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Nocturnal heart rate variability parameters as potential fibromyalgia biomarker: correlation with symptoms severity

Claudia Lerma1, Aline Martinez2, Natllely Ruiz2, Angelica Vargas2, Oscar Infante1 and Manuel Martinez-Lavin2*

Author Affiliations

1 Electromechanical Instrumentation Department, National Institute of Cardiology Ignacio Chavez, Mexico. Juan Badiano 1, 14080. Mexico City, Mexico

2 Rheumatology Department, National Institute of Cardiology Ignacio Chavez, Mexico. Juan Badiano 1, 14080. Mexico City, Mexico

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Arthritis Research & Therapy 2011, 13:R185  doi:10.1186/ar3513

Published: 16 November 2011



At present, there is neither a laboratory test nor an imaging technique able to differentiate people with fibromyalgia (FM) from healthy controls. This lack of an objective biomarker has hampered FM recognition and research. Heart rate variability (HRV) analyses provide a quantitative marker of autonomic nervous system activity. Nighttime is a stable period in which most people are resting. Sleep is modulated by autonomic activity. Sleeping problems are prominent in FM. The objectives of this study are: 1) to explore different nocturnal HRV parameters as potential FM biomarkers and 2) to seek correlation between such HRV parameters and diverse FM symptoms.


We studied 22 women suffering from FM and 22 age-matched controls. All participants filled out several questionnaires related to FM symptoms. All participants used a Holter monitor over 24 hours while undertaking their routine activities during the day and while sleeping at their homes at night. Time-domain HRV parameters analyzed from 0000 to 0600 hours included, among others: mean normal-normal interbeat intervals (mean NN), standard deviation of the NN intervals (SDNN), and standard deviation of the successive NN differences (SDSD).


Nocturnal SDNN of less than 114 ms had the greatest predictive value to set apart patients from controls with an odds ratio of 13.6 (95% confidence interval: 3.9 to 47.8). In patients, decreased nighttime HRV markers indicative of sympathetic predominance had significant correlations with several FM symptoms: SDSD was associated with pain intensity (r = - 0.65, P = 0.001). SDNN correlated with constipation (r = - 0.53, P = 0.001), and mean NN with depression (r = - 0.53, P = 0.001). Controls displayed an opposite behavior. For them, increased nighttime SDNN correlated with Fibromyalgia Impact Questionnaire scores (r = 0.69, P = 0.001) and with other FM symptoms.


Nocturnal HRV indices indicative of sympathetic predominance are significantly different in FM women when compared to healthy individuals. In FM patients, these HRV parameters correlated with several symptoms including pain severity. Opposite associations were seen in controls. FM may not be just one end of a continuous spectrum of common symptoms. Nocturnal HRV analyses are potential FM biomarkers.