The relationship between sleep disorders and excessive daytime sleepiness and anxiety in semi rural areas in Eskisehir, Turkey

Abstract

The study was conducted on a sample of people from semi rural areas in Eskisehir Province, located in central Anatolia region of Turkey with ages 20 and over. The aim of this study was to determine the 3 major sleep disorders (insomnia, obstructive sleep apnea syndrome [OSAS] and restless legs syndrome [RLS]) and their relationship to excessive daytime sleepiness [EDS], anxiety and related symptoms. This was a cross-sectional study. The sample size determined by assuming the prevalence of sleep disordered breathing (SDB) prevalence is 30% in Turkey. Each region of sample size was calculated as 504 with 95% confidence interval and 4% error margin. A two-stage stratified cluster sampling procedure was used. The survey team visited the selected households and listed all the people age 20 and over between September 2009 and May 2010. A total of 1452 subjects were enrolled in the study. The survey was based on a questionnaire of six parts: socio-demographic information, insomnia severity scale, symptoms of RLS, the Berlin questionnaire, Epworth Sleepiness Scale and Hamilton anxiety scale. In the study group 28.5% reported snoring, 7.6% apnea, 34.0% sleep onset problems, 30.3% problems returning to sleep after awakening, 30% fatigue,33.5% EDS, 34.9% insufficient sleep. The frequency in the population of insomnia was 29.9%, OSAS 16.3%, RLS 7.3%, and EDS 7.3%. In the multivariable analysis the only the Hamilton anxiety score was related to insomnia. Older age, lower education, having low economic status, obesity, hypertension, EDS, high Hamilton anxiety scores were associated with OSAS. Hypertension and higher Hamilton anxiety scores were associated with RLS. More attention should be paid to diagnosing specific sleep disorders in general practice particularly given the relationship between different sleep disorders and anxiety, obesity, diabetes and hypertension. We would like to thank the interns who took part in collecting the questionnaries.