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• Competing interests
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Letter

Recently, Martinez-Lavin [1] proposed a model of sympathetically maintained neuropathic pain syndrome that has the merit of scrutinizing possible mechanisms behind the central sensitization model [2]. Eisinger [3], in an editorial comment, raises the issue of heterogeneity permeating Martinez-Lavin's proposition. Since it is difficult to establish a traumatic trigger event in all cases, Eisinger considers multicausality as more reasonable than a single post-traumatic etiology for all cases. Félix and Fontenele [4] further explored this venue, speculating that the orthostatic intolerance symptoms seen in the majority of fibromyalgia patients are a consequence of sympathetic hyperactivity. The idea that a COMT val-158-met polymorphism may cause higher cathecolamine levels has been explored [5]. Loevinger and colleagues [6] have shown that the metabolic syndrome is more common in individuals with fibromyalgia who also have higher body mass index, blood pressure, and waist-to-hip ratio than controls.

Interestingly, elevated body mass index, blood pressure, and waist-to-hip ratio are associated with sleep-disordered breathing. We recently reported in a study that 50% of the women with obstructive sleep apnea syndrome or upper airway resistance syndrome had chronic pain and more than 11 tender points when pressed with 4 kgf/cm² [7]. Guille-minault and colleagues [8] reported orthostatic intolerance in patients with upper airway resistance syndrome. We believe that the authors investigating this theme should discuss the possibility of sleep-disordered breathing being the missing link between fibromyalgia, pain, disturbed sleep, alpha-delta sleep, hypotension, sympathetic hyperactivity, and metabolic syndrome.

We are conducting investigations into whether exposition to the typical stress of sleep-disordered breathing – with repeated arousal episodes and hypoxemia – has fibromyalgia as a possible outcome. Our preliminary results underline the need to consider and further explore this hypothesis.

Competing interests

The authors declare that they have no competing interests.

References

1. Martinez-Lavin M: Biology and therapy of fibromyalgia: Stress, the stress response system, and fibromyalgia.

   Arthritis Res Ther 2007, 9:216. PubMed Abstract | BioMed Central Full Text | PubMed Central Full Text

2. Staud R: Biology and therapy of fibromyalgia: pain in fibromyalgia syndrome.

   Arthritis Res Ther 2006, 8:208. PubMed Abstract | BioMed Central Full Text | PubMed Central Full Text

3. Eisinger J: Dysautonomia, fibromyalgia and reflex dystrophy.

   Arthritis Res Ther 2007, 9:105. PubMed Abstract | BioMed Central Full Text | PubMed Central Full Text

4. Félix FHC, Fontenele JB: Is fibromyalgia a cardiovascular disease? A comment on Martinez-Lavin's review 'Stress, the stress response system, and fibromyalgia'.

   Arthritis Res Ther 2007, 9:404. PubMed Abstract | BioMed Central Full Text | PubMed Central Full Text

5. Vargas-Alarcón G, Fragoso JM, Cruz-Robles D, Vargas A, Vargas A, Lao-Villadóniga JI, García-Fructuoso F, Ramos-Kuri M, Hernández F, Springall R, Bojalil R, Vallejo M, Martínez-Lavín M: Catechol-O-methyltransferase gene haplotypes in Mexican and Spanish patients with fibromyalgia.

   Arthritis Res Ther 2007, 9:R110. PubMed Abstract | BioMed Central Full Text | PubMed Central Full Text

6. Loevinger BL, Muller D, Alonso C, Coe CL: Metabolic syndrome in women with chronic pain.

   Metabol Clin Exp 2007, 56:87-93. PubMed Abstract | Publisher Full Text

7. Germanowicz D, Lumertz MS, Martinez D, Margarites AF: Coexistência de transtornos respiratórios do sono e síndrome fibromiálgica.

   J Bras Pneumol 2006, 32:333-338. PubMed Abstract | Publisher Full Text

8. Guilleminault C, Faul JL, Stoohs R: Sleep-disordered breathing and hypotension.

   Am J Respir Crit Care Med 2001, 164:1242-1247. PubMed Abstract | Publisher Full Text

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