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BACKGROUND: Fatigue is a frequent symptom of patients with sarcoidosis. The origin of fatigue associated with sarcoidosis is unclear. The aim of this study was to assess the impact of affected organs, medication, and comorbidity on fatigue related to sarcoidosis. METHOD: In collaboration with the German Sarcoidosis Society, a sample of 1,197 subjects diagnosed with sarcoidosis was examined. The participants completed a questionnaire that contained the Fatigue Assessment Scale and the Multidimensional Fatigue Inventory. RESULTS: In this study, muscles, bones, and nerves were most strongly associated with fatigue. Patients receiving prednisolone showed heightened fatigue levels. However, the association between the duration of prednisolone therapy and fatigue was weak. The concomitant diseases, pulmonary hypertension and sleep apnea, showed the greatest impact elevating fatigue (effect sizes d > 0.50). In the combined regression analysis, comorbidity was the most important predictor of fatigue. CONCLUSIONS: It is important to consider that multiple clinical factors, especially comorbidities, contribute to the high degrees of fatigue in sarcoidosis.

Obstructive sleep apnea patients show positive correlations between blood pressure and venous anandamide concentrations independent of confounding factors. Our data suggest a previously not recognized role of the endocannabinoid system for blood pressure regulation in patients with high risk for hypertension and cardiovascular disease.

Background: Fatigue is common among patients with sarcoidosis. The etiology of this problem is unknown and multifactorial. Fatigue can be confounded with excessive daytime sleepiness (EDS). Fatigue and sleepiness have rarely been studied simultaneously in sarcoidosis patients. Objectives: The aim of this study was the confounder-adjusted estimation of risks for severe fatigue and EDS in a large population of sarcoidosis patients and the development of multivariate predictors from this population. Methods: 1,197 German sarcoidosis patients were examined using the Epworth Sleepiness Scale (ESS), the Fatigue Assessment Scale (FAS), the Hospital Anxiety and Depression Scale (HADS), and the Medical Research Council (MRC) dyspnea scale. Results: 16.5% (123 patients) had EDS (ESS ≥16), 16.4% had severe fatigue (FAS ≥35), and 6.3% had both extreme findings. In a multivariate logistic regression model, predictors of the risk of EDS were a history of sleep apnea (odds ratio [OR] 2.46, 95% confidence interval [CI] 1.5-3.9), dyspnea MRC grade ≥2 (OR 2.29, 95% CI 1.5-3.5), and organ involvement of 4-7 organs (OR 1.60, 95% CI 1.1-2.4). Significantly associated with higher risk of severe fatigue were the following: conspicuous depression (OR 5.95, 95% CI 4.1-8.7), conspicuous anxiety (OR 2.38, 95% CI 1.6-3.4), and muscle pain (OR 1.92, 95% CI 1.32-2.75). The logit models for severe fatigue with and without simultaneous EDS differed only slightly. Conclusion: An extreme form of fatigue and/or sleepiness was found in 27% of all sarcoidosis patients questioned. Because there is a certain overlap, both should be examined simultaneously to allow for a combined assessment.

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