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Polysomnography With Quantitative EEG in Patients With and Without Fibromyalgia

Rosenfeld, Victor W.*; Rutledge, Dana N.; Stern, John M.

Journal of Clinical Neurophysiology: April 2015 - Volume 32 - Issue 2 - p 164–170
doi: 10.1097/WNP.0000000000000134
Original Research

Purpose: Characterize the polysomnographic (PSG) and quantitative EEG (qEEG) features of fibromyalgia and determine whether fibromyalgia patients differ in these measures when compared with a control sleep disorder population.

Methods: All undergoing all-night PSG for evaluation of a sleep disorder were evaluated for fibromyalgia. The PSGs were interpreted for routine sleep measures, and qEEG was performed to measure the delta and alpha frequency power during non-rapid eye movement sleep. Measures and qEEG were analyzed according to fibromyalgia diagnosis.

Setting: Community-based sleep medicine center.

Patients: All patients undergoing PSG over a 2-year period.

Interventions: None.

Results: Of the 385 patients in the study population, 133 had fibromyalgia according to American College of Rheumatology criteria. The population's average Epworth Sleepiness Score was 10.5, the average sleep efficiency was 78%, and the Periodic Limb Movement disorder prevalence was 15%. None of these sleep measures differed significantly between the fibromyalgia and non-fibromyalgia groups. Obstructive sleep apnea was present in 45% of the fibromyalgia group. Significant differences were present in the qEEG ratio of delta to alpha frequency power, which was 95% specific for fibromyalgia when ≤1. A qEEG ratio ≤10.5 was 85% sensitive for fibromyalgia, and a qEEG ratio >10.5 had an 89% negative predictive value for fibromyalgia. Among patients with fibromyalgia who were not taking a benzodiazepine or benzodiazepine agonist, a qEEG ratio ≤10.5 was 84% specific and had a 78% positive predictive value.

Conclusions: Sleep disorders identified by routine PSG, including obstructive sleep apnea, are common in fibromyalgia, but periodic leg movement disorder and poor sleep efficiency are not. A qEEG low delta/alpha ratio during non-rapid eye movement sleep can differentiate patients with fibromyalgia from others who are referred for PSG. Consideration of benzodiazepine and benzodiazepine agonist use is important when interpreting the delta/alpha ratio.

*SouthCoast Medical Group, Savannah, Georgia, U.S.A.;

School of Nursing, California State University, Fullerton, California, U.S.A.; and

University of California, Los Angeles, California, U.S.A.

Address correspondence and reprint requests to John M. Stern, MD, UCLA Department of Neurology, 710 Westwood Plaza, Suite 1250, Los Angeles, CA 90095, U.S.A.; e-mail:

© 2015 by the American Clinical Neurophysiology Society