Circadian variation of fatigue in both patients with paralytic poliomyelitis and post-polio syndrome

Abstract

ObjectiveIt was to evaluate the degree of fatigue in patients with paralytic poliomyelitis (PP) and with post-polio syndrome (PPS), and correlate it with parameters of sleep and the circadian cycle.MethodsThirty patients, 17 female (56.7%), participated in the study: they answered the Revised Piper Fatigue Scale and performed a nocturnal polysomnographic study. Eleven had PP (mean age±standard deviation of 47.9±6.4 years), and 19 had PPS (mean age±standard deviation of 46.4±5.6 years).ResultsOur study showed that fatigue was worse in the afternoon in the PP Group and had a progressive increase throughout the day in the PPS Group. We also observed compromised quality of sleep in both groups, but no statically significant difference was found in the sleep parameters measured by polysomnography.ConclusionFatigue has a well-defined circadian variation, especially in PPS Group. Poor sleep quality is associated with fatigue and, therefore, sleep disturbances should be evaluated and treated in this group of PPS.

Circadian Fatigue or Unrecognized Restless Legs Syndrome? The Post-Polio Syndrome Model

“…In addition, fatigue represents a cardinal symptom of PPS, marked by a progressive course, and able to affect significantly patient quality of life (6). Moreover, fatigue in PPS may be characterized by circadian changes, as recently showed by Viana and colleagues in a small cohort of PPS patients (1). Although, these authors did not explore clinical RLS in these PPS sample, it is intriguing to note that fatigue could resemble the circadian pattern of RLS symptoms.…”

“…Therefore, we conjecture that a circadian variation of fatigue may be related to unrecognized RLS symptoms in PPS previously reported in few PPS cases (3, 5). Although small PPS samples with RLS and/or PLMS does not allow any generalization, the common inflammatory pathways and also a natural propensity to circadian trend of fatigue in PPS, as interestingly demonstrated by Viana et al (1), may support the hypothesis of a secondary RLS in PPS. Epidemiologic studies with controlled design are needed to explore the real magnitude of RLS in PPS besides in other neurological diseases and to evaluate possible common mechanisms involved in the development of fatigue and RLS.…”

“…These authors observed in a small cohort of patients with paralytic poliomyelitis (PP) and post-polio syndrome (PPS) a significant circadian variation of subjective fatigue evaluated by means of a validated scale. These authors showed a progressive worsening of fatigue during afternoon in both PP and PPS (1). Polysomnographic variables did not correlate with fatigue, albeit restless legs syndrome (RLS) symptoms were not evaluated.…”

Restless legs syndrome and post polio syndrome: a case−control study

“…Fatigue represents a cardinal symptom of PPS, marked by a progressive course, a widespread distribution and an ability to significantly affect patient HRQoL [46,47]. Moreover, fatigue in PPS may be characterized by circadian changes, as recently observed by Viana and colleagues in a small cohort of PPS patients [48]. Although these authors did not explore clinical RLS in the PPS sample, it is intriguing to note that fatigue could resemble the circadian pattern of RLS symptoms.…”

Fatigue in Post-Polio Syndrome

“…Conde et al (2009) pointed out that fatigue in patients with PPS is not related to a period of the day, but to the type of activity performed. However, Viana et al (2013) reported that fatigue is more intense in the afternoon for patients with poliomyelitis sequelae and worsens progressively in patients with PPS.…”