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Morning cortisol and fasting glucose are elevated in women with chronic widespread pain independent of comorbid restless legs syndrome
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Anaesthesiology and Intensive Care.ORCID iD: 0000-0001-6461-7868
Capio Hlth Ctr, Sleep Disorders Ctr, Örebro, Sweden.
Univ Gothenburg, Sahlgrenska Acad, Ctr Sleep & Vigilance Disorders, Gothenburg, Sweden.
Univ Gothenburg, Sahlgrenska Acad, Ctr Sleep & Vigilance Disorders, Gothenburg, Sweden; Sahlgrens Univ Hosp, Sleep Disorders Ctr, Gothenburg, Sweden.
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2018 (English)In: Scandinavian Journal of Pain, ISSN 1877-8860, E-ISSN 1877-8879, Vol. 18, no 2, p. 187-194Article in journal (Refereed) Published
Abstract [en]

Background and aims: Chronic widespread pain (CWP) is associated with poor quality of sleep, but the detailed underlying mechanisms are still not fully understood. In this study we investigated the influence of CWP on morning cortisol and fasting glucose concentrations as well as sleep disordered breathing.

Methods: In this case-control study, subjects with CWP (n=31) and a control group without CWP (n=23) were randomly selected from a population-based cohort of women. Current pain intensity, sleep quality, excessive daytime sleepiness [Epworth sleepiness scale (ESS)], psychiatric comorbidity and occurrence of restless legs syndrome (RLS) were assessed. Overnight polygraphy was applied to quantify sleep apnoea, airflow limitation and attenuations of finger pulse wave amplitude (>50%) as a surrogate marker for increased skin sympathetic activity. Morning cortisol and fasting glucose concentrations were determined. Generalised linear models were used for multivariate analyses.

Results: CWP was associated with higher cortisol (464±141 vs. 366±111 nmol/L, p=0.011) and fasting glucose (6.0±0.8 vs. 5.4±0.7 mmol/L, p=0.007) compared with controls. The significance remained after adjustment for age, body mass index, RLS and anxiety status (β=122±47 nmol/L and 0.89±0.28 mmol/L, p=0.009 and 0.001, respectively). The duration of flow limitation in sleep was longer (35±22 vs. 21±34 min, p=0.022), and pulse wave attenuation was more frequent (11±8 vs. 6±2 events/h, p=0.048) in CWP subjects compared with controls. RLS was associated with higher ESS independent of CWP (β=3.1±1.3, p=0.018).

Conclusions: Elevated morning cortisol, impaired fasting glucose concentration and increased skin sympathetic activity during sleep suggested an activated adrenal medullary system in subjects with CWP, which was not influenced by comorbid RLS.

Implications: CWP is associated with activated stress markers that may deteriorate sleep.

Place, publisher, year, edition, pages
2018. Vol. 18, no 2, p. 187-194
Keywords [en]
cortisol, finger pulse wave, glucose, multi-site pain, restless legs syndrome, skin sympathetic activation
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
URN: urn:nbn:se:uu:diva-355688DOI: 10.1515/sjpain-2018-0026ISI: 000431225000005PubMedID: 29794301OAI: oai:DiVA.org:uu-355688DiVA, id: diva2:1230479
Available from: 2018-07-03 Created: 2018-07-03 Last updated: 2018-07-03Bibliographically approved

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Stehlik, Romana

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