Aurelija Podlipskyte

Fatigue in Patients With Coronary Artery Disease: Association With Thyroid Axis Hormones and Cortisol

Objective In people with coronary artery disease, the association between endocrine measures and fatigue is not well understood. We evaluated possible associations of fatigue and exercise capacity with function of adrenal axis and thyroid axis. Methods Sixty-five men and 18 women (mean age 55 years) attending a rehabilitation program were examined using the Multidimensional Fatigue Inventory, Dutch Exertion Fatigue Scale, and the Hospital Anxiety and Depression Scale. Exercise capacity was measured using a bicycle ergometer procedure. Serum concentrations of free triiodothyronine (T3), free thyroxine (T4), morning cortisol, afternoon cortisol, and change in cortisol concentrations (&Dgr;Cortisol) were measured. Results In univariate regression analysis, lower free T4 concentrations were associated with general and exertion fatigue, lower free T3 concentrations were associated with general and physical fatigue, and lower &Dgr;Cortisol was associated with mental fatigue. After adjusting for age, sex, body mass index, hypertension, previous myocardial infarction, heart failure, diabetes, New York Heart Association functional class, depressive symptoms, and anxiety symptoms, lower free T3 concentrations remained associated with physical fatigue (&bgr; = −.224, p = .03); lower free T4 concentrations, with exertion fatigue (&bgr; = −.219, p = .03); and lower morning cortisol and lower &Dgr;Cortisol concentrations, with mental fatigue (&bgr; = −.193 [p = .03] and &bgr; = −.180 [p =.04], respectively). Exercise capacity was not associated with endocrine factors. Conclusions In coronary artery disease patients, increased thyroid hormone concentrations are associated with decreased physical fatigue and decreased exertion fatigue, and increased cortisol concentrations with decreased mental fatigue. Exercise capacity is not associated with endocrine factors. Abbreviations CAD = coronary artery disease T3 = triiodothyronine T4 = thyroxine CFS = chronic fatigue syndrome &Dgr;Cortisol = change in cortisol concentration HPA = hypothalamic-pituitary-adrenal TSH = thyroid-stimulating hormone NYHA = New York Heart Association MI = myocardial infarction BMI = body mass index HADS = Hospital Anxiety and Depression Scale MFI-20 = Multidimensional Fatigue Inventory DEFS = Dutch Exertion Fatigue Scale

OBSESSIVE COMPULSIVE PERSONALITY AND FATIGUE IN PATIENTS WITH ANXIETY AND MOOD DISORDERS

Introduction Prior analysis has demonstrated executive dysfunction as a cardinal feature of fatigue in a post myocardial infarction population [1]. Executive problems have also been demonstrated in a group of subjects with obsessive compulsive personality disorder (OCPD) [2]. Traits of OCPD are commonly associated with depression, which has fatigue as an intrinsic element; however, so far no study has investigated the possibility of a specific association between fatigue and OCPD. Aim To investigate whether measures of fatigue and OCPD were associated, in a sample of patients with anxiety and mood disorders (AMD) demonstrating high levels of fatigue. Material and Methods A cross-sectional study of patients with AMD attending a Stress Disorders Clinic. Socio-demographic and clinical information including diagnosis (as defined by The Mini International Neuropsychiatric Interview), medication use, body mass index, and history of smoking were collected. The severity of OCPD traits was evaluated using the observer-rated Compulsive Personality Assessment Scale (CPAS) [2]. The Multidimensional Fatigue Inventory (MFI-20) was used to assess general, physical and mental fatigue, reduced activity and motivation. The Beck Depression Inventory-II (BDI-II) and the Hamilton Depression Rating Scale (HAM-D) were employed to measure subjective and objective symptoms of depression, while the Hamilton Anxiety Rating Scale (HAM-A) measured anxiety symptoms. Two-tailed Student’s t-test or Fisher’s χ2 test were applied to compare socio-demographic, clinical, fatigue, anxiety and depression characteristics in AMD patients with and without OCPD. Binary logistic regression analyses were performed to test associations between OCPD and fatigue, while controlling for possible confounders. Results Sixty-seven patients participated, 49 (73.1 %) females with a mean age of 39±13. In this group, 14 (20.9%) patients had one mood disorder, 17 (25.4%) had one anxiety disorder, and the remaining 36 (53.7%) patients suffered simultaneously from AMD. Nine patients (13.4%) fulfilled operational criteria for OCPD. The OCPD group had higher subjective depression scores on the BDI-II relative to patients without OCPD (35.1±14.1 vs. 23.5±11.1; p = 0.007). However, scores on the HAM-D and HAM-A scales did not show any difference between groups (p’s > 0.05). Measures of physical and mental fatigue were higher among OCPD patients than non-OCPD (respectively, 81.9±22.8 vs. 62.5±25.8, p = 0.037; 88.9±13.5 vs. 65.7±27.6, p = 0.017). Controlling for potential confounders i.e. depression scores (BDI-II), age, gender, medication use and reduced motivation, the association between mental fatigue and OCPD remained significant and was associated with a 1.072-fold increase (95% confidence, 1.002 to 1.147, p = 0.045) in risk for OCPD. There was no longer a significant effect of physical fatigue on OCPD. Conclusions Mental fatigue in patients with AMD is associated with OCPD traits even when depression and reduced motivation symptoms are taken into account. Thus, mental fatigue might represent a previously under-explored marker of OCPD. Further investigation of mental fatigue in diverse groups of patients is needed to confirm this finding.

P.3.022 Obstructive sleep apnea, anxiety and depression symptoms in men with coronary artery disease

Conclusions Obstructive sleep apnea (OSA) is a common sleep disorder which can result in mood problems. Studies show that depression and anxiety symptoms are the most prevalent psychological disturbances in OSA [1]. High prevalence of anxiety and depression is also present in coronary artery disease patients (CAD) [2]. High OSA morbidity with CAD is reported [3]. However, there is a lack of studies investigating mood problems in CAD patients with OSA.