Top

Sleep and Breathing

Published in:

22-07-2021 | Affective Disorder | Epidemiology • Original Article

Fatigue is associated with depression independent of excessive daytime sleepiness in the general population

Authors: Jun-Sang Sunwoo, Daeyoung Kim, Min Kyung Chu, Chang-Ho Yun, Kwang Ik Yang

Published in: Sleep and Breathing | Issue 2/2022

Abstract

Purpose

This study aimed to investigate sleep problems and comorbid conditions associated with fatigue in the general population.

Methods

The data were obtained from a nationwide cross-sectional survey conducted in 2018. The Fatigue Severity Scale was used to assess fatigue. We examined sleep habits, such as workday sleep duration, chronotype, and free-day catch-up sleep, excessive daytime sleepiness (EDS), depression, and other comorbid conditions. We conducted multiple logistic regression analysis with the presence of fatigue as a dependent variable.

Results

Of 2,493 adults aged 19 to 92 years, 50% men, mean age was 47.9 ± 16.4 years. The average workday sleep duration was 7.1 ± 1.1 h, and the prevalence of fatigue was 31%. After adjusting for potential confounders, fatigue was associated with EDS (odds ratio [OR] 3.751, 95% confidence interval [CI] 2.928–4.805), depression (OR 3.736, 95% CI 2.701–5.169), perceived insufficient sleep (OR 1.516, 95% CI 1.249–1.839), free-day catch-up sleep (OR 1.123, 95% CI 1.020–1.235), less alcohol intake (OR 0.570, 95% CI 0.432–0.752), and physical inactivity (OR 0.737, 95% CI 0.573–0.948). On subgroup analysis, fatigue was additionally associated with short workday sleep duration (OR 0.899, 95% CI 0.810–0.997) in individuals without EDS. However, among those with EDS, only depression (OR 2.842, 95% CI 1.511–5.343) and less alcohol intake (OR 0.476, 95% CI 0.247–0.915) were associated with fatigue.

Conclusion

Fatigue was significantly associated with depression independent of EDS. Further research is warranted to better understand the pathophysiological relationship between fatigue, depression, and sleep.

Shen J, Barbera J, Shapiro CM (2006) Distinguishing sleepiness and fatigue: focus on definition and measurement. Sleep Med Rev 10(1):63–76. https://doi.org/10.1016/j.smrv.2005.05.004CrossRefPubMed

Addington AM, Gallo JJ, Ford DE, Eaton WW (2001) Epidemiology of unexplained fatigue and major depression in the community: the Baltimore ECA follow-up, 1981–1994. Psychol Med 31(6):1037–1044. https://doi.org/10.1017/s0033291701004214CrossRefPubMed

van’t Leven M, Zielhuis GA, van der Meer JW, Verbeek AL, Bleijenberg G (2010) Fatigue and chronic fatigue syndrome-like complaints in the general population. Eur J Public Health 20(3):251–257. https://doi.org/10.1093/eurpub/ckp113CrossRefPubMed

Kim CH, Shin HC, Won CW (2005) Prevalence of chronic fatigue and chronic fatigue syndrome in Korea: community-based primary care study. J Korean Med Sci 20(4):529–534. https://doi.org/10.3346/jkms.2005.20.4.529CrossRefPubMedPubMedCentral

Racciatti D, Vecchiet J, Ceccomancini A, Ricci F, Pizzigallo E (2001) Chronic fatigue syndrome following a toxic exposure. Sci Total Environ 270(1):27–31. https://doi.org/10.1016/S0048-9697(00)00777-4CrossRefPubMed

Kluger BM, Krupp LB, Enoka RM (2013) Fatigue and fatigability in neurologic illnesses: proposal for a unified taxonomy. Neurology 80(4):409–416. https://doi.org/10.1212/WNL.0b013e31827f07beCrossRefPubMedPubMedCentral

Chen MK (1986) The epidemiology of self-perceived fatigue among adults. Prev Med 15(1):74–81. https://doi.org/10.1016/0091-7435(86)90037-xCrossRefPubMed

Shahid A, Shen J, Shapiro CM (2010) Measurements of sleepiness and fatigue. J Psychosom Res 69(1):81–89. https://doi.org/10.1016/j.jpsychores.2010.04.001CrossRefPubMed

Phillips RO (2015) A review of definitions of fatigue – and a step towards a whole definition. Transport Res F Traffic Psychol Behav 29:48–56. https://doi.org/10.1016/j.trf.2015.01.003CrossRef

10.

Matsangas P, Shattuck NL (2018) Discriminating between fatigue and sleepiness in the naval operational environment. Behav Sleep Med 16(5):427–436. https://doi.org/10.1080/15402002.2016.1228645CrossRefPubMed

11.

Slater G, Steier J (2012) Excessive daytime sleepiness in sleep disorders. J Thorac Dis 4(6):608–616. https://doi.org/10.3978/j.issn.2072-1439.2012.10.07CrossRefPubMedPubMedCentral

12.

Chellappa SL, Schroder C, Cajochen C (2009) Chronobiology, excessive daytime sleepiness and depression: is there a link? Sleep Med 10(5):505–514. https://doi.org/10.1016/j.sleep.2008.05.010CrossRefPubMed

13.

Hossain JL, Ahmad P, Reinish LW, Kayumov L, Hossain NK, Shapiro CM (2005) Subjective fatigue and subjective sleepiness: two independent consequences of sleep disorders? J Sleep Res 14(3):245–253. https://doi.org/10.1111/j.1365-2869.2005.00466.xCrossRefPubMed

14.

Hwangbo Y, Kim WJ, Chu MK, Yun CH, Yang KI (2013) Association between weekend catch-up sleep duration and hypertension in Korean adults. Sleep Med 14(6):549–554. https://doi.org/10.1016/j.sleep.2013.02.009CrossRefPubMed

15.

Krupp LB, LaRocca NG, Muir-Nash J, Steinberg AD (1989) The fatigue severity scale. Application to patients with multiple sclerosis and systemic lupus erythematosus. Arch Neurol 46(10):1121–1123. https://doi.org/10.1001/archneur.1989.00520460115022CrossRefPubMed

16.

Suh S, Kim SH, Ryu H, Choi SJ, Joo EY (2018) Validation of the Korean Munich Chronotype Questionnaire. Sleep Breath 22(3):773–779. https://doi.org/10.1007/s11325-017-1609-zCrossRefPubMed

17.

Roenneberg T, Allebrandt Karla V, Merrow M, Vetter C (2012) Social jetlag and obesity. Curr Biol 22(10):939–943. https://doi.org/10.1016/j.cub.2012.03.038CrossRefPubMed

18.

Johns MW (1991) A new method for measuring daytime sleepiness: the Epworth sleepiness scale. Sleep 14(6):540–545. https://doi.org/10.1093/sleep/14.6.540CrossRefPubMed

19.

Kroenke K, Spitzer RL, Williams JB (2001) The PHQ-9: validity of a brief depression severity measure. J Gen Intern Med 16(9):606–613. https://doi.org/10.1046/j.1525-1497.2001.016009606.xCrossRefPubMedPubMedCentral

20.

Lewis G, Wessely S (1992) The epidemiology of fatigue: more questions than answers. J Epidemiol Community Health 46(2):92–97. https://doi.org/10.1136/jech.46.2.92CrossRefPubMedPubMedCentral

21.

Roenneberg T, Allebrandt KV, Merrow M, Vetter C (2012) Social jetlag and obesity. Curr Biol 22(10):939–943. https://doi.org/10.1016/j.cub.2012.03.038CrossRefPubMed

22.

Ford ES, Cunningham TJ, Croft JB (2015) Trends in self-reported sleep duration among US adults from 1985 to 2012. Sleep 38(5):829–832. https://doi.org/10.5665/sleep.4684CrossRefPubMedPubMedCentral

23.

Chaiard J, Deeluea J, Suksatit B, Songkham W, Inta N (2018) Short sleep duration among Thai nurses: influences on fatigue, daytime sleepiness, and occupational errors. J Occup Health 60(5):348–355. https://doi.org/10.1539/joh.2017-0258-OACrossRefPubMedPubMedCentral

24.

Chami HA, Ghandour B, Isma’eel H, Nasreddine L, Nasrallah M, Tamim H (2020) Sleepless in Beirut: sleep duration and associated subjective sleep insufficiency, daytime fatigue, and sleep debt in an urban environment. Sleep Breath 24(1):357–367. https://doi.org/10.1007/s11325-019-01833-3CrossRefPubMed

25.

Goldman SE, Ancoli-Israel S, Boudreau R, Cauley JA, Hall M, Stone KL, Rubin SM, Satterfield S, Simonsick EM, Newman AB, Health Aging and Body Composition Study (2008) Sleep problems and associated daytime fatigue in community-dwelling older individuals. J Gerontol A Biol Sci Med Sci 63(10):1069–1075. https://doi.org/10.1093/gerona/63.10.1069CrossRefPubMed

26.

Brostrom A, Wahlin A, Alehagen U, Ulander M, Johansson P (2018) Sex-specific associations between self-reported sleep duration, depression, anxiety, fatigue and daytime sleepiness in an older community-dwelling population. Scand J Caring Sci 32(1):290–298. https://doi.org/10.1111/scs.12461CrossRefPubMed

27.

Liu X, Uchiyama M, Kim K, Okawa M, Shibui K, Kudo Y, Doi Y, Minowa M, Ogihara R (2000) Sleep loss and daytime sleepiness in the general adult population of Japan. Psychiatry Res 93(1):1–11. https://doi.org/10.1016/S0165-1781(99)00119-5CrossRefPubMed

28.

Corfield EC, Martin NG, Nyholt DR (2016) Co-occurrence and symptomatology of fatigue and depression. Compr Psychiatry 71:1–10. https://doi.org/10.1016/j.comppsych.2016.08.004CrossRefPubMed

29.

Kim SJ, Kim S, Jeon S, Leary EB, Barwick F, Mignot E (2019) Factors associated with fatigue in patients with insomnia. J Psychiatr Res 117:24–30. https://doi.org/10.1016/j.jpsychires.2019.06.021CrossRefPubMed

30.

Kim SA, Koo BB, Kim DE, Hwangbo Y, Yang KI (2017) Factors affecting fatigue severity in patients with obstructive sleep apnea. Clin Respir J 11(6):1045–1051. https://doi.org/10.1111/crj.12682CrossRefPubMed

31.

Neu D, Mairesse O, Hoffmann G, Valsamis JB, Verbanck P, Linkowski P, Le Bon O (2010) Do ‘sleepy’ and ‘tired’ go together? Rasch analysis of the relationships between sleepiness, fatigue and nonrestorative sleep complaints in a nonclinical population sample. Neuroepidemiology 35(1):1–11. https://doi.org/10.1159/000301714CrossRefPubMed

32.

Neu D, Hoffmann G, Moutrier R, Verbanck P, Linkowski P, Le Bon O (2008) Are patients with chronic fatigue syndrome just ‘tired’ or also ‘sleepy’? J Sleep Res 17(4):427–431. https://doi.org/10.1111/j.1365-2869.2008.00679.xCrossRefPubMed

33.

Woolley J, Allen R, Wessely S (2004) Alcohol use in chronic fatigue syndrome. J Psychosom Res 56(2):203–206. https://doi.org/10.1016/S0022-3999(03)00077-1CrossRefPubMed

34.

Razazian N, Kazeminia M, Moayedi H, Daneshkhah A, Shohaimi S, Mohammadi M, Jalali R, Salari N (2020) The impact of physical exercise on the fatigue symptoms in patients with multiple sclerosis: a systematic review and meta-analysis. BMC Neurol 20(1):93. https://doi.org/10.1186/s12883-020-01654-yCrossRefPubMedPubMedCentral

35.

Puetz TW (2006) Physical activity and feelings of energy and fatigue: epidemiological evidence. Sports Med 36(9):767–780. https://doi.org/10.2165/00007256-200636090-00004CrossRefPubMed

36.

Boneva RS, Lin J-MS, Maloney EM, Jones JF, Reeves WC (2009) Use of medications by people with chronic fatigue syndrome and healthy persons: a population-based study of fatiguing illness in Georgia. Health Qual Life Outcomes 7(1):67. https://doi.org/10.1186/1477-7525-7-67CrossRefPubMedPubMedCentral

Title: Fatigue is associated with depression independent of excessive daytime sleepiness in the general population
Authors: Jun-Sang Sunwoo
Daeyoung Kim
Min Kyung Chu
Chang-Ho Yun
Kwang Ik Yang
Publication date: 22-07-2021
Publisher: Springer International Publishing
Keywords: Affective Disorder
Affective Disorder
Fatigue
Published in: Sleep and Breathing / Issue 2/2022
Print ISSN: 1520-9512
Electronic ISSN: 1522-1709
DOI: https://doi.org/10.1007/s11325-021-02448-3

ACC 2024 Congress Coverage

Heart Failure Video

Keynote webinar | Spotlight on sleep in brain health

Springer Medicine

Fatigue is associated with depression independent of excessive daytime sleepiness in the general population

Abstract

Purpose

Methods

Results

Conclusion

ACC 2024 Congress Coverage

Year in Review: Heart failure and cardiomyopathies

Semaglutide benefits people with type 2 diabetes and obesity-related heart failure

Incentivised to exercise

New intervention for STEMI-related cardiogenic shock

» View more highlights on the ACC 2024 congress hub page

Keynote webinar | Spotlight on sleep in brain health

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusion

Please log in to get access to this content

Other articles of this Issue 2/2022

Breathing irregularities before sleep onset on polysomnography in patients with heart diseases

Temporomandibular disorders in patients with polysomnographic diagnosis of sleep bruxism: a case–control study

Barriers to sleep in acute hospital settings

Changes in platelet count and coagulation parameters in children with obstructive sleep apnea

Slow-wave sleep and obstructive sleep apnea in patients with type 2 diabetes mellitus

Comments on “Increase in the circulating levels of malondialdehyde in patients with obstructive sleep apnea: a systematic review and meta-analysis”

ACC 2024 Congress Coverage

Year in Review: Heart failure and cardiomyopathies

Semaglutide benefits people with type 2 diabetes and obesity-related heart failure

Incentivised to exercise

New intervention for STEMI-related cardiogenic shock

» View more highlights on the ACC 2024 congress hub page