(164) Co-relation of Psychological Factors in Fibromyalgia Patients Diagnosed with Obstructive Sleep Apnea and Other Co-morbidities

Background: Fibromyalgia (FM) is a chronic pain condition that commonly co-occurs with obstructive ‎sleep apnea (OSA) and obesity [1]. Patients with FM commonly experience depression and anxiety, ‎which may be exacerbated by OSA and contribute to the severity of FM symptoms [2]. Obesity is also ‎a common co-morbidity in FM and OSA patients, and it may contribute to the severity of FM ‎symptoms [3]. By understanding the co-occurrence between these co-morbidities and psychological ‎factors, healthcare providers can more effectively manage the health of FM patients.‎

Methods: This IRB approved retrospective study was conducted using EPIC chart review. Patients with ‎fibromyalgia were identified using ICD-9 (729.1) and ICD-10 (M79.7) codes, while patients with ‎obstructive sleep apnea were identified using ICD-9 (327.23) and ICD-10 (G47.33) codes. The total ‎number of medical diagnoses, including any psychiatric conditions, and BMI were documented for ‎each patient. The prevalence of psychiatric conditions was compared between patients with fewer ‎than 25 medical diagnoses and those with 25 or more diagnoses, as well as between patients with and ‎without obesity (BMI > 30).‎

Results: The total FM and OSA N = 331. Mean BMI was 36.69 ± 8.86, with 77.95% of the patients having ‎obesity. Diagnoses mean: 31.79 ± 17.25 and the mean total psychiatric diagnoses was 2.80 ± 1.66. Of ‎patients with 25 or greater number of medical problems, 66.99% of patients had comorbid anxiety and ‎depression vs. 33.01% of patients who had less than 25 medical problems (odds ratio = 1.50). Patients ‎with a BMI < 30 (N f71) had rates of anxiety and depression at 64.79% and a mean total of 2.79 ± 1.66 ‎psychiatric diagnoses, whereas patients with a BMI > 30 (N f258) had rates of anxiety and depression ‎at 61.63% (odds ratio = 1.28) and a mean total of 2.80 ± 1.66 psychiatric diagnoses. In addition to ‎depression and anxiety, the most common psychiatric conditions among FM/OSA patients included ‎hypersomnia and substance use disorders.‎

Discussion: Patients with 25 or more diagnoses had higher rates of anxiety and depression. The odds ‎ratios indicate that a patient with 25 or greater number of medical problems were 1.5 times more likely ‎to have anxiety and depression than those with fewer diagnoses. Additionally, those with a BMI > 30 ‎were 1.3 times more likely to have anxiety and depression than those with a normal BMI.‎

Conclusion: The high healthcare utilization and comorbidity burden of this patient population highlights ‎the importance of addressing psychological factors in the management of FM and OSA.‎

References: ‎
‎[1] Meresh E, Artin H, Joyce C et al. Obstructive sleep apnea co-morbidity in patients with fibromyalgia: ‎a single-center retrospective analysis and literature review. Open Access Rheumatol. 2019; 11: 103–‎‎109.‎
‎[2] Sánchez AI, Martínez MP, Miró E. Factors associated with depression in patients with fibromyalgia: a ‎cross-sectional study. BMC Psychiatry. 2016;16(1):188.‎
‎[3] Martínez-Martínez LA, Mora T, Vargas A, et al. The impact of obesity in the clinical and health-‎related quality of life perception of patients with fibromyalgia. Clin Rheumatol. 2014;33(12):1801-1806.‎