Abstract
Epidemiological evidence on the association between macronutrient intake and excessive daytime sleepiness (EDS) is scarce. Using data from the North West Adelaide Health Study, we aimed to determine the association between iso-caloric substitution of macronutrients and EDS. Data from 1997 adults aged ≥ 24 years were analyzed. Daytime sleepiness was measured using the Epworth Sleepiness Scale, a score ≥ 11 was considered EDS. Dietary intake data were collected using a food frequency questionnaire. We determined absolute and relative energy intake based on consumption of saturated and unsaturated fats, protein, and carbohydrate. Odds ratios (ORs) were used to determine the associations using log-binomial logistic regression with and without iso-caloric substitution methods, and models were adjusted for confounders. The prevalence of EDS in the sample was 10.6%. After adjusting for potential confounders, substituting 5% energy intake from protein with an equal amount of saturated fat (OR = 1.57; 95% CI: 1.00–2.45) and carbohydrate (OR = 1.23; 95% CI: 0.92–1.65) increased the odds of EDS. When carbohydrate was substituted with saturated fat (OR = 1.27; 95% CI: 0.93–1.59), the odds of EDS were increased. The odds of EDS were lower when saturated fat was substituted with unsaturated fat (OR = 0.74; 95% CI: 0.51–1.06), protein (OR = 0.63; 95% CI: 0.41–0.99) or carbohydrate (OR = 0.79; 95% CI: 0.57–1.08). While these results were consistent over different iso-caloric substitution methods, inconsistent results were found with standard regression. While substitution of fat and carbohydrate with protein was inversely associated with EDS, substitution of protein with fat and carbohydrate was positively associated with EDS. Randomized trials are needed to confirm if dietary interventions can be used to improve daytime alertness in those with EDS.
Highlights
Excessive daytime sleepiness (EDS) is defined as a state of pressure or perceived need to sleep in different situations or activities when wakefulness should be anticipated [1]
We developed two models: model 1 was adjusted for no covariates and for total energy intake; model 2 was adjusted for sex, age, marital status, education, work status, SEIFA, waist-to-hip ratio, sleep duration, alcohol intake, exercise level, pulse pressure, sleep apnea, diabetes status, and depression
A 5% decrease in EI from saturated fat and a simultaneous increase of EI from protein was inversely associated with EDS (OR = 0.74; 95% CI: 0.51–1.06)
Summary
Excessive daytime sleepiness (EDS) is defined as a state of pressure or perceived need to sleep in different situations or activities when wakefulness should be anticipated [1]. Excessive daytime sleepiness is often an indicator of underlying chronic health conditions and is recognized as an indicator of sleep problems [2]. The prevalence of EDS in the general population of Australia is about 15% [3,4] and it is associated with health and societal consequences [5] including increased risk of work-related errors and injuries [5,6,7] and cardiovascular diseases and mortality [8]. A relationship between diet and EDS is recognized. In addition to contributing to regulation of the circadian rhythms [16] and affecting sleep quality [17], diet has been linked with daytime alertness [18]
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