DO PATIENTS WITH PURE CHRONIC-FATIGUE-SYNDROME (NEURASTHENIA) HAVE ABNORMAL SLEEP

Objective: To determine whether patients with ''pure'' chronic fatigue syndrome (neurasthenia) have sleep abnormalities which may contribute to subjective measures of daytime fatigue. Method: Sleep characterist ics of 20 patients meeting research criteria for chronic fatigue syndr ome (CFS) but not depression, anxiety, or sleep disorder were compared with sleep characteristics of 20 healthy subjects matched for age and sex. Measures of sleep included a) subjective interview reports and s leep diaries and b) home-based polysomnography. Results: Patients with CFS complained of poor quality unrefreshing sleep. They also napped d uring the day. Polysomnograph data showed no difference in actual noct urnal sleep time between the two groups although patients with CFS spe nt significantly longer in bed (p < .01), slept less efficiently (p < .03), and spent longer awake after sleep onset (p < .05). The polysomn ographs of seven patients with CFS and one healthy subject were regard ed as significantly abnormal. Five patients and one healthy subject ha d difficulty maintaining sleep. One patient had a disorder of both ini tiating and maintaining sleep and one patient woke early. Conclusions: Patients with ''pure'' CFS complain of unrefreshing sleep but only a minority have a clearly abnormal polysomnograph. The most common abnor mality is of long periods spent awake after initial sleep onset. Altho ugh sleep abnormalities may play a role in the etiology of CFS, they s eem to be unlikely to be an important cause of daytime fatigue in the majority of patients. However, pharmacological and behavioral methods that improve sleep quality may be an important component of a pragmati cally based treatment package for patients who do have abnormal sleep.