Browsing by Subject "Fatigue"

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  • Lammers, Gert Jan; Bassetti, Claudio L.A.; Dolenc-Groselj, Leja; Jennum, Poul J.; Kallweit, Ulf; Khatami, Ramin; Lecendreux, Michel; Manconi, Mauro; Mayer, Geert; Partinen, Markku; Plazzi, Giuseppe; Reading, Paul J.; Santamaria, Joan; Sonka, Karel; Dauvilliers, Yves (2020)
    Summary The aim of this European initiative is to facilitate a structured discussion to improve the next edition of the International Classification of Sleep Disorders (ICSD), particularly the chapter on central disorders of hypersomnolence. The ultimate goal for a sleep disorders classification is to be based on the underlying neurobiological causes of the disorders with clear implication for treatment or, ideally, prevention and or healing. The current ICSD classification, published in 2014, inevitably has important shortcomings, largely reflecting the lack of knowledge about the precise neurobiological mechanisms underlying the majority of sleep disorders we currently delineate. Despite a clear rationale for the present structure, there remain important limitations that make it difficult to apply in routine clinical practice. Moreover, there are indications that the current structure may even prevent us from gaining relevant new knowledge to better understand certain sleep disorders and their neurobiological causes. We suggest the creation of a new consistent, complaint driven, hierarchical classification for central disorders of hypersomnolence; containing levels of certainty, and giving diagnostic tests, particularly the MSLT, a weighting based on its specificity and sensitivity in the diagnostic context. We propose and define three diagnostic categories (with levels of certainty): 1/“Narcolepsy” 2/“Idiopathic hypersomnia”, 3/“Idiopathic excessive sleepiness” (with subtypes)
  • Arponen, Heidi; Waltimo-Siren, Janna; Valta, Helena; Mäkitie, Outi (2018)
    Background: Persisting fatigue has been reported to be a common complaint by individuals with connective tissue disorders, including Osteogenesis imperfecta (OI). This controlled study evaluated in an adult OI population the subjective experience of fatigue, affecting daily life. Sleep disturbances and chronic pain were examined as hypothesized underlying factors. Methods: This cross-sectional study analyzed the answers of 56 OI patients and 56 matched healthy controls to a questionnaire, designed to evaluate levels of experienced fatigue and bodily pain, as well as the presence or absence of symptoms related to sleep disturbances or sleep apnea. The relationships between fatigue, pain, and sleep disturbances were evaluated with correlation analysis and regression analysis. Results: Fatigue was reported by 96%, and daily pain by 87% of the individuals with OI. Notably, the level of fatigue was similarly experienced by patient respondents and controls. In total, 95% of the patients and 77% of the controls reported one to several sleep disturbance symptoms. These symptoms as well as previously diagnosed sleep apnea were statistically significantly more prevalent in the patient group than in the controls (p <0.05). Likewise, the experienced bodily pain was statistically highly significantly more severe among the respondents with OI (p <0.001), and correlated with the reported fatigue. Conclusions: In comparison with age-matched controls, adults with OI do not differ in experienced fatigue, unlike hypothesized. Therefore, sleep disturbances, which based on the frequency of reported related symptoms and previous sleep apnea diagnoses appear to be common in OI patients, may remain undiagnosed.
  • Arponen, Heidi; Waltimo-Sirén, Janna; Valta, Helena; Mäkitie, Outi (BioMed Central, 2018)
    Abstract Background Persisting fatigue has been reported to be a common complaint by individuals with connective tissue disorders, including Osteogenesis imperfecta (OI). This controlled study evaluated in an adult OI population the subjective experience of fatigue, affecting daily life. Sleep disturbances and chronic pain were examined as hypothesized underlying factors. Methods This cross-sectional study analyzed the answers of 56 OI patients and 56 matched healthy controls to a questionnaire, designed to evaluate levels of experienced fatigue and bodily pain, as well as the presence or absence of symptoms related to sleep disturbances or sleep apnea. The relationships between fatigue, pain, and sleep disturbances were evaluated with correlation analysis and regression analysis. Results Fatigue was reported by 96%, and daily pain by 87% of the individuals with OI. Notably, the level of fatigue was similarly experienced by patient respondents and controls. In total, 95% of the patients and 77% of the controls reported one to several sleep disturbance symptoms. These symptoms as well as previously diagnosed sleep apnea were statistically significantly more prevalent in the patient group than in the controls (p < 0.05). Likewise, the experienced bodily pain was statistically highly significantly more severe among the respondents with OI (p < 0.001), and correlated with the reported fatigue. Conclusions In comparison with age-matched controls, adults with OI do not differ in experienced fatigue, unlike hypothesized. Therefore, sleep disturbances, which based on the frequency of reported related symptoms and previous sleep apnea diagnoses appear to be common in OI patients, may remain undiagnosed.
  • Arnstad, Ellen D; Glerup, Mia; Rypdal, Veronika; Peltoniemi, Suvi; Fasth, Anders; Nielsen, Susan; Zak, Marek; Aalto, Kristiina; Berntson, Lillemor; Nordal, Ellen; Herlin, Troels; Romundstad, Pål R; Rygg, Marite (BioMed Central, 2021)
    Abstract Background To study fatigue in young adults with juvenile idiopathic arthritis (JIA) 18 years after disease onset, and to compare with controls. Methods Consecutive children with onset of JIA between 1997 and 2000, from geographically defined areas of Norway, Sweden, Denmark and Finland were followed for 18 years in a close to population-based prospective cohort study. Clinical features, demographic and patient-reported data were collected. Inclusion criteria in the present study were a baseline visit 6 months after disease onset, followed by an 18-year follow-up with available self-reported fatigue score (Fatigue Severity Scale (FSS), 1–7). Severe fatigue was defined as FSS ≥4. For comparison, Norwegian age and sex matched controls were used. Results Among 377 young adults with JIA, 26% reported severe fatigue, compared to 12% among controls. We found higher burden of fatigue among participants with sleep problems, pain, poor health, reduced participation in school/work, physical disability, active disease, or use of disease-modifying anti-rheumatic drugs (DMARDs)/biologics/systemic steroids. In contrast, participants without these challenges, had fatigue scores similar to controls. Active disease assessed at all three time points (baseline, 8-year and 18-year follow-up) was associated with higher mean fatigue score and higher percentage of severe fatigue compared to disease courses characterized by periods of inactive disease. Predictors of fatigue at the 18-year follow-up were female sex and diagnostic delay of ≥6 months at baseline, and also pain, self-reported poor health, active disease, and previous/ongoing use of DMARDs/biologics at 8 years. Conclusions Fatigue is a prominent symptom in young adults with JIA, with higher fatigue burden among participants with poor sleep, pain, self-reported health problems, active disease, or use of DMARDs/biologics. Participants without these challenges have results similar to controls. Patient- and physician-reported variables at baseline and during disease course predicted fatigue at 18-year follow-up.
  • Arponen, Heidi; Bachour, Adel; Bäck, Leif; Valta, Helena; Mäkitie, Antti; Waltimo-Siren, Janna; Mäkitie, Outi (2018)
    BackgroundPatients with Osteogenesis imperfecta (OI) suffer from increased bone fracture tendency generally caused by a mutation in genes coding for type I collagen. OI is also characterized by numerous co-morbidities, and recent data from questionnaire studies suggest that these may include increased risk for sleep apnea, a finding that lacks clinical evidence from cohort studies. In this cross-sectional study, 25 adults with OI underwent clinical otorhinolaryngology examination as well as overnight polysomnography to address the question. The participants were aged between 19 and 77years, and ten of them had mild clinical OI phenotype, seven had a moderately severe phenotype, and eight had a severe phenotype.ResultsWe found obstructive sleep apnea (apnea hypopnea index 5/h) in as many as 52% of the OI patients in the cohort. Unexpectedly, however, no correlation was present between sleep apnea and daytime sleepiness, experienced bodily pain, severity of OI, Mallampati score, or neck circumference.ConclusionsSeeing that the usual predictors showed no association with occurrence of sleep apnea, we conclude that obstructive sleep apnea may easily be left as an undetected disorder in individuals with OI. Recurrent nocturnal hypoxia due to episodes of apneas can even affect bone metabolism, thereby further aggravating bone fragility in patients with OI.
  • Arponen, Heidi; Bachour, Adel; Bäck, Leif; Valta, Helena; Mäkitie, Antti; Waltimo-Sirén, Janna; Mäkitie, Outi (BioMed Central, 2018)
    Abstract Background Patients with Osteogenesis imperfecta (OI) suffer from increased bone fracture tendency generally caused by a mutation in genes coding for type I collagen. OI is also characterized by numerous co-morbidities, and recent data from questionnaire studies suggest that these may include increased risk for sleep apnea, a finding that lacks clinical evidence from cohort studies. In this cross-sectional study, 25 adults with OI underwent clinical otorhinolaryngology examination as well as overnight polysomnography to address the question. The participants were aged between 19 and 77 years, and ten of them had mild clinical OI phenotype, seven had a moderately severe phenotype, and eight had a severe phenotype. Results We found obstructive sleep apnea (apnea hypopnea index ≥5/h) in as many as 52% of the OI patients in the cohort. Unexpectedly, however, no correlation was present between sleep apnea and daytime sleepiness, experienced bodily pain, severity of OI, Mallampati score, or neck circumference. Conclusions Seeing that the usual predictors showed no association with occurrence of sleep apnea, we conclude that obstructive sleep apnea may easily be left as an undetected disorder in individuals with OI. Recurrent nocturnal hypoxia due to episodes of apneas can even affect bone metabolism, thereby further aggravating bone fragility in patients with OI.
  • Kuitunen, Mikael (2021)
    Suomessa syntynyt 14-vuotias somalinuori tuli päivystykseen pari viikkoa jatkuneiden rintatuntemusten vuoksi. Väsymystä, heikotusta ja huimausta oli ollut pitempään.
  • Partinen, Markku; Alakuijala, Anniina; Sarkanen, Tomi; Sved, Gabriele (2018)
  • Ylikoski, Ari; Partinen, Markku (2017)
    Unettomuuden lisääntyminen ja yöunen rikkonaisuus ovat tavallisia sekä ikääntymiseen että ¬neurodegeneraatioon liittyviä vaivoja. Ihmisen ikääntyessä useat välittäjäaineet vähenevät, kuten myös hermosolut erityisesti sinitumakkeessa ja hypotalamuksen tumakkeissa. Kohorttitutkimuksissa on havaittu, että unihäiriöt edeltävät usein neurodegeneratiivisten sairauksien tyypillisiä ydinoireita. Uuden tutkimustiedon mukaan unihäiriöt voivat altistaa neurodegeneratiivisille sairauksille ja pahentaa niitä. Unihäiriöt kuuluvat näiden sairauksien hoidettavissa oleviin riskitekijöihin. Uni tai sen puute saattavat suojata neurodegeneraatiolta tai altistaa sille usealla eri mekanismilla.
  • Åström, Max (2020)
  • Partanen, Jenna; Keski-Rahkonen, Anna (2021)
    Nuori urheilija tasapainoilee opintojen ja urheilun välillä. Stressi, suorituspaineet, paine erikoistua varhain yhteen lajiin, loukkaantumiset ja epäonnistumiset voivat uhata nuoren urheilijan henkistä hyvinvointia, mikä voi pahimmillaan johtaa uupumiseen ja masennukseen. Suhteellinen energiavaje, syömishäiriöt ja väkivalta ovat urheilijan hyvinvoinnin uhkia. Lääkäri voi auttaa ongelmien tunnistamisessa ja selvittelyssä. Vanhemmilla, valmentajilla ja urheilujärjestelmällä on tärkeä tehtävä nuoren urheilijan henkisen ¬hyvinvoinnin tukijoina.
  • Arponen, Heidi; Bachour, Adel; Bäck, Leif; Valta, Helena; Mäkitie, Antti; Mäkitie, Outi; Waltimo-Siren, Janna (2021)
    BackgroundObstructive sleep apnea (OSA) is prevalent in individuals with Osteogenesis imperfecta (OI). To date, no study has investigated treatment of OSA in adult individuals with OI using positive airway pressure (PAP). This observational pilot study examined the adherence of adults with OI to treatment of OSA with PAP therapy, and the evolution of self-experienced sleepiness and depression symptoms before and after treatment.MethodsWe included 20 patients, with a mean age of 51 years, who represented varying severity of OI and displayed an apnea and hypopnea index >= 5 /sleeping hour as recorded by an overnight polysomnography. PAP therapy was proposed to all patients. Epworth Sleepiness Scale (ESS) questionnaire to evaluate daytime sleepiness, and a validated self-rating depression questionnaire to identify possible depression, were completed prior to PAP therapy and repeated after a minimum of one year. The datasets supporting the conclusions of this article are included within the article.ResultsFrom the 20 patients, 15 initiated PAP therapy, and two patients later interrupted it. The mean PAP follow-up period was 1230 days. At baseline, an abnormally high ESS score was reported by 29% of the respondents, and an abnormally high number of symptoms suggesting depression by 29%. Follow-up questionnaires were completed by 60% of the patients, of whom 83% were adherent to PAP treatment. ESS score and depression symptoms did not decrease significantly with PAP therapy.ConclusionsPatients with OI accepted well PAP therapy and remained compliant. Sleepiness and depression persisted unaltered despite good PAP adherence. These unexpectedly poor improvements in symptoms by PAP therapy may be due to subjective depression symptoms and the complexity of factors underlying persisting sleepiness in OI. Further research is needed to confirm this novel finding.
  • Arponen, Heidi; Bachour, Adel; Bäck, Leif; Valta, Helena; Mäkitie, Antti; Mäkitie, Outi; Waltimo-Sirén, Janna (BioMed Central, 2021)
    Abstract Background Obstructive sleep apnea (OSA) is prevalent in individuals with Osteogenesis imperfecta (OI). To date, no study has investigated treatment of OSA in adult individuals with OI using positive airway pressure (PAP). This observational pilot study examined the adherence of adults with OI to treatment of OSA with PAP therapy, and the evolution of self-experienced sleepiness and depression symptoms before and after treatment. Methods We included 20 patients, with a mean age of 51 years, who represented varying severity of OI and displayed an apnea and hypopnea index ≥ 5 /sleeping hour as recorded by an overnight polysomnography. PAP therapy was proposed to all patients. Epworth Sleepiness Scale (ESS) questionnaire to evaluate daytime sleepiness, and a validated self-rating depression questionnaire to identify possible depression, were completed prior to PAP therapy and repeated after a minimum of one year. The datasets supporting the conclusions of this article are included within the article. Results From the 20 patients, 15 initiated PAP therapy, and two patients later interrupted it. The mean PAP follow-up period was 1230 days. At baseline, an abnormally high ESS score was reported by 29% of the respondents, and an abnormally high number of symptoms suggesting depression by 29%. Follow-up questionnaires were completed by 60% of the patients, of whom 83% were adherent to PAP treatment. ESS score and depression symptoms did not decrease significantly with PAP therapy. Conclusions Patients with OI accepted well PAP therapy and remained compliant. Sleepiness and depression persisted unaltered despite good PAP adherence. These unexpectedly poor improvements in symptoms by PAP therapy may be due to subjective depression symptoms and the complexity of factors underlying persisting sleepiness in OI. Further research is needed to confirm this novel finding.
  • Alanen, Hanna-Mari; Koponen, Hannu; Leinonen, Esa (2016)
    Enemmistö muistisairauspotilaista saa haittaavia käytösoireita jossakin sairauden vaiheessa. Käytösoireiden ensisijainen lääkehoito on muistisairauden asianmukainen lääkehoito. Psykoosilääkkeet saattavat lisätä aivoverenkierron häiriöiden määrää ja kuolleisuutta dementiapotilailla, joten niiden käyttö tulee rajata vain vaikeisiin psykoottisiin ja levottomuutena tai aggressiivisuutena ilmeneviin käytösoireisiin. Muistisairauksia sairastavilla on myös suurentunut riski saada psykoosilääkkeistä ekstrapyramidaalioireita, infektioita, väsymystä ja hypotensiota. Amerikan psykiatriyhdistyksen uunituore hoitosuositus linjaa ja tarkentaa psykoosilääkkeiden käytön ­periaatteita tällä potilasryhmällä.
  • Markkula, Ritva; Heiskanen, Tarja; Zetterman, Teemu (2016)
  • Annanmäki, Tua (2020)
  • Suomela, Jarkko (2018)
    65-vuotias mies tuli terveysasemalle lääkärin akuuttivastaanotolle tärisyttävän olon takia. Mies oli ahdistuneen ja väsyneen oloinen. Pitkään jatkuneessa remonttiprojektissa kaikki oli mennyt pahasti pieleen.
  • Suomela, Jarkko (2017)
    Viime vuosina vaivannutta masennusta lukuun ottamatta 33-vuotias mies oli ollut yleensä terve. Nyt hän oli hakeutunut työterveyslääkärille masennuksen ja uupumuksen vuoksi.
  • Niku, Suvi; Rosengård-Bärlund, Milla (2018)