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Predicting daytime sleepiness and fatigue: a 9-year prospective study in myotonic dystrophy type 1

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Abstract

Objective

Daytime sleepiness and fatigue are prominent symptoms of myotonic dystrophy type I (DM1) that exact a heavy toll on patients’ quality of life, but information is scarce on their predictive factors. This study aimed to determine factors that may influence levels of daytime sleepiness and fatigue in a large cohort of DM1 patients followed for 9 years.

Methods

This study included 115 patients with DM1 at baseline (Time 1, T1) and at Time 2 (T2) who were questioned for daytime sleepiness, fatigue, history of depression, psychological distress, pain, hypothyroidism, and sleep habits. Also, their muscular impairment and intellectual quotient were evaluated. Regression models were used to identify correlates of daytime sleepiness and fatigue while controlling for time effect.

Results

Both daytime sleepiness and fatigue increased between T1 and T2, but their rate of change are higher when CTG repeat number is higher (p < 0.05). Also, higher psychological distress level is associated with higher daytime sleepiness and fatigue levels both at T1 and T2 (p < 0.01). Moreover, patients with a history of depression report higher daytime sleepiness levels both at T1 and T2 (p < 0.05). In addition, patients with higher fatigue levels both at T1 and T2 have more severe muscular impairment (p < 0.01) and report a longer habitual sleep duration (p < 0.05). Finally, a higher BMI and a history of hypothyroidism predict higher daytime sleepiness levels at T2 (p < 0.05).

Conclusion

This study identified potentially modifiable risk factors of future daytime sleepiness and fatigue in DM1 patients, including BMI, psychological distress, hypothyroidism, and sleep habits.

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Acknowledgements

We would like to thank all participants. The study was funded by the Canadian Institutes of Health Research (CIHR; Grant nos. MOP-49556 and JNM-108412) and Muscular Dystrophy Canada. Also, CG was funded by the Fonds de recherche du Québec—Santé (FRQS; Grant nos. 22193, 31011) as a junior 1 researcher at the time of the study.

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Correspondence to Luc Laberge.

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Conflicts of interest

YD has acted as a consultant for UCB Pharma, Jazz, Theranexus, Flamel, Idorsia, Takeda, Harmony Biosciences, and Bioprojet.

Ethical approval

This study has been approved by an appropriate ethics committee and has been performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki and its later amendments. Also, all patients gave their informed consent prior to their inclusion in the study.

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Laberge, L., Gallais, B., Auclair, J. et al. Predicting daytime sleepiness and fatigue: a 9-year prospective study in myotonic dystrophy type 1. J Neurol 267, 461–468 (2020). https://doi.org/10.1007/s00415-019-09592-7

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  • DOI: https://doi.org/10.1007/s00415-019-09592-7

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