Prevalence of depressive symptoms and related risk factors in Japanese patients with pulmonary nontuberculous mycobacteriosis

Association of poor sleep quality with clinical variables in nontuberculous mycobacterial pulmonary disease

BACKGROUND

The high prevalence of poor sleep quality in patients with chronic respiratory diseases makes it an important clinical topic. However, the prevalence and characteristics of poor sleep quality in those with nontuberculous mycobacterial pulmonary disease and its association with clinical variables remain unclear.

METHODS

This retrospective study involved patients with nontuberculous mycobacterial pulmonary disease between June 2017 and May 2022. The prevalence of poor sleep quality was measured by the Pittsburgh Sleep Quality Index was used to and its association with clinical variables including age, sex, laboratory data, pulmonary function, respiratory symptoms, mental health, health-related quality of life, and physical function was assessed.

RESULTS

The median age of 233 participants was 65 years, with poor sleep quality present in 123 patients (52.8%) who were older, female, and unemployed with dyspnea, anxiety symptoms, low health-related quality of life, and low exercise capacity. Many reported that they "cannot get to sleep within 30 min," "wake up in the middle of the night or early morning," "have to get up to use the bathroom," "cannot breathe comfortably," or "cough or snore loudly." Multivariate logistic regression analysis indicated a significant association between poor sleep quality, female sex, and low health-related quality of life.

CONCLUSION

Our results suggested that for the patients in this study, a multidisciplinary management that considers poor sleep quality is required and assessment of sleep quality as a screening is needed.

Assessment of health-related quality of life in patients with nontuberculous mycobacterial pulmonary disease: A comprehensive review

The global incidence of nontuberculous mycobacterial pulmonary disease (NTM-PD) is increasing. The primary aim of pharmacotherapeutic treatment for NTM-PD is to achieve negative bacterial conversion, but this goal is challenging, especially in cases with poor prognosis factors. Moreover, recurrence frequently occurs following successful treatment. Consequently, patient-reported outcomes (PROs) have attracted an increasing amount of attention due to their potential to elucidate the pathophysiology of NTM-PD. The current review article aimed to describe the current understanding of PROs related to health-related quality of life (HRQoL). HRQoL is influenced by a variety of factors; notably, those factors associated with the prognosis of NTM-PD significantly impair HRQoL. In patients with refractory NTM-PD, HRQoL tends to worsen over time. Assessing HRQoL through PROs involves short-term or long-term evaluation tools, which are selected based on their relevance to the patient's condition and the clinician's goals. Understanding the nuances of PROs can be helpful for delivering empathetic care tailored to patients in even the most complex treatment scenarios.

Incidence and associated risk factors of nontuberculous mycobacterial infection in patients with depression

BACKGROUND

It has been reported that the risk of mental health problems such as anxiety or depression increases in patients with nontuberculous mycobacterial (NTM) infection. However, no studies have investigated whether the incidence of NTM infection increases in patients with depression. This study aimed to investigate the incidence of NTM infection in patients with depression and evaluate the association between NTM infection and depression stratified by age and sex.

METHODS

Data from 2002 to 2013 were collected from patients aged ≥ 20 years in the National Health Insurance Service-National Sample Cohort database. Patients with and without depression aged over 20 years were matched with 1 to 4 by sex, age, and year of diagnosis. The incidence rate was calculated in 100,000 person-years, and a multivariable subdistribution hazard model was used to evaluate the adjusted hazard ratio (aHR) for the development of NTM infection.

RESULTS

We included 37,554 individuals (12,752 men and 24,802 women) and 149,213 controls in the depression and non-depression groups, respectively. The cumulative incidence of NTM infection did not differ significantly between the depression and non-depression groups during the follow-up period (22.2 vs. 24.5 per 100,000 person-years, p = 0.571). The age- and sex-stratified effects on the incidence of NTM infection were not significantly higher in patients with depression than in those without depression. After adjusting for covariates including age, sex, comorbidity, income, and region, the risk of NTM infection did not significantly differ between the depression and non-depression groups (aHR 0.83, 95% confidence interval 0.58-1.17).

CONCLUSION

The incidence of NTM infections in patients with depression was not significantly higher than that in patients without depression. However, due to the small number of NTM infections, we might have underestimated the differences between the two groups. Further studies are needed to identify factors associated with NTM pulmonary disease in patients with depression.

Comorbidities of nontuberculous mycobacteria infection in Korean adults: results from the National Health Insurance Service–National Sample Cohort (NHIS–NSC) database

Background

The global prevalence and incidence of nontuberculous mycobacteria (NTM) infection are increasing. However, the prevalence of NTM infection-associated comorbidities remains understudied. Thus, we investigated the comorbidities associated with NTM infection using the National Health Insurance Service-National Sample Cohort (NHIS–NSC) 2.0 database of the National Health Insurance Service (NHIS).

Methods

In this case–control study, patients with NTM infection and controls aged 20–89 years of age were matched 1:4 by sex, age, region, and income. A total of 26 comorbidities were selected based on previous reports and claims data analysis. The distribution of comorbidities was compared between patients with NTM infection and controls by sex and age using logistic regression analysis.

Results

In total, 893 patients (379 men and 514 women) with NTM infection (mean age, 56.1 years) and 3,572 controls (mean age, 55.6 years) were included. The odds ratio for prevalence of respiratory diseases, metabolic diseases, musculoskeletal disorders, gastrointestinal diseases, skin diseases, mental diseases, and neoplasms was significantly higher in patients with NTM infection than in the control group. Among comorbid diseases, the odds ratios (ORs) for the prevalence of the respiratory diseases such as bronchiectasis (OR [95% confidence interval (CI)]: 26.79 [19.69–36.45]) and interstitial pneumonitis (OR [95% CI]: 15.10 [7.15–31.89]) were the highest. No significant differences were observed in NTM infection-related comorbidities between men and women. In the younger age group (20–39 years old), the prevalence of respiratory and systemic diseases such as hypertension and diabetes was higher in the patient group than in the control group.

Conclusions

NTM infection is associated with several respiratory and systemic diseases that should be considered when providing medical care to patients with NTM infection.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12890-022-02075-y.

Anxiety and depression in patients with nontuberculous mycobacterial pulmonary disease: a prospective cohort study in South Korea

BACKGROUND

The mental health of patients with nontuberculous mycobacterial pulmonary disease (NTM-PD) has been underestimated.

RESEARCH QUESTION

What is the prevalence of, associated factors for, and clinical impact of anxiety and depression in patients with NTM-PD?

STUDY DESIGN AND METHODS

Among the patients diagnosed with NTM-PD between July 1, 2011 and December 31, 2019, who were a part of Seoul National University Hospital's prospective cohort, we included those who completed the Hospital Anxiety and Depression Scale (HADS) at least twice. Multivariable logistic regression analysis was used to identify the factors associated with anxiety and depression. Multilevel mixed-effects regression was used to analyze the HADS scores' longitudinal trends.

RESULTS

A total of 368 patients were included in this study, including 84 (22.8%) with anxiety (HADS-A score ≥8) and 83 (22.5%) with depression (HADS-D score ≥8). The presence of cough (adjusted odds ratio [aOR] 2.01, 95% confidence interval [CI] 1.19-3.39) and febrile sensation (aOR 4.45, 95% CI 2.13-9.30) were associated with anxiety, whereas dyspnea (aOR 4.13, 95% CI 1.38-12.37) and febrile sensation (aOR 2.91, 95% CI 1.38-6.13) were associated with depression. Although the HADS scores of patients with anxiety or depression at the time of enrollment and throughout the follow-up period were higher than those without, these scores declined significantly within one year after enrollment. Patients with anxiety (P=0.006) or depression (P=0.004) received antibiotic treatment more frequently than those without. Treatment outcomes did not differ depending on the initial anxiety or depression status.

INTERPRETATION

Anxiety and depression were common in patients with NTM-PD and were associated with patient-reported symptoms. While these persisted over time, the treatment outcomes did not differ.

Effects of pain on depression, sleep, exercise tolerance, and quality of life in patients with nontuberculous mycobacterial pulmonary disease

The experience and causes of pain in patients with nontuberculous mycobacterial pulmonary disease (NTM-PD) have not been clarified.This study aimed to determine the prevalence and severity of bodily pain (BP) in patients with NTM-PD. We also investigated the clinical indicators that contribute to pain.We used a retrospective cross-sectional study design. The participants were 114 NTM-PD patients (109 women) with a mean age of 65 years. The prevalence and severity of pain were measured using 2 items from the 36-Item Short Form Survey version 2 (SF-36), and the BP score was calculated. Functional limitation due to dyspnea was quantified using the Modified Medical Research Council Dyspnea Scale (mMRC), depression was assessed using the Center for Epidemiological Studies Depression Scale (CES-D), sleep quality was assessed using the Pittsburgh Sleep Quality Index (PSQI); health-related quality of life was assessed using the Leicester Cough Questionnaire (LCQ), and exercise tolerance was measured using the Incremental Shuttle Walk Test (ISWT).Pain was reported by 70.2% of the patients (n = 80), and of these, 35.7% (n = 25) reported moderate to very severe pain. NTM-PD patients with high levels of pain had significantly higher scores on the mMRC, CES-D, and PSQI scores, and significantly lower performance on the ISWT and LCQ. Multiple regression analysis identified ISWT, CES-D, and PSQI as independent factors that affected BP scores.Our findings suggest that pain significantly impacts daily life associated with reduced exercise tolerance, the presence of depressive symptoms, and poor sleep quality in patients with NTM-PD.