Clinical significance and correlates of behaviorally induced insufficient sleep syndrome

Japan Somnology Center, Neuropsychiatric Research Institute, Shibuya, Tokyo, Japan.
Sleep Medicine (Impact Factor: 3.15). 12/2007; 9(8):851-6. DOI: 10.1016/j.sleep.2007.08.018
Source: PubMed


The aim of this study was to investigate the demographic variables and clinical characteristics of behaviorally induced insufficient sleep syndrome (BIISS) and to compare it with the other major hypersomnia disorders.
One-thousand two-hundred forty-three consecutive patients referred to the outpatient clinic for complaint of excessive daytime sleepiness (EDS) were retrospectively investigated.
The rate of BIISS in patients with EDS was 7.1%, predominant in males. The mean age of initial visit was younger than that for obstructive sleep apnea syndrome (OSAS), while the mean age of onset of symptoms was older than that for idiopathic hypersomnia, narcolepsy, and circadian rhythm sleep disorders. The mean Epworth sleepiness scale (ESS) score before treatment was lower than that for narcolepsy but higher than that for both OSAS and circadian rhythm sleep disorders. Twenty-two percent of BIISS cases reported having accidents or near-miss accidents during the five-year period preceding the investigation, and this group showed higher ESS scores than the group without accidents.
Our findings showed that an unignorably large number of people suffer from BIISS, and that people with severe cases of the disorder are at high risk for getting into an accident. Characteristics and demographic information could be helpful for making a differential diagnosis of BIISS.

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    • "It is important, however, to consider that some individuals , particularly adolescents and young adults, may have unmet sleep needs (Bixler et al., 2005; Pallesen et al., 2011) and may fulfill diagnostic criteria for behaviorally induced insufficient sleep syndrome—that is, a complaint of EDS lasting at least 3 months, a shorter than expected habitual main sleep episode, and extended sleep when the habitual sleep schedule is not anchored, such as during weekends or holidays (American Academy of Sleep Medicine, 2005). The prevalence of this syndrome in the general population remains unknown; it may only represent about 7% of patients with a complaint of EDS (Pallesen et al., 2011), and it may be strongly associated with depression, particularly in the young (Komada et al., 2008; Pallesen, et al., 2007). Taken together, these data indicate that the increased prevalence of the complaint of EDS in the young may reflect unmet sleep needs and/or depression (Bixler et al., 2005). "
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    ABSTRACT: Excessive daytime sleepiness (EDS) is a highly prevalent complaint associated with significant negative effects on health, workplace and academic performance, absenteeism, and overall health and safety, such as motor vehicle collisions. Furthermore, EDS represents a substantial cost burden to the health care system. In clinical practice, EDS is not only the cardinal symptom for the diagnosis of disorders of central nervous system origin such as narcolepsy or idiopathic hypersomnia, but it is the most frequent complaint reported in sleep disorders centers. Epidemiological studies have shown that the prevalence of EDS ranges between 4 and 20%, depending on the methods and definitions used. These studies have also shown that the prevalence of EDS is strongly modulated by age, being highest in children, adolescents, and young adults (10–15%), decreasing during middle age (about 6%), and peaking again in the elderly. In this chapter, we review the multifactorial modulation of EDS. First, we clarify the definitions used. Second, we explore each of the most researched factors etiologically linked to EDS. Third, we explore how each potential factor associated with EDS may be modulated by age within each section.
    Modulation of Sleep by Obesity, Diabetes, Age, and Diet, 1 edited by Ronald R Watson, 01/2015: chapter 21: pages 193-202; Elsevier Academic Press., ISBN: 978-0-12-420168-2
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    • "No epidemiological study has investigated BIISS prevalence in the general adult population. However, one study reported a 7.1% prevalence in outpatient clinic patients with a complaint of EDS [91]. From computerized self-report questionnaires, estimated BIISS prevalence was 10.4% in a large Norwegian cohort of students and associated with severe self-reported depressed mood [92]. "
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    ABSTRACT: The associations between depressive symptoms and hypersomnia are complex and often bidirectional. Of the many disorders associated with excessive sleepiness in the general population, the most frequent are mental health disorders, particularly depression. However, most mood disorder studies addressing hypersomnia have assessed daytime sleepiness using a single response, neglecting critical and clinically relevant information about symptom severity, duration and nighttime sleep quality. Only a few studies have used objective tools such as polysomnography to directly measure both daytime and nighttime sleep propensity in depression with normal mean sleep latency and sleep duration. Hypersomnia in mood disorders, rather than a medical condition per se, is more a subjective sleep complaint than an objective finding. Mood symptoms have also been frequently reported in hypersomnia disorders of central origin, especially in narcolepsy. Hypocretin deficiency could be a contributing factor in this condition. Further interventional studies are needed to explore whether management of sleep complaints improves mood symptoms in hypersomnia disorders and, conversely, whether management of mood complaints improves sleep symptoms in mood disorders.
    BMC Medicine 03/2013; 11(1):78. DOI:10.1186/1741-7015-11-78 · 7.25 Impact Factor
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    • "Possible explanations are first night effect leading to degraded sleep architecture on the preceding nocturnal in-laboratory study or chronic behavioral-induced insufficient sleep syndrome (BIISS). The high prevalence of BIISS (Komada et al., 2008) and its impact on mean SL has been previously reported (Janjua et al., 2003; Marti et al., 2009). We found a negative correlation between total sleep time (TST) on the preceding nocturnal PSG and mean SL on the following MSLT (r = −0.37; "
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    ABSTRACT: Purpose: Excessive daytime sleepiness is highly prevalent in the general population, is the hallmark of narcolepsy, and is linked to significant morbidity. Clinical assessment of sleepiness remains challenging and the common objective multiple sleep latency test (MSLT) and subjective Epworth sleepiness scale (ESS) methods correlate poorly. We examined the relative utility of pupillary unrest index (PUI) as an objective measure of sleepiness in a group of unmedicated narcoleptics and healthy controls in a prospective, observational pilot study. Methods: Narcolepsy (n = 20; untreated for >2 weeks) and control (n = 56) participants were tested under the same experimental conditions; overnight polysomnography was performed on all participants, followed by a daytime testing protocol including: MSLT, PUI, sleepiness visual analog scale (VAS), ESS, and the psychomotor vigilance test (PVT). Results: The narcolepsy and control groups differed significantly on psychomotor performance and each measure of objective and subjective sleepiness, including PUI. Across the entire sample, PUI correlated significantly with objective (mean sleep latency, SL) and subjective (ESS and VAS) sleepiness, but none of the sleepiness measures correlated with performance (PVT). Among narcoleptics, VAS correlated with PVT measures. Within the control group, mean PUI was the only objective sleepiness measure that correlated with subjective sleepiness. Finally, in an ANCOVA model, SL and ESS were significantly predictive of PUI as measure of sleepiness. Conclusion: The role of PUI in quantifying and distinguishing sleepiness of narcolepsy from sleep-satiated healthy controls merits further investigation as it is a portable, brief, and objective test.
    Frontiers in Psychiatry 06/2011; 2:35. DOI:10.3389/fpsyt.2011.00035
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