This is the first study to examine and quantify sleep quality in the context of well-defined early Lyme disease (LD) and post-treatment Lyme disease syndrome (PTLDS). The findings provide support that sleep disturbance should be considered in the clinical picture of individuals with LD. Sleep quality may particularly be poor and associated with the pain experience for individuals with PTLDS. Future research will need to validate and expand upon these findings to investigate sleep quality in individuals exposed to LD who are not well-defined and/or ideally treated.
Why was this study done?
Lyme disease (LD), caused by the bite of an infected tick, is the most common vector-borne disease in the US, with over 300,000 new cases each year. Some patients treated for LD go on to develop post-treatment Lyme disease syndrome (PTLDS) which is characterized by ongoing fatigue, pain, nervous system and cognitive complaints that can lead to a decline in daily life functioning.
The primary objective of this study is to examine and quantify sleep quality among a well-defined group of patients with early LD and those that go on to develop PTLDS.
How was this study done?
This study followed 122 participants with early Lyme disease (LD) at four time-points over one year after completion of their antibiotic treatment. All participants enrolled in the study had the rash of early Lyme disease present and were free of a range of health conditions also associated with pain, fatigue, and cognitive complaints. Twenty-six healthy controls were also enrolled from the same referral network and were screened for the presence of the same health conditions. At all study visits, symptoms of sleep disruption were elicited through a structured clinical interview and through a self-administered symptom survey. Participants also completed a set of standardized surveys, including the Pittsburgh Sleep Quality Index, the Beck Depression Inventory, the Fatigue Severity Scale, the McGill Pain Questionnaire, and the SF-36 Health-Related Quality of Life Instrument. At one year, a subset of 6 participants with LD were determined to have PTLDS using a standardized case definition. These patients were compared to controls and to patients without PTLDS.
What were the major findings?
At the pre-treatment visit, participants with early Lyme disease reported poorer sleep than controls. By six months post-treatment, participant sleep scores as a group returned to control levels. The subset of patients who developed PTLDS reported significantly worse global sleep and sleep disturbance scores and worse fatigue, pain, functional impact, and more cognitive-affective depressive symptoms compared to a control group of poor sleepers.
What is the impact of this work?
This is the first study to examine and quantify sleep quality in the context of well-defined early Lyme disease (LD) and post-treatment Lyme disease syndrome (PTLDS). Sleep quality can be poor and associated with pain, particularly for individuals who meet criteria for PTLDS. The relationship between sleep, pain, and fatigue is important and additional studies are needed to delineate the relationships between these symptoms among patients with LD and PTLDS. Furthermore, future studies are needed to compare sleep disruption in PTLDS to other illnesses with similar symptoms, such as fibromyalgia and chronic fatigue syndrome, and to understand if and how it may differ among individuals exposed to LD who did not meet criteria for this study.
These findings provide support that sleep disturbance should be considered in the clinical picture of individuals with LD, and additionally, addressing sleep disturbance may represent a treatment target for improving the management of PTLDS.
Sleep Quality in Well-defined Lyme Disease: A Clinical Cohort Study in Maryland. Weinstein ER1, Rebman AW1, Aucott JN1, Johnson-Greene D2, Bechtold KT3.
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