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

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

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

Citation: SLEEP AND BREATHING, Vol.28(2) : 989-997, 2024-05

Journal Title: SLEEP AND BREATHING

ISSN: 1520-9512

Issue Date: 2024-05

MeSH: Adult ; Comorbidity* ; Correlation of Data ; Cross-Sectional Studies ; Depressive Disorder* / diagnosis ; Depressive Disorder* / epidemiology ; Disorders of Excessive Somnolence* / diagnosis ; Disorders of Excessive Somnolence* / epidemiology ; Fatigue / diagnosis ; Fatigue / epidemiology ; Female ; Humans ; Male ; Middle Aged ; Republic of Korea / epidemiology ; Statistics as Topic ; Surveys and Questionnaires

Keywords: Depression ; Excessive daytime sleepiness ; Fatigue

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.