Libman, Eva, Creti, Laura, Baltzan, Marcel et al. · Journal of health psychology · 2009 · DOI
This study looked at whether sleep apnea (a condition where breathing stops and starts during sleep) is common in people with ME/CFS and how it affects mood and psychological well-being. The researchers found that 68% of ME/CFS patients had sleep apnea, but those who did were not significantly more ill than those without it. Both the ME/CFS and sleep apnea groups showed more psychological difficulties than healthy controls, but the researchers suggest these emotional struggles are likely a natural response to living with a chronic illness rather than a separate psychiatric condition.
This study challenges a longstanding diagnostic criterion that may exclude ME/CFS patients from diagnosis if they have sleep apnea, potentially preventing them from receiving appropriate care. It suggests that sleep apnea is actually quite common in ME/CFS and may need to be managed as a co-occurring condition rather than ruled out as a disqualifying factor.
This study does not prove that sleep apnea causes ME/CFS or vice versa—it only shows they frequently occur together. The findings do not establish whether treating sleep apnea improves ME/CFS outcomes or whether the high rate of sleep apnea reflects shared underlying biological mechanisms. As a cross-sectional study, it cannot determine the temporal relationship or causal direction between these conditions.
About the PEM badge: “PEM required” means post-exertional malaise was an explicit required diagnostic criterion for participant inclusion in this study — not that PEM was studied, observed, or discussed. Studies using criteria that do not require PEM (e.g. Fukuda, Oxford) are tagged “PEM not required”. How the atlas works →
The first block is for the primary paper and is the citation you should use in research work. The atlas-snapshot line only applies if you are specifically referring to this atlas’s reading of the paper on the date shown.
Primary citation
Libman, Eva, Creti, Laura, Baltzan, Marcel, Rizzo, Dorrie, Fichten, Catherine S, & Bailes, Sally (2009). Sleep apnea and psychological functioning in chronic fatigue syndrome.. Journal of health psychology. https://doi.org/10.1177/1359105309344895
BibTeX
@article{mecfsatlas-libman-2009-sleep-apnea,
author = {Libman, Eva and Creti, Laura and Baltzan, Marcel and Rizzo, Dorrie and Fichten, Catherine S and Bailes, Sally},
title = {Sleep apnea and psychological functioning in chronic fatigue syndrome.},
journal = {Journal of health psychology},
year = {2009},
doi = {10.1177/1359105309344895},
note = {PubMed: 19858344},
url = {https://www.mecfsatlas.com/evidence/libman-2009-sleep-apnea},
}Atlas snapshot reference
ME/CFS Atlas. Generator v1 / Scanner v1.4 / policy v0.1. Accessed 2026-05-30. https://www.mecfsatlas.com/evidence/libman-2009-sleep-apnea
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