sleep Time and the highest percentage of wake time and wake after sleep onset.

Conclusions: The results highlight the need to routinely screen for Primary Sleep Disorders in clinical practice and tailor sleep interventions, based on phenotype, to patients presenting with CFS. The results are discussed in terms of matching patients’ self-reported sleep to these phenotypes in clinical practice.

Source: BMJ Open 2013;3:e002999 doi:10.1136/bmjopen-2013-002999. Zoe M Gotts, Vincent Deary, Julia Newton, Donna Van der Dussen, Pierre De Roy, Jason G Ellis. Correspondence to: Dr Jason G Ellis;

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