Sleep, Immune and Endocrine
Function in FMS
Principal Investigator: Harvey
Moldofsky, M.D.
University of Toronto Centre for Sleep
Toronto, Ontario, Canada
Award: $29,770 - June 1995
As the brain goes through its
sleep-wake cycles, it continually communicates with
the immune and neuroendocrine systems (processes that
produce serotonin, growth hormone and cytokines like
interleukin-1). Moldofsky and co-workers theorize that
FMS symptoms result from a disruption of sleep, immune
and endocrine functions. In this study, Moldofsky
hypothesizes that alterations of the immune and
neuroendocrine systems are associated with "alpha"
brain wave intrusions during deep level sleep. The
"alpha" brain waves indicate an awake-like state and
are thought to be associated with the production of
symptoms in people with FMS and CFS. They can occur
the moment you close your eyes during a boring
lecture--you are not fully alert, but you certainly
aren't asleep.
A number of studies using healthy
males have shown various immune changes associated
with sleep. For example, interleukin-1 is increased
and natural killer cells are decreased. These changes
occur at about the same time of night as the "alpha"
brain waves in FMS patients. Moldofsky is studying the
interleukin-1 and natural killer cell differences in
healthy women and FMS women to determine if "alpha"
brain wave intrusion is associated with these immune
changes. He is studying these women at times in their
menstrual cycle when progesterone is high and
low. This study will further our understanding on the
interactions between these substances with sleep and
clinical symptoms. It may also influence the
development of therapeutic interventions specifically
targeted for women during various stages of their
menstrual cycle.
Dr. Moldofsky was the first
researcher to point out that non-refreshing sleep was
a problem in both FMS and CFS patients (e.g., waking
up feeling tired).
Preliminary Results --
Presented at the 1998 ACR
Moldofsky has shown that the rhythm
or chronobiology of how FMS/CFS patients feel
throughout a 24-hour period is dramatically different
from that of healthy people. He presented preliminary
findings at the 1998 ACR meeting on FMS. Patients
showed an overall decline in natural killer cell
activity during the day and night, as well as
alterations in prolactin and cortisol. Moldofsky
hypothesizes that the rhythmic patterning of immune
and endocrine substances will be distinctly different
in patients when compared to healthy controls. The
study is now completed and the rest of Dr. Moldofsky's
data are being analyzed for submission to a medical
journal. We will continue to report on Dr. Moldofsky's
progress in the AFSA Update.
Autonomic Function in FMS and CFS
Principal Investigator: Daniel J.
Clauw, M.D.
Georgetown University Medical Center
Washington, DC
Award: $29,650 - June 1995
Has received NIH funding to further his
investigation.
The autonomic nervous system is responsible for
controlling functions of internal organs and tissues. It
enables you to breathe without having to consciously
think about it. It also plays an important role in your
body's stress responses, getting your heart pumping,
your adrenaline flowing, and your muscles charged should
the situation warrant it (i.e., when faced with
stressful challenges).
Several studies have suggested that autonomic function
may be abnormal in FMS and CFS patients. For this
project, Clauw performed (1) tilt-table testing which
involved tilting a person from a horizontal position to
a 60 degree angle with their head above their feet, (2)
Holter monitoring of the heart responses to the tilting
process, and (3) serum collection to measure various
levels of autonomic hormones and transmitting substances
in 40 FMS patients and 20 controls. In addition,
symptomatology, which may be caused by dysautonomic
function, was assessed.
Study Results - Presented at 1996 ACR
(1) Tilt-table testing: Twenty percent of the patients
tilted had dizziness along with a significant drop in
blood pressure.
(2) Holter monitoring: With the Holter monitor, it is
possible to measure the strength of the nerve
transmissions going to the heart as well as roughly
identify whether the signals are coming from the
sympathetic and related neurohormonal systems, or the
parasympathetic system. Clauw found that the sympathetic
and neurohormonal transmission to the heart was
significantly reduced in patients. Under this situation,
the autonomic nervous system might be partially crippled
in its ability to respond to stressful challenges, such
as physical trauma, exertion, or infections.
(3) Neuropeptide Y: This compound functions as a long
acting form of norepinephrine (meaning that neuropeptide
Y is more stable and easier to analyze). Norepinephrine
is one of the transmitting substances involved in the
sympathetic part of the autonomic nervous system. Levels
of neuropeptide Y in the blood before and during the
tilt-table test appeared to be low in the patient group,
but there was too much variation in the healthy controls
to draw any conclusions. In 1997, Dr. Clauw received NIH
funding to further explore his dysautonomic findings in
relationship to allergic rhinitis in CFS/FMS patients.