Fatigue, depression, and physical activity in patients with malignant hyperthermia: a cross-sectional observational study
Fadiga, depressão e atividade física em pacientes portadores de Hipertermia Maligna: estudo observacional transversal.
Pâmela Vieira de Andrade, Lívia Maria Valim, Joilson Moura dos Santos, Isac de Castro, José Luiz Gomes do Amaral, Helga Cristina Almeida da Silva
Abstract
Background
Malignant Hyperthermia (MH) is a pharmacogenetic disorder triggered by halogenated anesthesia agents/succinylcholine and characterized by hypermetabolism crisis during anesthesia, but also by day-to-day symptoms, such as exercise intolerance, that may alert the health professional.
Objective
The study aimed to analyze the incidence of fatigue in MH susceptible patients and the variables that can impact perception of fatigue, such as the level of routine physical activity and depression.
Methods
A cross-sectional observational study was carried out with three groups – 22 patients susceptible to MH (positivein vitro muscle contracture test), 13 non-susceptible to MH (negative in vitro muscle contracture test) and 22 controls (no history of MH). Groups were assessed by a demographic/clinical questionnaire, a fatigue severity scale (intensity, specific situations, psychological consequences, rest/sleep response), and the Beck depression scale. Subgroups were re-assessed with the Baecke habitual physical exercise questionnaire (occupational physical activity, leisure physical exercise, leisure/locomotion physical activity).
Results
There were no significant differences among the three groups regarding fatigue intensity, fatigue related to specific situations, psychological consequences of fatigue, fatigue response to resting/sleeping, depression, number of active/sedentary participants, and the mean time and characteristics of habitual physical activity. Nevertheless, unlike the control sub-group, the physically active MH-susceptible subgroup had a higher fatigue response to resting/sleeping than the sedentary MH susceptible subgroup (respectively, 5.9 ± 1.9 vs. 3.9 ± 2,t-test unpaired, p < 0.05).
Conclusion
We did not detect subjective fatigue in MH susceptible patients, although we reported protracted recovery after physical activity, which may alert us to further investigation requirements.
Keywords
Resumo
Introdução: Hipertermia maligna é doença farmacogenética, desencadeada por anestésicos halogenados/succinilcolina, que se manifesta por crise de hipermetabolismo na anestesia, mas também por sintomas na vida diária que podem alertar o profissional de saúde, tais como intolerância ao exercício.
Objetivo: Analisar ocorrência de fadiga em pacientes suscetíveis à HM, bem como variáveis que podem interferir na percepção da fadiga, como grau de atividade física habitual e depressão.
Métodos: Realizado estudo observacional transversal, com três grupos: 22 pacientes suscetíveis à HM (teste de contratura muscular in vitro positivo), 13 não suscetíveis à HM (teste de contratura muscular in vitro negativo) e 22 controles (sem história de HM). Grupos foram avaliados por meio de questionário demográfico/clínico, escala de severidade da fadiga (intensidade, situações específicas, consequências psicológicas, resposta repouso/sono), e escala depressão Beck. Subgrupos foram reavaliados com questionário exercício físico habitual Baecke (atividade física ocupacional, exercício físico lazer, atividade física lazer/locomoção).
Resultados: Não houve diferença significante entre os três grupos em relação à intensidade da fadiga, fadiga relacionada a situações específicas, consequências psicológicas da fadiga, resposta da fadiga ao repouso/sono, depressão, número de ativos/sedentários, e tempo médio/características de atividade física habitual. Entretanto, diferentemente dos controles, o subgrupo suscetível à HM fisicamente ativo apresentou mais resposta da fadiga ao repouso/sono do que o subgrupo suscetível à HM sedentário (respectivamente, 5,9±1,9 vs. 3,9±2, teste t não pareado, p<0,05).
Conclusão : Não detectamos fadiga subjetiva em suscetíveis à HM, mas houve atraso na recuperação após a atividade física que pode alertar para necessidade de investigação complementar.
Palavras-chave
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Submitted date:
05/11/2020
Accepted date:
07/19/2021