Given the evidence that secondary fibromyalgia may cause sleep disturbance, specifically delta-wave sleep disturbance, should all patients with fibromyalgia undergo sleep studies?—ABE KEATING, FNP, MPH, Maysville, Ky.

Sleep-cycle disturbance in fibromyalgia is a well-established occurrence. If patients are not responding to typical medications and sleep-hygiene approaches, additional assessment is indicated. Although commonly used to assess for obstructive sleep apnea (OSA), the Epworth Sleepiness Scale is also useful for other types of sleep dysfunction. The Mallampati scoring system is another sleep-assessment scale. Usually used to predict intubation difficulty, the Mallampati system also considers anatomical aspects that are typical in OSA. Consequently, if a patient with fibromyalgia has no evidence of sleep apnea, a sleep study is unlikely to yield additional information.—Sherril Sego, FNP-C, DNP (137-10)

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