A study offers evidence that teens with chronic fatigue syndrome have longer sleep onset latency, time in bed, total sleep time, and later rise time than healthy counterparts.
Chronic fatigue syndrome (CFS), also called myalgic encephalomeyelitis (ME), is a chronic illness that affects up to 2.5 million Americans and is characterized by extreme fatigue that doesn’t improve with rest.
A recent study published in the Journal of Clinical Sleep Medicine has found that teens with chronic fatigue syndrome experience more sleep disturbances than those in a healthy control group, which could lead to poorer quality of life and impaired development. Other studies have shown the illness to also be linked to obesity, eating difficulties, and chronic widespread pain.
“Pediatric CFS/ME is a debilitating and poorly understood condition that can cause an adverse functional impact during a critical phase of development, typically adolescence between 10 and 19 years,” says Elisha Josev, lead author of the study. “The consequences of this condition can be different in adolescents compared to adults, including impacts on school functioning and school attendance, socializing, and vocational prospects.”
However, according to Josev, there hasn’t been a lot of research on this specific population, especially when it comes to sleep quality. “We are interested in improving our understanding of pediatric CFS/ME to ultimately improve the quality of care and health outcomes for child and adolescent patients. We were inspired to look at sleep specifically because research from our team and other international research groups has shown that sleep disturbance is one of the most commonly reported symptoms of CFS/ME in adolescents. However, this sleep disturbance has not been well characterized, nor do we know how it compares to the quality of sleep experienced by their healthy peers.”
It was important to use both objective and subjective measures so the results could potentially lead to targeted research on proper interventions for this population, Josev says. “Subjective complaints of sleep disturbance are common in the pediatric CFS/ME population, but results from our small study showed that teenagers with CFS/ME were not just ‘feeling’ more tired and unrefreshed from sleep compared with their healthy peers. These adolescents were shown to have objective and scientifically-measured differences in their sleep quality and quantity compared with healthy adolescents.”
For the study, objective sleep variables were measured using actigraphy watches on 21 teens with chronic fatigue syndrome and 145 healthy teens, worn continuously for two weeks. The subjective measure of sleep quality was reached using the Pittsburgh Sleep Quality Index. The research team found those with CFS/ME presented longer sleep onset latency, time in bed, total sleep time and a later rise time, as well as poorer sleep quality—meaning the afflicted population not only didn’t get to sleep as fast as the healthy controls, but once they did they needed more time to sleep and did not report feeling rested. The chronic fatigue syndrome group also experienced more anxiety.
“These preliminary research findings show us that sleep may potentially be an important treatment target for pediatric CFS/ME, and could help focus our research on effective sleep interventions for this vulnerable group,” says Josev. “It will be important for clinicians to individually assess sleep problems for each adolescent patient to adequately determine the required targeted treatment. Treating sleep disturbance and promoting good sleep hygiene may not only be important for adolescents’ development, but may also have the benefit of reducing exacerbation of their other CFS/ME symptoms.”
In a recent article published by BMC Pediatrics, experts from different healthcare fields concluded that CFS/ME affects multiple areas of health and that a priority should be placed on increasing physical function and improving school function and participation in adolescents with the illness.
According to Josev, there is still much more research to be done involving diagnosis and other factors involved with CFS/ME. “With further investigation in bigger samples, we might be able to find the right mix of objective measures to use in order to bring more consistency and speed to the diagnosis of CFS/ME in adolescence,” she says. “Our pediatric CFS/ME clinical research team at the Murdoch Children’s Research Institute is also currently investigating other aspects of the CFS/ME condition, including brain functioning and brain connectivity using MRI [magnetic resonance imaging]. We hope to be able to map fatigue in the brains of adolescents with CFS/ME compared with healthy adolescents, and identify biological markers in the brain that could potentially identify individuals with CFS/ME.”
Dillon Stickle is associate editor for Sleep Review.