PubMed · 1047215
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I Manenica. 1976. Fatigue.. https://pubmed.ncbi.nlm.nih.gov/1047215/
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OBJECTIVE: The aim of this study was to identify the frequency of fatigue and musculoskeletal pain in hepatitis C compared with other liver diseases. METHODS: Hepatology outpatients were evaluated by questionnaire for musculoskeletal pain and fatigue. Charts were reviewed for diagnoses, aminotransferases, histology, treatment, and presence of hepatitis C by second generation ELISA and/or polymerase chain reaction. The frequency of symptoms in patients with and without hepatitis C were compared. RESULTS: In 239 patients (mean age 46.7 +/- 11.6 yr; 52% male) musculoskeletal pain was present in 70% for 6.7 +/- 8.3 yr and fatigue in 56% for 3.3 +/- 5.1 yr. Backache was the most common complaint (54%), followed by morning stiffness (45%), arthralgia (42%), myalgia (38%), neck pain (33%), pain "all over" (21%), and subjective joint swelling (20%). Diffuse body pain was present in 23% on a pain diagram and was strongly associated with fatigue. There was a significant association between hepatitis C positivity and the presence of musculoskeletal pain (81% of HCV-positive compared with 56% of HCV-negative patients, respectively; p = 0.0001), and fatigue (67% compared with 44%; p = 0.001). Musculoskeletal pain was more frequent among patients with isolated hepatitis C infection than among patients with isolated hepatitis B or alcoholic liver disease (91%, 59%, and 48%, respectively; p = 0.004). Similarly, fatigue was more frequent among patients with isolated hepatitis C than among those with isolated alcoholic liver disease or hepatitis B (66%, 30%, and 29%, respectively; p = 0.004). There was no relationship between musculoskeletal complaints and possible route of acquiring hepatitis C, levels of aminotransferases, liver disease severity on biopsy, or interferon treatment. CONCLUSIONS: Musculoskeletal pain and fatigue are frequent in hepatology clinic attendees, particularly those with hepatitis C and are unrelated to severity of liver disease, route of infection, or interferon therapy.
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A RECENTLY DEFINED SYNDROME: Sleep apnea syndrome is defined as 5 episodes of apnea or 10 episodes of hyopnea per hour of sleep; the cardinal symptom is excessive diurnal somnolence. Two factors could explain sleep apnea syndrome: hypoxemia and fragmented sleep. ROLE OF HYPOXEMIA: Early studies focused on hypoxemia, but few took into account the effect of subjective complaints of somnolence. Further investigations based on objective measurements introduced a certain degree of complexity distinguishing between sleepiness and the capacity for voluntary vigilance. FRAGMENTARY SLEEP: More recent work has demonstrated the important role played by perturbed sleep rhythm and particularly the effect of short repeated periods of vigilance fragmenting sleep. It has been suggested that finer fragmentation exists but non-documented on electroencephalograms. SIMPLE AND EFFECTIVE TREATMENT: The relative contribution of hypoxemia and fragmented sleeping patterns is still a topic of debate, but the clinical strategy is simple and based on the results of a therapeutic test with continuous positive pressure ventilation. There is an improvement both in hypoxemia and sleep pattern which resolves the problem of excessive diurnal somnolence in most cases.