Fatigue or excessive daytime sleepiness: which is more closely related to depression?

OBJECTIVE/BACKGROUND: This study investigated fatigue and excessive daytime sleepiness to determine which was more closely related to depression in the general population. PATIENTS/METHODS: Participants were investigated across 15 South Korean districts. Excessive daytime sleepiness, fatigue, and depression were evaluated using the Epworth Sleepiness Scale (ESS), Fatigue Severity Scale (FSS), and Patient Health Questionnaire-9 (PHQ-9), respectively. Depression was defined as PHQ-9 ≥ 10. The authors classified the combination of excessive daytime sleepiness and fatigue as excessive daytime sleepiness with fatigue (E+F+, ESS ≥ 11, FSS ≥ 36), fatigue without excessive daytime sleepiness (E-F+, ESS < 11, FSS ≥ 36), excessive daytime sleepiness without fatigue (E+F-, ESS ≥ 11, FSS < 36), and no fatigue and excessive daytime sleepiness (E-F-, ESS < 11, FSS < 36). RESULTS: Among 2,493 participants (1,257 women), mean age was 47.9 ± 0.3 years. The prevalence of depression, fatigue, and excessive daytime sleepiness was 8.4% (n = 210), 30.8% (n = 767), and 15.3% (n = 382), respectively. The frequency of the four categories with depression (vs. controls) was as follows.: E+F+ (n = 67, 31.9% vs. 7.3%) (P < 0.001), E-F+ (n = 71, 33.8% vs. 20.3%) (P < 0.001), E+F-( n = 16, 7.6% vs. 5.8%) (P = 0.294), and E-F- (n = 56, 26.7% vs. 66.6%) (P < 0.001). After adjusting for covariates, depression was associated with E+F+ (odds ratio, OR 8.804, 95% confidence interval (CI) 5.818-13.132), E-F+ (OR 3.942, 95% CI 2.704-5.747), E+F- (OR 2.812, 95% CI 1.542-5.131), and E-F- (reference). Additionally, we performed logistic regression according to two categories. There was no significant difference in the association of depression between E+F- (reference) and E-F+ (OR 1.399, 95% CI 0.760-2.575). CONCLUSION: Although fatigue and excessive daytime sleepiness were associated with depression regardless of the presence of each other, we could not clarify which was more closely related to depression.

Weight Change Is Associated with Osteoporosis: A Cross Sectional Study Using the Korean Community Health Survey.

The purpose of the present study was to analyze the associations between weight change and osteoporosis in Korean adults. METHODS: Data from the 2016 Korean Community Health Survey were analyzed. A total of 159,741 participants who were ≥40 years of age were included. The histories of osteoporosis were surveyed in two ways: 'osteoporosis for entire life' and 'current osteoporosis'. The participants were grouped into three categories for simplification as follows: 'Weight L&M' (Tried to lose weight or Tried to maintain weight), 'Weight gain' (Tried to gain weight), and 'Never tried'. Additionally, we analyzed their relationship with obesity using the BMI. RESULTS: The adjusted ORs for 'osteoporosis for entire life' were 1.20 (95% confidence interval [CI] 1.13-1.27) in the Weight L&M group and 1.83 (95% CI 1.64-2.05) in the Weight gain group. The adjusted ORs for 'current osteoporosis' were 1.16 (95% CI 1.08-1.25) in the Weight L&M group and 1.77 (95% CI 1.54-2.02) in the Weight gain group. CONCLUSIONS: Compared to the Never tried group, being in either the Weight L&M or Weight gain groups showed a significant impact on the possibility of osteoporosis.

Association between eveningness preference, socio-behavioral factors, and insomnia symptoms in Korean adolescents.

OBJECTIVE/BACKGROUND: Studies focusing on insomnia in adolescents are relatively scarce compared to those on excessive daytime sleepiness. We aimed to investigate the prevalence of insomnia symptoms and associated factors in Korean high school students. PATIENTS/METHODS: A total of 8565 students (girls: 4104) were investigated nationwide, across 15 South Korean districts using an online self-report questionnaire. Insomnia symptoms were evaluated using the Global Sleep Assessment Questionnaire. The participants' mean age was 16.77 ± 0.85 years. RESULTS: The prevalence of insomnia symptoms was 39.43% (n = 3377). Logistic regression was used to estimate the odds ratio (OR) of insomnia symptoms associated with sleep characteristics and social behaviors after adjusting for the relevant covariates. Evening preference (OR, 2.51, 95% CI, 2.20-2.86), perception of insufficient sleep (OR, 3.55, 95% CI, 3.11-4.06), snoring usually/always (OR, 1.25; 95% CI, 1.00-1.55), witnessed sleep apnea usually/always (OR, 1.70; 95% CI, 1.17-2.46), increased internet addiction (OR, 1.02; 95% CI, 1.02-1.03), bad sleep environment (OR, 1.77; 95% CI, 1.50-2.10), ≥3 private extra classes (OR, 1.23; 95% CI, 1.01-1.49), often coffee consumption (OR, 1.31; 95% CI, 1.10-1.56), and often nocturnal eating (OR, 1.24; 95% CI, 1.06-1.45) were associated with insomnia symptoms. Evening preference (OR, 3.48; 95% CI, 2.52-4.82) was also associated with insomnia symptoms in the perceived sufficient sleep subgroup. CONCLUSION: Insomnia symptoms were common in Korean high school students. Evening preference was the major factor associated with insomnia symptoms. Various socio-behavioral factors were also associated with insomnia symptoms.

A case of dyskinesia after levetiracetam administration.

BACKGROUND: Antiepileptic drug (AED) induced dyskinesia is an unusual manifestation in the medical field. In the previous case reports describing first generation-AED related involuntary movements, the authors suggested that a plausible cause is pharmacokinetic interactions between two or more AEDs. To date, development of dyskinesia after levetiracetam (LEV) has not been reported. CASE PRESENTATION: A 28-year-old woman with a history of brain metastasis from spinal cord glioblastoma presented with several generalized tonic-clonic seizures without restored consciousness. LEV was administered intravenously. Thereafter no more clinical or electroencephalographic seizures were noted on video-EEG monitoring, while chorea movement was observed in her face and bilateral upper limbs. DISCUSSION AND CONCLUSIONS: To our knowledge, there is no case report of dyskinesia after administration of LEV. Considering the temporal relationship and absence of ictal video-EEG findings, we suggest that development of choreoathetosis was closely associated with the undesirable effects of LEV. We propose that dopaminergic system dysregulation and genetic susceptibility might underlie this unusual phenomenon after LEV treatment.

Distribution of the corticobulbar tract in the internal capsule.

It is generally thought that the corticobulbar tract descends through the genu of the internal capsule (IC). There have been several reports that genu lesions cause bulbar symptoms such as facial palsies, dysarthria, and dysphagia. However, the precise location of the corticobulbar tract in the IC remains controversial. The purpose of our study is to assess whether the corticobulbar tract passes through the IC genu. We reviewed 26 patients with selective IC infarction and located the sites related to bulbar symptoms. In addition, using diffusion tensor imaging, we reconstructed tracts passing through the IC in ten subjects without cerebral infarction. Patients with genu infarction, which extended to more than half of the posterior limb of the IC, showed bulbar symptoms. However, patients with genu infarction, which was limited to the genu, did not have bulbar symptoms. In contrast, patients with lesions limited to the posterior limb may show bulbar symptoms. According to statistical maps of the region of interest, the lesions related to bulbar symptoms were localized to areas that were beyond the midpoint of the posterior limb of the IC. In diffusion tensor imaging of subjects without cerebral infarctions, the corticobulbar and corticospinal tracts did not pass through the IC genu. Our data provide evidence that the corticobulbar tract does not pass through the IC genu. The proposed location of the corticobulbar tract in the level of the IC lies beyond the midpoint of the posterior limb.