Complaints of chronic fatigue as well as sleep disturbances are
prevalent in Lyme disease. We compared polysomnographic
measures of sleep in patients with documented Lyme disease
with those of a group of age-matched normal control subjects.
Eleven patients meeting Centers for Disease Control criteria
for late Lyme disease with serologic confirmation by
enzyme-linked immunosorbent assay and Western blot without a
history of other medical or psychiatric illness and 10
age-matched control subjects were studied. Lyme disease
patients and controls underwent 2 nights of polysomnography.
Multiple sleep latency testing (MSLT) was performed in the
patients. Sleep was staged by standard criteria, and
continuity of sleep was assessed for each stage of frequency
analysis of consecutive epochs.
All patients studied reported sleep-related complaints, including
difficulty initiating sleep (27%), frequent nocturnal awakenings (27%),
excessive daytime somnolence (73%) and restless legs/nocturnal
leg jerking (9%). Greater sleep latency, decreased sleep
efficiency and a greater arousal index were noted in Lyme
patients. The median length of uninterrupted occurrences of
stage 2 and stage 4 non-rapid eye movement (NREM) sleep was
less in Lyme patients (6.3 +/- 3.0 epochs in patients vs. 11.4
+/- 4.4 epochs in controls for stage 2, p < 0.01, and 4.3 +/-
4.4 epochs in patients vs. 11.2 +/- 6.3 epochs in controls for
stage 4, p < 0.01), indicating greater sleep fragmentation.
Mean sleep onset latency during the MSLT was normal (12.7 +/-
5.6 minutes). Three patients demonstrated alpha-wave intrusion
into NREM sleep. These sleep abnormalities may contribute to
the fatigue and sleep complaints common in this disease.
Greenberg HE, Ney G, Scharf SM, Ravdin L, Hilton E