Associations Among Emotional State, Sleep Quality, and Resting-State EEG Spectra: A Longitudinal Study in Graduate Students

University students are routinely influenced by a variety of natural stressors and experience irregular sleep-wake cycles caused by the necessity to trade sleep for studying while dealing with academic assignments. Often these factors result in long-term issues with daytime sleepiness, emotional instability, and mental exhaustion, which may lead to difficulties in the educational process. This study introduces the Daily Sampling System (DSS) implemented as a smartphone application, which combines a set of self-assessment scales for evaluating variations in the emotional state and sleep quality throughout a full academic term. In addition to submitting the daily sampling scores, the participants regularly filled in the Depression, Anxiety, and Stress Scales (DASS) reports and took part in resting-state EEG data recording immediately after report completion. In total, this study collected 1835 daily samples and 94 combined DASS with EEG datasets from 18 university students (aged 23-27 years), with 79.3± 15.3% response ratio in submitting the daily reports during an academic semester. The results of pairwise testing and multiple regression analysis demonstrate that the daily level of self-perceived fatigue correlates positively with stress, daytime sleepiness, and negatively with alertness on awakening, self-evaluated sleep quality, and sleep duration. The spectral analysis of the EEG data reveals a significant increase in the resting-state spectral power density across the theta and low-alpha frequency bands associated with increased levels of anxiety and stress. Additionally, the state of depression was accompanied by an intensification of high-frequency EEG activity over the temporal regions. No significant differences in prefrontal alpha power asymmetry were observed under the described experimental conditions while comparing the states of calmness and emotional arousal of the participants for the three conditions of depression, anxiety, and stress.

Pain and depression are associated with both physical and mental fatigue independently of comorbidities and medications in primary Sjögren's syndrome

Objectives

To report on fatigue in patients from the United Kingdom primary Sjögren's syndrome (pSS) registry identifying factors associated with fatigue and robust to assignable causes such as comorbidities and medications associated with drowsiness.

Methods

From our cohort (n = 608), we identified those with comorbidities associated with fatigue, and those taking medications associated with drowsiness. We constructed dummy variables, permitting the contribution of these potentially assignable causes of fatigue to be assessed. Using multiple regression analysis, we modelled the relationship between Profile of Fatigue and Discomfort physical and mental fatigue scores and potentially related variables.

Results

Pain, depression and daytime sleepiness scores were closely associated with both physical and mental fatigue (all p ≤ 0.0001). In addition, dryness was strongly associated with physical fatigue (p ≤ 0.0001). These effects were observed even after adjustment for comorbidities associated with fatigue or medications associated with drowsiness.

Conclusions

These findings support further research and clinical interventions targeting pain, dryness, depression and sleep to improve fatigue in patients with pSS.This finding is robust to both the effect of other comorbidities associated with fatigue and medications associated with drowsiness.

Age modification of the relationship between C-reactive protein and fatigue: findings from Understanding Society (UKHLS)

BACKGROUND

Systemic inflammation may play a role in the development of idiopathic fatigue, that is, fatigue not explained by infections or diagnosed chronic illness, but this relationship has never been investigated in community studies including the entire adult age span. We examine the association of the inflammatory marker C-reactive protein (CRP) and fatigue assessed annually in a 3-year outcome period for UK adults aged 16-98.

METHODS

Multilevel models were used to track fatigue 7, 19, and 31 months after CRP measurement, in 10 606 UK individuals. Models accounted for baseline fatigue, demographics, health conditions diagnosed at baseline and during follow-up, adiposity, and psychological distress. Sensitivity analyses considered factors including smoking, sub-clinical disease (blood pressure, anaemia, glycated haemoglobin), medications, ethnicity, and alcohol consumption.

RESULTS

Fatigue and CRP increased with age, and women had higher values than men. CRP was associated with future self-reported fatigue, but only for the oldest participants. Thus, in those aged 61-98 years, high CRP (>3 mg/L) independently predicted greater fatigue 7, 19, and 31 months after CRP measurement [odds ratio for new-onset fatigue after 7 months: 1.88, 95% confidence interval (CI) 1.21-2.92; 19 months: 2.25, CI 1.46-3.49; 31 months: 1.65, CI 1.07-2.54]. No significant longitudinal associations were seen for younger participants.

CONCLUSIONS

Our findings support previously described CRP-fatigue associations in older individuals. However, there are clear age modifications in these associations, which may reflect a contribution of unmeasured sub-clinical disease of limited relevance to younger individuals. Further work is necessary to clarify intervening processes linking CRP and fatigue in older individuals.

What impact does written information about fatigue have on patients with autoimmune rheumatic diseases? Findings from a qualitative study

OBJECTIVES

Although fatigue is a common symptom for people with rheumatic diseases, limited support is available. This study explored the impact of written information about fatigue, focusing on a booklet, Fatigue and arthritis.

METHODS

Thirteen patients with rheumatic disease and fatigue were recruited purposively from a rheumatology outpatient service. They were interviewed before and after receiving the fatigue booklet. Two patients, plus six professionals with relevant interests, participated in a focus group. Transcripts were analysed thematically and a descriptive summary was produced.

RESULTS

Interviewees consistently reported that fatigue made life more challenging, and none had previously received any support to manage it. Reflecting on the booklet, most said that it had made a difference to how they thought about fatigue, and that this had been valuable. Around half also said that it had affected, or would affect, how they managed fatigue. No one reported any impact on fatigue itself. Comments from interviewees and focus group members alike suggested that the research process may have contributed to the changes in thought and behaviour reported. Its key contributions appear to have been: clarifying the booklet's relevance; prompting reflection on current management; and introducing accountability.

CONCLUSIONS

This study indicated that written information can make a difference to how people think about fatigue and may also prompt behaviour change. However, context appeared to be important: it seems likely that the research process played a part and that the impact of the booklet may have been less if read in isolation. Aspects of the research appearing to facilitate impact could be integrated into routine care, providing a pragmatic (relatively low-cost) response to an unmet need.

Barriers to exercise for patients with renal disease: an integrative review

Renal disease is a common health condition that leads to loss of physical function, frailty, and premature loss of independence in addition to other severe comorbidities and increased mortality. Increased levels of physical activity and initiation of exercise training is recommended in the current guidelines for all patients with renal disease, but participation and adherence rates are low. The barriers to exercise and physical activity in patients with renal disease are not well defined and currently based on patient provider perception and opinion. There have been no published reviews that have synthesized published findings on patient reported barriers to exercise. This integrative literature review therefore aimed to identify the current understanding of patient reported barriers to regular exercise. This integrative review found that patient perceived barriers to exercise are not consistent with the barriers that have been identified by renal disease specialists and healthcare providers, which were disinterest, lack of motivation, and being incapable of exercise. The patient reported barriers identified through this review were complex and diverse, and the most frequently reported patient perceived barrier to exercise was low energy levels and fatigue. It is clear that additional research to identify patient perceived barriers to exercise is needed and that patient directed interventions to address these barriers should be developed. This integrative review provides information to the interdisciplinary nephrology team that can be used to tailor their assessment of barriers to exercise and provide exercise education for patients with renal disease.

The prevalence of medical symptoms in military aircrew

Background

The prevalence of medical symptoms in aviators has not been described in the medical literature.

Methods

An anonymous questionnaire was handed to all Israeli Air Force aviators who went through the routine yearly examination. Because only two women filled the questionnaire, we excluded them. The questionnaire contained a list of 49 symptoms and the aviators were asked to mark symptoms that were present in the last month before the examination as well as age, estimated weekly flying hours, military service status (reserve or career) and type of aircraft (jet-fighter, helicopter or transport). A general linear model was used to determine the association between age, weekly flying hours, type of aircraft and type of service with the number of symptoms. Binary logistic regression analyses was used to assess the association of these factors with lack of symptoms, and the top five ranking symptoms.

Results

Data was available for 323 male aviators. 62.5% of the aviators reported at least one symptom in the previous month. 26.9% reported three or more symptoms. 25.1% reported spinal symptoms, 22% respiratory symptoms, 21.4% fatigue, 11.5% headache and 6.5% general weakness. Career service was associated with the number of symptoms, fatigue and general weakness. Age was associated with fatigue and general weakness. Aircraft type and weekly flying hours were not associated with any symptom.

Conclusions

Medical symptoms are prevalent in military aviators. Career personnel report on medical symptoms, especially fatigue, more often than reserve personnel. Further study is warranted to examine this association.