Somatic Symptoms and Sleep Disorders: A Literature Review of Their Relationship, Comorbidities and Treatment
Abstract
:1. Introduction
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- Definitions and classifications regarding SSD have been a subject of controversy over the past few years. For example, the new DSM-V definition of SSD [11], although being focused on abnormal and excessive thoughts, feelings, and behaviors associated with the burden of somatic symptoms, puts a lower emphasis on their medical explicability and sourcing [18,19,20];
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- Despite somatic patients often displaying sleep disorders, not all of them fully meet the DSM-V criteria for SSD. This is partially explained by the DSM-V requiring the symptoms to be persistent (more than six months) and to generate a significant disruption of daily life [11];
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- A further cause of bias is represented by the discrepancy between subjective and objective overall sleep quality measures [21]. Although subjective sleep measures have certain advantages (they are less expensive, able to be utilized in large population-based or community-based studies, and very easily standardized), they may over-report sleep duration length among elderly adults or adults in poor health. In contrast, objective measures, despite being more suitable for an adequate evaluation of sleep patterns, are generally costly, invasive, and less tolerated by patients. As a result, 25–50% of patients seek medical attention for sleep disorders [22], while about 20–30% of them develop persisting symptoms, and 71% display a significantly lower quality of life and/or extreme social burden [23,24]; and
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- Among SSD patients, a high number of them exhibit conditions, such as depression, anxiety, and fatigue, which themselves are correlated with sleep disorders [25].
2. Materials and Methods
3. Results
3.1. How Are Somatic Symptoms in SSD Correlated to Sleep Disorders?
3.2. What Are the Most Common Psychiatric Comorbidities Seen in Patients with SSD and Insomnia?
3.3. What Are the Potentially Effective Pharmacological and Non-Pharmacological Treatment Options for Both Somatic Symptoms and Insomnia?
4. Discussion
4.1. Limitations
4.2. Future Research
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Conflicts of Interest
References
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---|---|---|---|---|---|
Vollrath et al. (1989) [28] | Switzerland | Cohort | 457 | The association of insomnia with functional syndromes | Insomnia was associated with functional somatic complaints |
Kim et al. (2001) [29] | Japan | Cohort | 303 | The correlation between insomnia and somatic and psychological complaints | The prevalence of insomnia increased with the number of somatic complaints |
Aigner et al. (2003) [30] | Austria | Cross- sectional | 147 | Pain intensity in patients with and without sleep disorders | Sleep disorders were correlated with higher pain in somatoform pain disorder patients |
El-Anzi (2006) [31] | Kuwait | Cross- sectional | 358 | Results of scales regarding depression, anxiety, insomnia, and somatic symptoms | Somatic symptoms were correlated to insomnia |
Zhang et al. (2012) [32] | Hong Kong | Cohort | 256 | Gender differences in patients presenting both sleep disorders and somatization | Insomnia and poor sleep quality was closely associated with pain and somatic symptoms |
Schlarb et al. (2017) [33] | Germany | Cohort | 2443 | The association between somatic complaints and sleep disorders | Somatic complaints are positively associated with subjectively poor sleep quality |
Asai et al. (2006) [34] | Japan | Cohort | 28,714 | The relationship between somatization and sleep disorders | The prevalence of sleep disorders increased with the number of somatic complaints |
LeBlanc et al. (2009) [35] | Canada | Cohort | 464 | Factors related to new-onset insomnia | Higher bodily pain was associated with new-onset insomnia |
Zhang et al. (2012) [36] | Hong Kong | Cohort | 2316 | The longitudinal course of insomnia in patients with mental disorders | Baseline insomnia was associated with chronic pain and poor mental health |
Nagane et al. (2016) [37] | Japan | Cross- sectional | 135 | Sleep-wake patterns as predictors for somatic complaints | The sleep-wake pattern may predict somatic complaints |
Tan et al. (1984) [38] | USA | Cross- sectional | 100 | The association between high emotional arousal and insomnia in SSD patients | SSD were much more common as an additional diagnosis in patients with primary insomnia |
Ohaeri and Adeyemi (1990) [39] | Nigeria | Cross- sectional | 74 | Patterns of somatization symptoms | Insomnia was the most common symptom in patients with somatization |
Schneider- Helmert et al. (2001) [40] | The Netherlands | Cross- sectional | 51 | The association between insomnia and chronic non-organic pain | Insomnia is more than a minor component of chronic non-organic pain |
Guo et al. (2017) [41] | China | Cross- sectional | 7602 | The relationship between depression, pain, and sleep quality | Perceived pain and poor sleep quality were correlated with the number of doctor visits |
Moldofsky et al. (1976) [42] | Canada | Cross- sectional | 13 | The relationship between sleep disorders and musculoskeletal symptoms | The emergence of somatic symptoms is induced by a disorder of non-REM sleep |
Study Authors | Country | Study Design | n | Study Aim | Outcomes |
---|---|---|---|---|---|
Hartz et al. (2013) [43] | USA | Cross- sectional | 148,938 | The association between somatic symptoms and sleep disorders | Sleep disorders were positively correlated with somatic symptoms in depressive patients |
Gillespie et al. (1999) [44] | Australia | Cohort | 3468 | Depression and anxiety symptoms in patients with somatization | Somatic symptoms were not genetically or biologically associated to anxiety/depression |
Stapleton and Brunetti (2013) [45] | Australia | Cross- sectional | 167 | The association between depression, somatization, and anxiety and their effect on eating habits | Higher somatization scores were positively associated with depression, anxiety, and poor eating habits |
Annagür et al. (2014) [46] | Turkey | Case- control | 187 | Self-esteem, depressive mood, and their impact on somatic symptoms | Depression and anxiety were linked to chronic pain and sleep disorders |
Bekhuis et al. (2016) [47] | The Netherlands | Cohort | 2704 | The association of somatic symptoms and anxiety/depression | Depression and anxiety were associated with somatic complaints and insomnia |
Mol et al. (2005) [48] | The Netherlands | Cross- sectional | 193 | The pattern of association between depression, somatization, and benzodiazepines craving | Self-reported negative mood and somatization were positively associated with craving |
Barthels et al. (2021) [49] | Germany | Case- control | 61 | The association of orthorexia and depression in SSD patients | Orthorexia levels were elevated in patients with SSD |
Lankes et al. (2020) [50] | Germany | Cross- sectional | 160 | The effect of alexithymia on SSD patients | Alexithymia mediated by negative affect was found in patients with somatoform pain |
Davidson et al. (1985) [51] | USA | Cross- sectional | 52 | The pattern of neurovegetative symptoms in patients with depression | Major depression was linked with insomnia, anorexia, and weight loss in chronic pain patients |
Yu et al. (2019) [52] | Hong Kong | Cross- sectional | 998 | The association of stress, depressive symptoms, and somatization | Stress was associated with depressive symptoms and somatic complaints |
Byers et al. (2016) [53] | USA | Cross- sectional | 52 | The impact of cognitive pre-sleep arousal, catastrophizing on chronic pain, and insomnia | Cognitive pre-sleep arousal predicted insomnia severity in chronic pain patients |
Yu et al. (2011) [54] | Hong Kong | Cohort | 1433 | The pattern of somatic presentation of depression | People with depression were more likely to have multiple medically unexplained symptoms, insomnia, and fatigue |
Woud et al. (2016) [55] | Germany/ The Netherlands | Cohort | 1538 | The impact of catastrophic misinterpretations on SSD | Catastrophic misinterpretations were predictive for somatoform-related problems and new onset SSD |
Study Authors | Country | n | Study Aim | Treatment(s) Duration | Outcomes |
---|---|---|---|---|---|
Lewis-Hall et al. (1997) [56] | USA | 854 | The outcome of MDD and somatization with Fluoxetine and TCAs | Fluoxetine vs TCAs, 5 weeks | Significant reductions in somatization and insomnia for both |
Saletu-Zyhlarz et al. (2000) [57] | Austria | 30 | The effects of Zolpidem on insomnia and other psychiatric disorders | Zolpidem vs placebo, 1 week | Improvement in sleep efficiency and somatic complaints |
Saletu et al. (2005) [58] | Austria/ Bulgaria | 11 | The effects of Trazodone on sleep disturbances | Trazodone, 1 week | Increased slow-wave sleep and reduced arousal index |
Han et al. (2008) [59] | South Korea | 95 | The efficacy of Mirtazapine/Venlafaxine in SSD | Mirtazapine vs. Venlafaxine, 12 weeks | Somatization scores decreased from baseline to endpoint for both therapies, results in favor of Mirtazapine |
Kleinstäuber et al. (2014) [60] | Germany | 2159 | The effects of pharmacological therapies on SSD | SSRI vs. SSRI and AP; variable, according to included studies | Low-quality evidence in favor of combined treatment for reducing the severity of somatic complaints |
Study Authors | Country | n | Study Aim | Compared Interventions | Outcomes |
---|---|---|---|---|---|
Kleinstäuber et al. (2011) [61] | Germany | 1781 | The accuracy of STPP for somatization and depression | STPP vs. control | STPP significantly reduced somatic symptoms and depression |
Van Dessel et al. (2014) [62] | The Netherlands | 2658 | The effectiveness of CBT on somatization patients | CBT vs. usual/enhanced care | CBT reduced somatic symptoms at 1-year follow-up but was not more effective compared with enhanced care |
Abbas et al. (2020) [63] | United Kingdom | 2004 | STPP on patients with somatization | STPP vs. minimal treatment | STPP significantly outperformed minimal treatment |
Jungquist et al. (2010) [64] | USA | 28 | The efficiency of CBT for insomnia and chronic pain | CBT vs. control | CBT patients exhibited decreases in sleep latency and increases in efficiency of sleep but no difference in pain severity |
Schröder et al. (2012) [65] | Denmark | 66 | The efficiency of STreSS on patients with somatization | STreSS vs. enhanced care | STreSS group had a greater improvement of the primary outcome than enhanced care |
Tang et al. (2012) [66] | United Kingdom | 20 | The hybrid CBT intervention on sleep and pain outcomes | CBT PI vs. symptom monitoring | Hybrid intervention was associated with greater improvement in sleep, although pain intensity did not change |
Pigeon et al. (2012) [67] | USA | 21 | The efficiency of CBT PI on patients with co-occurring pain and insomnia | CBT PI vs. waiting list | CBT PI produced significant improvement in sleep and disability from pain |
Fjorback et al. (2013) [68] | Denmark | 119 | The efficiency of mindfulness on somatization | Mindfulness therapy vs. enhanced care | Mindfulness therapy was comparable with enhanced care in improvingsomatic symptoms and insomnia |
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Ionescu, C.G.; Popa-Velea, O.; Mihăilescu, A.I.; Talaşman, A.A.; Bădărău, I.A. Somatic Symptoms and Sleep Disorders: A Literature Review of Their Relationship, Comorbidities and Treatment. Healthcare 2021, 9, 1128. https://doi.org/10.3390/healthcare9091128
Ionescu CG, Popa-Velea O, Mihăilescu AI, Talaşman AA, Bădărău IA. Somatic Symptoms and Sleep Disorders: A Literature Review of Their Relationship, Comorbidities and Treatment. Healthcare. 2021; 9(9):1128. https://doi.org/10.3390/healthcare9091128
Chicago/Turabian StyleIonescu, Claudiu Gabriel, Ovidiu Popa-Velea, Alexandra Ioana Mihăilescu, Ana Anca Talaşman, and Ioana Anca Bădărău. 2021. "Somatic Symptoms and Sleep Disorders: A Literature Review of Their Relationship, Comorbidities and Treatment" Healthcare 9, no. 9: 1128. https://doi.org/10.3390/healthcare9091128