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Correspondence |

Sarcoidosis, Fatigue, and Sleep ApneaSarcoidosis, Fatigue, and Sleep Apnea FREE TO VIEW

Elyse E. Lower, MD; Atul Malhotra, MD, FCCP; Victoria Sudurlescu, MD, FCCP; Robert P. Baughman, MD, FCCP
Author and Funding Information

From Internal Medicine (Drs Lower, Surdurlescu, and Baughman), University of Cincinnati; and Pulmonary and Critical Care/Sleep Medicine (Dr Malhotra), Brigham and Women’s Hospital and Harvard Medical School.

Correspondence to: Elyse E. Lower, MD, 1001 Holes, Eden Ave, Cincinnati, OH 45267-0565; e-mail: lowere@ucmail.uc.edu


Financial/nonfinancial disclosures: The authors have reported to CHEST that no potential conflicts of interest exist with any companies/organizations whose products or services may be discussed in this article.

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians. See online for more details.


Chest. 2013;144(6):1976-1977. doi:10.1378/chest.13-1761
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To the Editor:

We read with interest the article by Patterson et al1 in a recent issue of CHEST (June 2013) that demonstrated a high proportion of daytime sleepiness using the Epworth Scale in patients with sarcoidosis. The authors concluded that sleepiness could be a contributing factor to fatigue in some of these patients. The authors are careful to point out that daytime sleepiness is not the same as fatigue, as emphasized by Brown2 in the accompanying editorial. We recently published a double-blind, placebo-controlled, crossover study examining the treatment of sarcoidosis-associated fatigue with armodafinil.3 In that study, we screened all patients for OSA and only included in the study those patients with an apnea/hypopnea index < 6/h. All patients then underwent an overnight sleep study followed by a multiple sleep-latency test before and after each treatment arm.

Despite the absence of OSA, we found one-half of the patients with sarcoidosis had a sleep onset latency of < 8 min, indicative of hypersomnolence. Furthermore, despite using two fatigue instruments, there was no difference in the fatigue severity for those patients with or without a shortened sleep-onset latency. In addition, armodafinil significantly improved fatigue in these patients, including those with objective evidence of hypersomnolence.

Fatigue can be due to several factors in patients with sarcoidosis, including not only sleepiness but also depression, medications, and ongoing inflammation from the disease.4 However, patients with sarcoidosis may still have marked fatigue without either depression or sleep apnea. For these patients, treatment with stimulants3,5 may be useful.

References

Patterson KC, Huang F, Oldham JM, Bhardwaj N, Hogarth DK, Mokhlesi B. Excessive daytime sleepiness and obstructive sleep apnea in patients with sarcoidosis. Chest. 2013;143(6):1562-1568. [CrossRef] [PubMed]
 
Brown LK. Fatigue is the best pillow: sleepiness vs fatigue in sarcoidosis. Chest. 2013;143(6):1523-1525. [CrossRef] [PubMed]
 
Lower EE, Malhotra A, Surdulescu V, Baughman RP. Armodafinil for sarcoidosis-associated fatigue: a double-blind, placebo-controlled, crossover trial. J Pain Symptom Manage. 2013;45(2):159-169. [CrossRef] [PubMed]
 
Drent M, Lower EE, De Vries J. Sarcoidosis-associated fatigue. Eur Respir J. 2012;40(1):255-263. [CrossRef] [PubMed]
 
Lower EE, Harman S, Baughman RP. Double-blind, randomized trial of dexmethylphenidate hydrochloride for the treatment of sarcoidosis-associated fatigue. Chest. 2008;133(5):1189-1195. [CrossRef] [PubMed]
 

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References

Patterson KC, Huang F, Oldham JM, Bhardwaj N, Hogarth DK, Mokhlesi B. Excessive daytime sleepiness and obstructive sleep apnea in patients with sarcoidosis. Chest. 2013;143(6):1562-1568. [CrossRef] [PubMed]
 
Brown LK. Fatigue is the best pillow: sleepiness vs fatigue in sarcoidosis. Chest. 2013;143(6):1523-1525. [CrossRef] [PubMed]
 
Lower EE, Malhotra A, Surdulescu V, Baughman RP. Armodafinil for sarcoidosis-associated fatigue: a double-blind, placebo-controlled, crossover trial. J Pain Symptom Manage. 2013;45(2):159-169. [CrossRef] [PubMed]
 
Drent M, Lower EE, De Vries J. Sarcoidosis-associated fatigue. Eur Respir J. 2012;40(1):255-263. [CrossRef] [PubMed]
 
Lower EE, Harman S, Baughman RP. Double-blind, randomized trial of dexmethylphenidate hydrochloride for the treatment of sarcoidosis-associated fatigue. Chest. 2008;133(5):1189-1195. [CrossRef] [PubMed]
 
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