Association Of Excessive Daytime Sleepiness Research Articles

Associations between Sleep Disorders and Impulsive-Compulsive Behaviors in Parkinson’s Disease: A Prospective Cohort Study

Objective: To examine the associations of excessive daytime sleepiness (EDS) and probable rapid eye movement sleep behavior disorder (pRBD), respectively, with impulsive-compulsive behaviors (ICBs) over a 5-year follow-up in patients with early Parkinson’s disease (PD). Methods: The Parkinson’s Progression Markers Initiative is a multicenter cohort study based on an ongoing and open-ended registry. Longitudinal associations of sleep disorders with ICB over 5-year follow-up visits were estimated using generalized linear mixed-effects models among PD participants. Results: A total of 825 PD participants were enrolled at baseline. The study sample had a median baseline age of 63.1 (interquartile range: 55.6–69.3) years and comprised 496 (61.5%) men. Among them, 201 (24.9%) had ICB at baseline. In the generalized mixed-effects models, EDS (odds ratio [OR] = 1.09, 95% confidence interval [CI] 1.05, 1.12) and RBD (OR = 1.07, 95% CI 1.03, 1.12) were substantially associated with higher odds of developing ICB over time in PD patients, after multivariate adjustment including age, gender, family history, GDS score, STAI-Y score, MDS-UPDRS part III score, LEDD, and disease duration. Consistent results were observed when stratifying by age at baseline, gender, and PD family history. Conclusions: The study findings suggest a longitudinal association between EDS and pRBD with an increased risk of developing ICB in patients with PD. The findings emphasize the significance of evaluating and addressing sleep disorders in PD patients as a potential approach to managing ICB.

Disease associations of excessive daytime sleepiness in multiple sclerosis: A prospective study.

Excessive daytime sleepiness (EDS) in multiple sclerosis (MS) can be a significant source of disability. Despite this, its prevalence as a patient-reported outcome in this condition has not been well established, and its causes are not well understood. We prospectively assessed EDS as part of an observational study for patients referred for diagnostic neuro-ophthalmological testing. EDS was evaluated by the Epworth Sleepiness Scale (ESS), and visual data were also collected as part of a research protocol. Analysis with patient data was performed following the exclusion of patients with known primary sleep disorders. A total of 69 patients with MS were included in the analysis. The mean ESS was 6.5 with a SD of 4.3. ESS ≥ 10 was present in 23% of the cohort even in the presence of minimal mean neurological disability (Patient Determined Disease Steps (PDDS) = 1.5). The ESS score was not associated with age, sex, disease-related disability, retinal nerve fiber layer (RNFL), or optic neuritis (ON), but displayed an association with visual dysfunction. There is an increased prevalence of EDS in MS. The increased values of the ESS are not explained by other sleep disorders, suggesting separate mechanisms. Further study of the underlying mechanisms is warranted.

The association of excessive daytime sleepiness with psychological distress among Saudi medical students

Background: Excessive daytime sleepiness (EDS) is a significant problem especially among medical students, which is affecting negatively the quality of their lives. We aimed to assess the prevalence of this issue and encourage healthy and adequate sleep to improve the academic performance of medical students. The Epworth Sleepiness Scale (ESS) has been used in this study. Methods: This cross-sectional study targeted medical students and interns from different universities in Saudi Arabia. The survey included three parts: socio-demographic data, the Kessler Psychological Distress Scale (K10), and ESS. The data were collected from July to August 2021. A total of 1,295 participants were included in the study. Results: On the ESS, (62.69%) of the students had a normal range of sleepiness with (10.88%) having severe sleepiness. While on the K10 test, (70.19%) had no psychological distress, and only (5.5%) of the students had very high psychological distress. A higher score on the ESS is correlated to a higher score on the K10 test. The association between the level of distress and EDS is significant (p < 0.05). Both scales had found to be significantly associated with Grade Point Average (GPA) (p < 0.05). Higher scores on the ESS and K10 test are correlated with lower GPAs. Conclusion: There are lot of positive points regarding the results of the study, but still there is a negative point and the need for an intervention and action.

Association of Excessive Daytime Sleepiness with Cerebral Small Vessel Disease in Community-Dwelling Older Adults.

PurposeExcessive daytime sleepiness (EDS) and cerebral small vessel disease (CSVD) are common problems among older adults; however, their association is not clear. The present study aimed to investigate the frequency of EDS in CSVD patients and the relationship between EDS and neuroimaging markers of CSVD.Patients and MethodsWe conducted a cross-sectional study among 1076 community-dwelling older adults aged 55–85 years. EDS was measured using the Epworth Sleepiness Scale (ESS), and EDS was defined as an ESS score greater than 10. Binary logistic regression was performed to assess the association between EDS and neuroimaging markers of CSVD.ResultsOf the 1076 participants (mean age: 65.58 ± 6.46 years, 60.5% female), the prevalence of EDS was 10.0%. EDS was more frequent in participants with CSVD than in the total sample (20.0% vs 10.0%, p <0.001). In fully adjusted models, EDS was significantly correlated with CSVD burden (OR = 1.39, 95% CI 1.16 to 1.68, p <0.001), the severity of white matter hyperintensities (WMH) (OR = 1.33, 95% CI 1.14 to 1.54, p <0.001), and presence of lacunes (OR = 2.47, 95% CI 1.53 to 4.00, p <0.001) but not with the presence of cerebral microbleeds (CMBs) (OR=1.54, 95% CI 0.92 to 2.56, p = 0.099) or severity of enlarged perivascular spaces (EPVS) in basal ganglia (OR = 1.16, 95% CI 0.70 to 1.92, p = 0.564).ConclusionWe found a high frequency of EDS symptoms in CSVD individuals. Further, EDS was significantly associated with WMH, lacunes, and CSVD burden. Our findings further suggest patients with CSVD may exhibit abnormal sleep-wake patterns.

Association of Excessive Daytime Sleepiness with the Zung Self-Rated Depression Subscales in Adults with Coronary Artery Disease and Obstructive Sleep Apnea.

Excessive daytime sleepiness (EDS) is a factor associated with both obstructive sleep apnea (OSA) and depressive symptoms. Continuous positive airway pressure (CPAP) treatment may decrease EDS in adults with OSA; however, the modulatory role of depressive symptoms on the improvement of EDS is not known. We aimed to explore the association between subscales of the Zung Self-rated Depression Scale (SDS) and Epworth Sleepiness Scale (ESS) over a 2-year period in coronary artery disease (CAD) patients with OSA. This was a post-hoc analysis of the RICCADSA cohort, in which 399 adults with CAD (155 sleepy OSA [apnea–hypopnea index ≥ 15/h] and ESS score ≥ 10, who were offered CPAP; and 244 nonsleepy OSA [ESS < 10]), randomized to CPAP [n = 122] or no-CPAP [n = 122]) were included. Three factors were extracted from the Zung SDS, based on the principal component analysis: F1, cognitive symptoms and anhedonia; F2, negative mood; and F3, appetite. In a mixed model, the ESS score decreased by 3.4 points (p < 0.001) among the sleepy OSA phenotype, which was predicted by the decline in the F2, but not in the F1 and F3 scores. The fixed effects of time were not significant in the nonsleepy OSA groups, and thus, further analyses were not applicable. Additional within-group analyses showed a significant decrease in all subscales over time both in the sleepy and nonsleepy OSA patients on CPAP whereas there was a significant increase in the nonsleepy OSA group randomized to no-CPAP. We conclude that the improvement in negative mood symptoms of depression, but not changes in cognitive symptoms and anhedonia as well as appetite, was a significant predictor of decline in the ESS scores over a 2-year period in this CAD cohort with sleepy OSA on CPAP treatment.

Assessment of vitamin D, exercise, and lipid profile associated with excessive daytime sleepiness in school children

Previous research reported associations of excessive daytime sleepiness (EDS) with a low vitamin D level, obesity, and sexual maturity. The aim of this study was to identify the association and rank the importance of these with EDS. This study examined 618 children who were 10–12 year-old. The pediatric daytime sleepiness scale (PDSS) was used to evaluate EDS and sleep patterns. EDS was defined as a total PDSS score above 17. We ranked the importance of the relationship of these factors with EDS using random forest analysis. EDS (n = 111, 18%) was positively associated with more advanced pubertal stage in girls, chronic cough, urticaria, and allergic rhinitis. Multivariable analysis with adjustment for confounding indicated that children with low level of 25-hydroxyvitaminD3 (25(OH)D3 (<20 ng/mL) and high-density lipoprotein-cholesterol (HDL-C) (<40 mg/dL) levels had an increased risk of EDS (25(OH)D3:adjusted odds ratio [aOR] = 1.73; 95% confidence interval [CI]: 1.06 to 2.81; P = 0.028; HDL-C: aOR = 2.84; 95% CI: 1.05 to 7.68; P = 0.039). Random forest analysis indicated that 25(OH)D3 level, exercise, and body mass index (BMI) were over three. This study indicated high levels of 25-(OH)D3 and HDL-C and performing regular exercise decreased the risk of EDS.

Association between excessive daytime sleepiness and measures of supraventricular arrhythmia burden: evidence from the Atherosclerosis Risk in Communities (ARIC) study.

Excessive daytime sleepiness is a common sleep complaint among older adults. Assessment of excessive daytime sleepiness is used to screen for obstructive sleep apnea, which may be linked to atrial fibrillation (AF) and other sustained arrhythmias. Using data from the Atherosclerosis Risk in Communities (ARIC) Study cohort, we examined the association of excessive daytime sleepiness with measures of arrhythmia burden derived from a continuous ECG recording device in a community-based sample of older adults. Participating older adults (N= 2306, mean age: 78.9 ± 4.5years, 57.8% female) wore a Zio® XT Patch for 14days. Excessive daytime sleepiness was assessed with the Epworth Sleepiness Scale. Measures of AF and supraventricular arrhythmia burden were derived from the Zio® XT Patch. Multiple adjusted logistic, multinomial, and linear regression models were used to assess associations of excessive daytime sleepiness with AF, AF burden, and supraventricular arrhythmia burden. Approximately 18% of the sample had excessive daytime sleepiness, and 8.5% had AF. After adjustment, excessive daytime sleepiness was not significantly associated with AF (odds ratio (OR), 1.20; Confidence Interval (CI), 0.81-1.75), continuous AF burden (OR, 1.36; CI, 0.85-2.16), or measures of supraventricular arrhythmia burden (SVE burden: β 0.01; 95% CI, -0.09-0.11; SVT burden: β 0.02; 95% CI, -0.04-0.08). In this community-based sample of older adults, excessive daytime sleepiness was not associated with measures of arrhythmia burden. Future studies with objective measures of sleep are needed to further examine the role of sleep in the development and progression of arrhythmia burden.

Association between ZNF184 and symptoms of Parkinson's disease in southern Chinese.

The aim was to investigate the association between ZNF184 and symptoms of Parkinson's disease (PD) in southern Chinese. A total of 241 PD patients were recruited in this study. All patients were evaluated by Sniffin' Sticks 16 (SS-16), Hamilton anxiety rating scale and Hamilton depression rating scale, 39-item Parkinson's disease Questionnaire (PDQ-39) and MDS-Unified PD Rating Scale (MDS-UPDRS). Symptoms were also recorded. There was association of rapid eye movement sleep behavior disorder (RBD) under additive, dominant and overdominant model (p 0.039, additive; p 0.028, dominant; p 0.044, overdominant). We also found the association of excessive daytime sleepiness under the dominant model, the association of urgent urination or urinary incontinence under the recessive model and the association of sensitive to hot under the overdominant model (excessive daytime sleepiness: p 0.032, dominant; p 0.038, dominant; urgent urination or urgent incontinence: p 0.027, recessive; sensitive to hot: p, 0.027, overdominant). ZNF184 rs9468199 was associated with the presence of RBD, excessive daytime sleepiness, urgent urination or urgent incontinence and sensitive to hot.

Association of Excessive Daytime Sleepiness With Psychological Distress in Medical Students.

To determine the prevalence of excessive daytime sleepiness among medical students and establish a relationship between self-perceived sleepiness and psychological distress. In a cross-sectional study, 441 medical students from a public-sector university in Pakistan completed a questionnaire from August to December 2018. The questionnaire included the Epworth Sleepiness Scale (ESS), which measured daytime sleepiness, and the 12-item General Health Questionnaire (GHQ-12), which measured mental health. Pearson correlations and student t tests were used for comparisons with a significance level of P < .05. Many of the students (44.9%) obtained a high score (≥ 10) on the ESS (ie, experience excessive daytime sleepiness). On average, higher scores on the ESS correlated with higher scores on the GHQ-12. A statistically significant correlation (P < .05) between ESS scores and GHQ-12 scores was obtained when the students with higher (≥ 10) ESS scores were compared with students with lower (< 10) ESS scores. Excessive daytime sleepiness is frequent among medical students and significantly associated with psychological distress. Thus, careful investment in planning appropriate university policies and class schedules is required to encourage healthy and adequate sleep among students, which could have a significant impact on learning, academic performance, and health of medical students.

Sleep Disturbances and Suicidal Behavior.

Sleep disturbances, particularly insomnia, nightmares, and excessive daytime sleepiness (EDS), are significant, proximal, and modifiable risk factors for suicidal ideation and behaviors (SIB) and could be targeted for preventative interventions. In this chapter, we review the evidence supporting the association of insomnia, nightmares, and EDS with SIB. We also describe these sleep disturbances in the general population, as well as their association with psychiatric disorders. A PubMed search was conducted to identify the relevant literature. Insomnia is very frequent across mental disorders, but SIB patients are particularly exposed. Specific interventions focused on insomnia are useful in contending suicidal ideation. Nightmares seem to constitute an independent risk factor for SIB, beyond insomnia, particularly in young people and when experienced frequently. The evidence regarding the association of EDS and SIB is less clear and probably explained by the reduction of health-related quality of life and comorbid depression. The mechanisms underlying the relationship between sleep disturbances and SIB as well as the role of potential confounders and future perspectives in this field are also discussed.

Neurodegenerative Dementias: Improving Brain Health to Decrease Risk.

Neurodegenerative Dementias: Improving Brain Health to Decrease Risk.

Excessive daytime sleepiness and napping in cognitively normal adults: associations with subsequent amyloid deposition measured by PiB PET.

Study objectives To determine the association of excessive daytime sleepiness (EDS) and napping with subsequent brain β-amyloid (Aβ) deposition in cognitively normal persons. Methods We studied 124 community-dwelling participants in the Baltimore Longitudinal Study of Aging Neuroimaging Substudy who completed self-report measures of EDS and napping at our study baseline and underwent [11C] Pittsburgh compound B positron emission tomography (PiB PET) scans of the brain, an average ±standard deviation of 15.7 ± 3.4 years later (range 6.9 to 24.6). Scans with a cortical distribution volume ratio of >1.06 were considered Aβ-positive. Results Participants were aged 60.1 ± 9.8 years (range 36.2 to 82.7) at study baseline; 24.4% had EDS and 28.5% napped. In unadjusted analyses, compared with participants without EDS, those with EDS had more than 3 times the odds of being Aβ+ at follow-up (odds ratio [OR] = 3.37, 95% confidence interval [CI]: 1.44, 7.90, p = 0.005), and 2.75 times the odds after adjustment for age, age2, sex, education, and body mass index (OR = 2.75, 95% CI: 1.09, 6.95, p = 0.033). There was a trend-level unadjusted association between napping and Aβ status (OR = 2.01, 95% CI: 0.90, 4.50, p = 0.091) that became nonsignificant after adjustment (OR = 1.86, 95% CI: 0.73, 4.75, p = 0.194). Conclusions EDS is associated with more than 2.5 times the odds of Aβ deposition an average of 15.7 years later. If common EDS causes (e.g., sleep-disordered breathing, insufficient sleep) are associated with temporally distal AD biomarkers, this could have important implications for AD prevention.

Excessive daytime sleepiness and napping in cognitively normal adults: associations with subsequent amyloid deposition measured by PiB PET.

To determine the association of excessive daytime sleepiness (EDS) and napping with subsequent brain β-amyloid (Aβ) deposition in cognitively normal persons. We studied 124 community-dwelling participants in the Baltimore Longitudinal Study of Aging Neuroimaging Substudy who completed self-report measures of EDS and napping at our study baseline and underwent [11C] Pittsburgh compound B positron emission tomography (PiB PET) scans of the brain, an average ±standard deviation of 15.7 ± 3.4 years later (range 6.9 to 24.6). Scans with a cortical distribution volume ratio of >1.06 were considered Aβ-positive. Participants were aged 60.1 ± 9.8 years (range 36.2 to 82.7) at study baseline; 24.4% had EDS and 28.5% napped. In unadjusted analyses, compared with participants without EDS, those with EDS had more than 3 times the odds of being Aβ+ at follow-up (odds ratio [OR] = 3.37, 95% confidence interval [CI]: 1.44, 7.90, p = 0.005), and 2.75 times the odds after adjustment for age, age2, sex, education, and body mass index (OR = 2.75, 95% CI: 1.09, 6.95, p = 0.033). There was a trend-level unadjusted association between napping and Aβ status (OR = 2.01, 95% CI: 0.90, 4.50, p = 0.091) that became nonsignificant after adjustment (OR = 1.86, 95% CI: 0.73, 4.75, p = 0.194). EDS is associated with more than 2.5 times the odds of Aβ deposition an average of 15.7 years later. If common EDS causes (e.g., sleep-disordered breathing, insufficient sleep) are associated with temporally distal AD biomarkers, this could have important implications for AD prevention.

Abstract P346: Joint Associations of Obstructive Sleep Apnea and Excessive Daytime Sleepiness With Incident Cardiovascular Disease

Background: Although excessive daytime sleepiness (EDS) is a common symptom of obstructive sleep apnea (OSA), and both EDS and OSA have separately been associated with increased risk of cardiovascular disease (CVD), their joint association with CVD risk is unknown. Examining the association of EDS and OSA with CVD risk may help refine the OSA phenotype. Methods: Among 3,874 Sleep Heart Health Study participants without prevalent CVD, moderate to severe OSA was defined by an apnea hypopnea index (AHI) ≥ 15 events per hour on in-home polysomnography. EDS was defined as an Epworth Sleepiness Scale score ≥ 11. Incident CVD events included adjudicated myocardial infarction, coronary revascularization and stroke. Cox proportional hazards models adjusted for age, sex, alcohol, smoking, and body mass index. Results: Mean age was 63.0 years with 55.4% female, mean AHI 9.3 events/hour, and 23.4% with EDS. Over a median of 10.4 years of follow-up, we identified 653 incident cases of CVD. In adjusted analyses, EDS (Hazard ratio: 1.22, 95% CI 1.01-1.47) but not moderate-severe OSA (HR: 0.98, 0.81-1.20) was associated with incident CVD. In stratified analyses, the CVD incidence rate varied from 15.6/1000 person-years in those with no OSA or EDS to 26.0/1000 person-years in those with OSA and EDS (figure). In multivariable analyses, the hazard ratio for moderate-severe OSA and EDS compared to no OSA and no EDS was 1.26 (0.91-1.73). Formal tests of statistical significance of the OSA and EDS interaction were not significant on either the additive or multiplicative scales. Conclusions: Having both EDS and moderate-severe OSA was not associated with an increased risk of CVD in our data.

Association of Excessive Daytime Sleepiness With Longitudinal β-Amyloid Accumulation in Elderly Persons Without Dementia

Aging is associated with excessive daytime sleepiness (EDS), which has been linked to cognitive decline in the elderly. However, whether EDS is associated with the pathologic processes of Alzheimer disease remains unclear. To investigate whether EDS at baseline is associated with a longitudinal increase in regional β-amyloid (Aβ) accumulation in a cohort of elderly individuals without dementia. This prospective analysis included participants enrolled in the Mayo Clinic Study of Aging, a longitudinal population-based study in Olmsted County, Minnesota. Of 2900 participants, 2172 (74.9%) agreed to undergo carbon 11-labeled Pittsburgh compound B positron emission tomography (PiB-PET). We included 283 participants 70 years or older without dementia who completed surveys assessing sleepiness at baseline and had at least 2 consecutive PiB-PET scans from January 1, 2009, through July 31, 2016, after excluding 45 (13.7%) who had a comorbid neurologic disorder. Excessive daytime sleepiness was defined as an Epworth Sleepiness Scale score of at least 10. The difference in Aβ levels between the 2 consecutive scans (ΔPiB) in Aβ-susceptible regions (prefrontal, anterior cingulate, posterior cingulate-precuneus, and parietal) was determined. Multiple linear regression models were fit to explore associations between baseline EDS and ΔPiB while adjusting for baseline age, sex, presence of the apolipoprotein E ε4 allele, educational level, baseline PiB uptake, global PiB positivity (standardized uptake value ratio ≥1.4), physical activity, cardiovascular comorbidities (obesity, hypertension, hyperlipidemia, and diabetes), reduced sleep duration, respiratory symptoms during sleep, depression, and interval between scans. Of the initial 283 participants, mean (SD) age was 77.1 (4.8) years; 204 (72.1%) were men and 79 (27.9%) were women. Sixty-three participants (22.3%) had EDS. Baseline EDS was significantly associated with increased regional Aβ accumulation in the anterior cingulate (B coefficient = 0.031; 95% CI, 0.001-0.061; P = .04), posterior cingulate-precuneus (B coefficient = 0.038; 95% CI, 0.006-0.069; P = .02), and parietal (B coefficient = 0.033; 95% CI, 0.001-0.065; P = .04) regions. Association of EDS with longitudinal Aβ accumulation was stronger in participants with baseline global PiB positivity in the anterior cingulate (B coefficient = 0.065; 95% CI, 0.010-0.118; P = .02) and cingulate-precuneus (B coefficient = 0.068; 95% CI, 0.009-0.126; P = .02) regions. Baseline EDS was associated with increased longitudinal Aβ accumulation in elderly persons without dementia, suggesting that those with EDS may be more vulnerable to pathologic changes associated with Alzheimer disease. Further work is needed to elucidate whether EDS is a clinical marker of greater sleep instability, synaptic or network overload, or neurodegeneration of wakefulness-promoting centers. Early identification of patients with EDS and treatment of underlying sleep disorders could reduce Aβ accumulation in this vulnerable group.

Excessive Daytime Sleepiness in Acute Ischemic Stroke: Association With Restless Legs Syndrome, Diabetes Mellitus, Obesity, and Sleep-Disordered Breathing.

Sleep disorders are frequent in stroke patients. The prevalence of sleep-disordered breathing (SDB), excessive daytime sleepiness (EDS), and restless legs syndrome (RLS) among stroke survivors is up to 91%, 72%, and 15%, respectively. Although the relationship between EDS and SDB is well described, there are insufficient data regarding the association of EDS with RLS. The aim of this study was to explore the association between EDS, SDB, and RLS in acute ischemic stroke. We enrolled 152 patients with acute ischemic stroke. Epworth Sleepiness Scale (ESS) was used to assess EDS. SDB was assessed using standard overnight polysomnography. All patients filled in a questionnaire focused on RLS. Clinical characteristics and medication were recorded on admission. EDS was present in 16 (10.5%), SDB in 90 (59.2%) and RLS in 23 patients (15.1%). EDS was significantly more frequent in patients with RLS in comparison with the patients without RLS (26.1% versus 7.8%, P = .008). ESS was significantly higher in the population with RLS compared to the population without RLS (7 [0-14] versus 3 [0-12], P = .032). We failed to find any significant difference in the frequency of EDS and values of ESS in the population with SDB compared to the population without SDB. Presence of RLS (beta = 0.209; P = .009), diabetes mellitus (beta = 0.193; P = .023), and body mass index (beta = 0.171; P = .042) were the only independent variables significantly associated with ESS in multiple linear regression analysis. Our results suggest a significant association of ESS with RLS, diabetes mellitus, and obesity in patients with acute ischemic stroke.

Association of excessive daytime sleepiness with migraine and headache frequency in the general population

BackgroundSome previous studies have postulated an association between migraine and excessive daytime sleepiness (EDS). This study evaluated the association of EDS with migraine and headache frequency in a general population, after adjusting for potential confounding variables.MethodsThe study was a postal survey of a random age and gender-stratified sample of 40,000 persons aged 20 to 80 years old drawn by the National Population Register in Norway. The questionnaire included questions about migraine, headache, the Epworth sleepiness scale (ESS) and various comorbidities. EDS was defined as ESS > 10. The association of EDS and migraine/headache were analysed by bivariate and multivariable logistic regression analyses.ResultsA total of 21,177 persons responded to the ESS and were included in the analyses. The odds ratio (OR) for EDS was increased for migraineurs (1.42 (95% CI 1.31─1.54), p < 0.001) compared to non-migraineurs; however, this finding was not significant after adjustment for a number of possible confounders. EDS increased with increasing headache frequency, with an OR of 2.74 (95% CI 2.05─3.65), p < 0.001) for those with headache on >179 days per year compared to those without headache in multivariable analysis.ConclusionsIn a general population, the odds for EDS increased significantly with the headache frequency, irrespective of migraine status. EDS was not associated with reported migraine in multivariable analysis.

Excessive Daytime Sleepiness Predicts Neurodegeneration in Idiopathic REM Sleep Behavior Disorder.

To determine the association of excessive daytime sleepiness (EDS) with the conversion of neurodegenerative diseases in patients with idiopathic REM sleep behavior disorder (iRBD). A total of 179 patients with iRBD (79.1% males, mean age = 66.3 ± 9.8 years) were consecutively recruited. Forty-five patients with Epworth Sleepiness Scale score ≥14 were defined as having EDS. Demographic, clinical, and polysomnographic data were compared between iRBD patients with and without EDS. The risk of developing neurodegenerative diseases was examined using Cox proportional hazards model. After a mean follow-up of 5.8 years (SD = 4.3 years), 50 (27.9%) patients developed neurodegenerative diseases. There was a significantly higher proportion of conversion in patients with EDS compared to those without EDS (42.2 % vs. 23.1%, p = .01). EDS significantly predicted an increased risk of developing neurodegenerative diseases (adjusted hazard ratios [HR] = 2.56, 95% confidence interval [CI] 1.37 to 4.77) after adjusting for age, sex, body mass index, current depression, obstructive sleep apnea, and periodic limb movements during sleep. Further analyses demonstrated that EDS predicted the conversion of Parkinson's disease (PD) (adjusted HR = 3.55, 95% CI 1.59 to 7.89) but not dementia (adjusted HR = 1.48, 95% CI 0.44 to 4.97). EDS is associated with an increased risk of developing neurodegenerative diseases, especially PD, in patients with iRBD. Our findings suggest that EDS is a potential clinical biomarker of α-synucleinopathies in iRBD.

Excessive daytime sleepiness does not correlate with sympathetic nervous system activation and arterial stiffening in patients with mild-to-moderate obstructive sleep apnoea: A proof-of-principle study

BackgroundIncreased arterial stiffness and sympathetic nervous system activity, independent markers of cardiovascular risk, are common in patients with severe obstructive sleep apnoea, who have excessive daytime sleepiness. Among patients with mild-to-moderate obstructive sleep apnoea, however, it remains unknown whether arterial stiffness and/or increased sympathetic nervous system activity correlate with excessive daytime sleepiness. MethodsWe measured heart rate variability, as an index of autonomic nervous system activity, and arterial stiffness index, as a marker of vascular damage and cardiovascular risk, in 56 men aged 18 to 75years, with mild-to-moderate obstructive sleep apnoea, and matched into two groups, “sleepy” (Epworth Sleepiness Scale≥10) and “non-sleepy” (Epworth Sleepiness Scale<10). ResultsWe found no association of excessive daytime sleepiness with sympathetic nervous system activation (very low frequency power 18,947±11,207ms2vs 15,893±8,272ms2, p=0.28; low frequency (LH) power 17,753±8,441ms2vs 15,414±5,666ms2, p=0.26; high frequency (HF) power 7,527±1,979ms2vs 8,257±3,416ms2, p=0.36; LF/HF ratio 3.04±1.37 vs 2.55±1.01, p=0.15) and mean arterial stiffness index (6.97±0.83 vs 7.26±0.66, p=0.18) in mild-to-moderate obstructive sleep apnoea patients. ConclusionsSymptoms of excessive daytime sleepiness are not associated with sympathetic nervous system activation and arterial stiffness in male subjects with mild-to-moderate obstructive sleep apnoea.

Longitudinal associations of hypersomnolence and depression in the Wisconsin Sleep Cohort Study

BackgroundHypersomnolence is common in depression, however longitudinal associations of excessive daytime sleepiness (EDS), long habitual sleep duration, and objective sleep propensity with depressive symptomatology are not well established. MethodsData from adults participating in the Wisconsin Sleep Cohort Study who had multiple assessments at 4-year intervals were utilized in analyses. Conditional (intrasubject) logistic regression estimated the likelihood of development of depression and three primary hypersomnolence measures: subjective EDS [Epworth Sleepiness Scale (ESS) >10], habitual sleep duration ≥9h/day, and increased physiological sleep propensity [multiple sleep latency test (MSLT) mean sleep latency <8min]. ResultsAfter adjusting for all covariates, the odds for development of depression were significantly increased 1.67-fold (95% CI 1.02–2.73, p=0.04) in participants who also developed subjective EDS. However, development of increased physiological sleep propensity on the MSLT was associated with a trend towards reduced odds for development of depression (odds ratio 0.50, 95% CI 0.24–1.06, p=0.07). No significant longitudinal association between excessive sleep duration and depression was observed. LimitationsDepression was not verified by psychiatric interview and an objective measure of sleep duration was not utilized. ConclusionsOur results demonstrate a significant longitudinal association between increased subjective EDS and depression. However, increased physiological sleep propensity on the MSLT was paradoxically marginally protective against the development of depression. Further research is indicated to determine the mechanism underling divergent effects of various aspects of hypersomnolence on the course of mood disorders.