Patients with chronic fatigue syndrome (CFS), as defined by Centers of Disease Control criteria, often have a potentially treatable sleep disorder. However, even when obstructive sleep apnea (OSA) is identified in these patients, improvement with treatment is not predictable. We sought to determine whether any parameters of the diagnostic or titration sleep study were associated with improvement in symptoms of CFS after a subsequent trial of home CPAP.
We reviewed the clinical and polysomnographic (PSG) findings of 78 patients with CFS. Thirty-nine (50%) were found to have OSA and underwent a CPAP titration night. Thirty-seven pts subsequently agreed to a therapeutic CPAP trial lasting up to 6 months. They then rated their CFS symptoms as “improved” or “not-improved”.
In the diagnostic PSG, patients with CFS who reported improvement to later CPAP had a higher mean arousal index 67.6 (70.1) vs. 26.1 (12.1) in those who did not improve (p = 0.037). The following table compares several PSG variables in patients who improved with the CPAP trial compared with those who did not. Each value represents the change between the diagnostic and CPAP titration nights (mean and standard deviation).
Patients with CFS and OSA are more likely to improve with CPAP if they have higher arousal indices in the diagnostic PSG and show improved sleep efficiency during CPAP titration. Changes in REM latency and stage 1 and 2 sleep may also predict improvement.
The above mentioned PSG variables may be clinically useful in predicting which patients with CFS and OSA are more likely to improve with CPAP use.
Marcel Baltzan, None.Diagnostic vs. TitrationImprovement with CPAPNo Improvement with CPAPp ValueChange in Sleep Efficiency (%)13.1 (27.8)−9.6 (14.2)0.010Change in Latency to REM-sleep (min)−40.8 (108)48.9 (75.8)0.023Change in Stage 1 Sleep (%)−4.8 (8.9)2.9 (12.1)0.050Change in Stage 2 Sleep (%)5.0 (10.3)−7.5 (18.2).0.023Change in Apnea-hypopnea index (per hour)−21.7 (50.7)3.3 (19.5)0.094