Excessive Daytime Sleepiness in a General Population Sample: The Role of Sleep Apnea, Age, Obesity, Diabetes, and Depression

Psychiatry , Universidad Autónoma de Madrid, Madrid, Madrid, Spain
Journal of Clinical Endocrinology & Metabolism (Impact Factor: 6.21). 09/2005; 90(8):4510-5. DOI: 10.1210/jc.2005-0035
Source: PubMed


Excessive daytime sleepiness (EDS) is commonly considered a cardinal sign of sleep apnea; however, the mechanism underlying the association is unclear.
The purpose of this study was to assess the association between the complaint of EDS and sleep apnea, considering a wide range of possible risk factors in a population sample.
We examined this question in the Penn State cohort (a random sample of 16,583 men and women from central Pennsylvania, ranging in age from 20 to 100 yr). A random subset of this cohort (n = 1,741) was further evaluated for one night in the sleep laboratory.
The main measure was a complaint of EDS.
The final logistic regression model indicated depression was the most significant risk factor for EDS followed by body mass index, age, typical sleep duration, diabetes, smoking, and finally sleep apnea. The strength of the association with EDS decreased with increasing age, whereas the association of depression with EDS was stronger in the young. EDS is more prevalent in the young (<30 yr), suggesting the presence of unmet sleep needs and depression, and in the very old (>75 yr), suggesting increasing medical illness and health problems. EDS was associated with a reduced report of typical sleep duration without any association with objective polysomnographic measures.
It appears that the presence of EDS is more strongly associated with depression and metabolic factors than with sleep-disordered breathing or sleep disruption per se. Our findings suggest that patients with a complaint of EDS should be thoroughly assessed for depression and obesity/diabetes independent of whether sleep-disordered breathing is present.

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Available from: Edward Bixler, Sep 25, 2014
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    • "EDS has been shown to be a predictor of severe hypoglycemia [7]. Importantly, EDS is also associated with depression and poorer health-related quality of life (HRQOL) [3] [8]. Due to these multiple adverse effects of sleep problems , sleep has become an emerging area of investigation in the area of modifiable factors affecting the management of diabetes. "
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    ABSTRACT: The present study aims to determine the prevalence of self-reported sleep duration and sleep habits and their associated factors in patients with type 2 diabetes in Trinidad. This was a cross-sectional multicenter study. There were 291 patients with type 2 diabetes studied. Sleep habits were assessed using the Epworth Sleepiness Scale (ESS) and the National Health and Nutrition Examination Survey sleep disorder questionnaire. Demographic, anthropometric and biochemical data were also collected. The sample had a mean age of 58.8years; 66.7% were female. The mean BMI was 28.9kg/m(2). The prevalence of Excessive Daytime Sleepiness (EDS) was 11.3%. The prevalence of patients with short sleep (⩽6h) was 28.5%. The prevalence of patients with poor sleep was 63.9%. Poor sleep was associated with age, intensive anti-diabetic treatment and longer duration of diabetes. Short sleep was associated with intensive anti-diabetic treatment and BMI, while EDS was associated with increased BMI. In a sample of patients with type 2 diabetes, a high prevalence of self-reported sleep duration and unhealthy sleep habits was found. There needs to be an increased awareness of sleep conditions in adults with type 2 diabetes by doctors caring for these patients. Copyright © 2015. Published by Elsevier Ltd.
    Full-text · Article · Jun 2015
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    • "of EDS among those with age over 75 years. This increase may be associated with age-related health problems [8]. In a longitudinal study by Singareddy et al., a marginal decline in new onset of insomnia was observed with higher age [23]. "
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    ABSTRACT: The objective of this study was to investigate the role of obesity and weight gain in the development of sleep problems in a population-based cohort. A population-based sample of men (n = 1896, aged 40-79 years) and women (n = 5116, age ≥20 years) responded to questionnaires at baseline and follow-up after 10-13 years. Sleep problems were assessed through questions about difficulties initiating sleep (DIS), difficulties maintaining sleep (DMS), excessive daytime sleepiness (EDS), and insomnia. Body mass index (BMI) was calculated from self-reported weight and height at both baseline and follow-up, while confounding factors (physical activity, tobacco and alcohol use, somatic disease, and snoring) were based on responses at baseline. Although overweight and obese subjects reported more sleep problems at baseline, there was no independent association between BMI level at baseline and development of new sleep problems. Subjects in the quartile with the highest rise in BMI with a weight gain exceeding 2.06 kg/m(2) had a higher risk of developing DMS [adjusted odds ratio (OR) 1.58; 95% confidence interval (CI) 1.25-2.01), EDS (2.25; 1.65-3.06], and insomnia (2.78; 1.60-4.82). Weight gain was not associated with the development of DIS. Weight gain is an independent risk factor for developing several sleep problems and daytime sleepiness. The presence of overweight and weight gain should be considered when treating patients with sleep problems. Copyright © 2015 Elsevier B.V. All rights reserved.
    Full-text · Article · Feb 2015 · Sleep Medicine
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    • "In fact, epidemiological studies have consistently shown that depression is one of the strongest risk factors associated with EDS both in children and adults from the general population (Bixler et al., 2005; Calhoun et al., 2011; Hasler et al., 2005; Ohayon et al., 2012; Theorell-Haglöw, Lindberg, & Janson, 2006). However, based only on selfreports , it is not possible to ascertain whether complaints of EDS in individuals with mood disorders reflect fatigue or physiological sleep propensity. "
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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.
    Full-text · Chapter · Jan 2015
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