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

Soo Hwan Yim; Jun-Sang Sunwoo; Daeyoung Kim; Min Kyung Chu; Chang-Ho Yun; Kwang Ik Yang

doi:10.1007/s11325-023-02964-4

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

Sleep Breath. 2023 Dec 14. doi: 10.1007/s11325-023-02964-4. Online ahead of print.

Authors

Soo Hwan Yim¹, Jun-Sang Sunwoo², Daeyoung Kim³, Min Kyung Chu⁴, Chang-Ho Yun⁵, Kwang Ik Yang⁶

Affiliations

¹ Department of Neurology, Ulsan University, College of Medicine, Gangneung Asan Hospital, Gangneung, Republic of Korea.
² Department of Neurology, Kangbuk Samsung Hospital, Seoul, Republic of Korea.
³ Department of Neurology, Chungnam National University College of Medicine, Daejeon, Republic of Korea.
⁴ Department of Neurology, College of Medicine, Severance Hospital, Yonsei University, Seoul, Republic of Korea.
⁵ Department of Neurology, Seoul National University Bundang Hospital and Seoul National University College of Medicine, Seongnam, Republic of Korea.
⁶ Sleep Disorders Center, Department of Neurology, Soonchunhyang University College of Medicine, Cheonan, Republic of Korea. neurofan@schmc.ac.kr.

PMID: 38095767
DOI: 10.1007/s11325-023-02964-4

Abstract

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.

Keywords: Depression; Excessive daytime sleepiness; Fatigue.