Risk Of Excessive Daytime Sleepiness Research Articles

#2856 Sleep disturbances in non-dialysis dependent chronic kidney disease—The CKD-REIN cohort study

Abstract Background and Aims Sleep disturbances are common in patients on dialysis, but little is known about their prevalence and determinants in earlier chronic kidney disease (CKD) stages. We assessed the prevalence of insomnia, excessive daytime sleepiness (EDS), and sleep apnea, and studied their relation with kidney function, before and after accounting for various other potential determinants in patients with moderate or severe CKD. Method This study included 2657 nephrology outpatients with non-dialysis dependent CKD (mean age, 67 ± 12 years; 66% men; mean eGFR, 33 ± 12 mL/min/1.73 m2) from the French CKD-REIN (CKD-Renal Epidemiology and Information Network) cohort study who completed the Basic Nordic Sleep Questionnaire at baseline. Insomnia was defined as having badly or rather badly been sleeping, or having had difficulties falling asleep or awakened too early without being able to fall asleep again at least 3 times per week, over the past 3 months. And EDS, as feeling excessively sleepy during daytime at least 3 times per week over the past 3 months. Sleep apnea with or without continuous positive airway pressure use were identified from medical records. For each sleep disturbance, we assessed the crude prevalence by sex and by estimated glomerular filtration rate (eGFR) categories. We estimated adjusted odds ratios (OR) with 95% confidence interval (95% CI) associated with eGFR decrease (per 10 mL/min/1.73 m2) and urinary albumin-to-creatinine ratio (ACR) categories (A1-A3), as well as with age, sex, education (years), smoking, alcohol consumption, physical activity (estimated by the Global Physical Activity Questionnaire), performance score in Instrumental Activities of Daily Living [IADL], obesity, diabetes, cardiovascular disease, depression, patient-reported cramps, itching and stress or worry about CKD, and relevant drug use. Results Overall prevalence of insomnia, EDS, and sleep apnea were 23%, 15%, and 14%, respectively, with differences between women and men for insomnia, 30% vs 19%, EDS, 17% vs 13%, and sleep apnea, 10% vs 17%, respectively (all P-values <.001). Crude prevalence of EDS significantly increased with decreasing eGFR category (without interaction with sex), but not those for insomnia and sleep apnea (Figure). ACR categories were not associated with either sleep disturbances. In multivariable analyses, factors significantly associated with higher prevalence of insomnia included female sex, smoking, low physical activity, depression, and thyroid hormone use. There were also strong dose-response relations between insomnia prevalence and to what extend patients reported being bothered by cramps or itching, or stressed/worried about CKD. The crude relation of eGFR with EDS tended to weaken (ORs [95% CI], 1.10 [0.99-1.22] per 10 mL/min decrease, p-value 0.09) in multivariable analysis, which showed higher ORs associated with past smoking, depression, lower IADL score, insomnia, and betablocker use, as well as dose-response relations with itching, and stress/worry about CKD. Factors significantly associated with increased prevalence of sleep apnea included male sex, alcohol consumption, lower IADL score, obesity, depression, and cardiovascular disease. Conclusion This analysis of baseline data from the CKD-REIN cohort shows that, in patients with non-dialysis dependent CKD, EDS alone appeared to be related to kidney function level. The study, however, suggests the potential role of modifiable CKD-related symptoms, cramps and itching, and of being stressed or worried about CKD, in addition to that well-documented for behavioral and clinical risk factors, and drugs in the risk of insomnia and EDS.

Flow Limitation Is Associated with Excessive Daytime Sleepiness in Individuals without Moderate or Severe Obstructive Sleep Apnea.

Rationale: Moderate-Severe Obstructive Sleep Apnea (OSA, AHI>15) disturbs sleep through frequent bouts of apnea and is associated with daytime sleepiness. However, many individuals without moderate-severe OSA (i.e., AHI<15) also report sleepiness. Objective: To test the hypothesis that sleepiness in the AHI<15 group is a consequence of substantial flow limitation, in the absence of overt reductions in airflow (i.e., apnea/hypopnea). Methods: N=1886 participants from the MESA sleep cohort were analyzed for frequency of flow limitation from polysomnogram recorded nasal airflow signal. Excessive daytime sleepiness (EDS) was defined by Epworth Sleepiness Scale ≥11. Covariate-adjusted logistic regression assessed the association between EDS (binary dependent variable) and frequency of flow limitation (continuous) in individuals with an AHI<15. Results: N=772 individuals with an AHI<15 were included in primary analysis. Flow limitation was associated with EDS (odds ratio of 2.04, CI95% [1.17-3.54], per 2 standard deviation (2SD) increase in flow limitation frequency) after adjusting for age, sex, BMI, race/ethnicity, and sleep duration. This effect size did not appreciably change after additionally adjusting for AHI. Conclusions: In individuals with an AHI<15, increasing flow limitation frequency by 2SD is associated with a 2-fold increase in risk of EDS. Future studies should investigate addressing flow limitation in low AHI individuals as a potential mechanism for ameliorating sleepiness.

Clinical safety and narcolepsy-like symptoms of dual orexin receptor antagonists in patients with insomnia: a systematic review and meta-analysis.

Dual orexin receptor antagonists (DORAs) are emerging treatments for insomnia. This meta-analysis study aimed to assess the safety of FDA-approved DORAs (suvorexant, lemborexant, and daridorexant), focusing on narcolepsy-like symptoms associated with these drugs. Five prominent databases were searched to identify randomized controlled trials (RCTs) on this topic. Primary safety outcomes included treatment-emergent adverse events (TEAEs), treatment-related TEAEs, TEAEs leading to discontinuation, and serious TEAEs. Excessive daytime sleepiness (EDS), sleep paralysis, and hallucinations were categorized as adverse events (AEs)-related narcolepsy-like symptoms. Eleven RCTs with 7703 patients were included. DORAs were associated with a higher risk of TEAEs (risk ratio [RR], 1.09; 95% confidence interval [CI], 1.03 to 1.15) and treatment-related TEAEs (RR, 1.69; 95% CI: 1.49 to 1.92) when compared to placebo. The DORA group exhibited a significantly higher risk of EDS (RR, 2.15; 95% CI: 1.02 to 4.52) and sleep paralysis (RR, 3.40; 95% CI: 1.18 to 9.80) compared to the placebo group. This meta-analysis achieved a comparative evaluation of the clinical safety and tolerability of FDA-approved DORAs for primary insomnia, specifically focusing on AEs-related narcolepsy-like symptoms. This study contributes to understanding the safety profile of FDA-approved DORAs for treating insomnia.

Subtyping at-risk adolescents for predicting response toward insomnia prevention program.

Previous study has shown that a brief cognitive-behavioral prevention insomnia program could reduce 71% risk of developing insomnia among at-risk adolescents. This study aimed to evaluate the differential response to insomnia prevention in subgroups of at-risk adolescents. Adolescents with a family history of insomnia and subthreshold insomnia symptoms were randomly assigned to a 4-week insomnia prevention program or nonactive control group. Assessments were conducted at baseline, 1 week, and 6- and 12-month after the intervention. Baseline sleep, daytime, and mood profiles were used to determine different subgroups by using latent class analysis (LCA). Analyses were conducted based on the intention-to-treat approach. LCA identified three subgroups: (a) insomnia symptoms only, (b) insomnia symptoms with daytime sleepiness and mild anxiety, and (c) insomnia symptoms with daytime sleepiness, mild anxiety, and depression. The incidence rate of insomnia disorder over the 12-month follow-up was significantly reduced for adolescents receiving intervention in subgroup 3 compared with the controls (hazard ratio [HR] = 0.37; 95% confidence interval [CI]: 0.13-0.99; p = .049) and marginally for subgroup 2 (HR = 0.14; 95% CI: 0.02-1.08; p = .059). In addition, adolescents who received intervention in subgroups 2 and 3 had a reduced risk of excessive daytime sleepiness (subgroup 2: adjusted OR [AdjOR] = 0.45, 95% CI: 0.23-0.87; subgroup 3: AdjOR = 0.32, 95% CI: 0.13-0.76) and possible anxiety (subgroup 2: AdjOR = 0.47, 95% CI: 0.27-0.82; subgroup 3: AdjOR = 0.33, 95% CI: 0.14-0.78) compared with the controls over the 12-month follow-up. Adolescents at risk for insomnia can be classified into different subgroups according to their psychological profiles, which were associated with differential responses to the insomnia prevention program. These findings indicate the need for further phenotyping and subgrouping at-risk adolescents to develop personalized insomnia prevention.

Moderate-to-high risk of obstructive sleep apnea with excessive daytime sleepiness is associated with postoperative neurocognitive disorders: a prospective one-year follow-up cohort study.

Few studies found that obstructive sleep apnea (OSA) may be related to postoperative neurocognitive disorders (PND) including postoperative delirium (POD) and cognitive decline (POCD) in the early postoperative period. However, the results are controversial and need further verification, and no research has explored the effect of OSA on the incidence of PND during the 1-year follow-up periods. Furthermore, OSA patients with excessive daytime sleepiness (EDS) as a severe phenotype have more significant neurocognitive impairments, but the relationship between OSA with EDS and PND within 1 year after surgery has not been studied. To explore the effect of moderate-to-high risk of OSA and the moderate-to-high risk of OSA with EDS on PND within 1 year after surgery. In this prospective cohort study, including 227 older patients, moderate-to-high risk of OSA (using STOP-BANG), subjective EDS (using Epworth Sleepiness Scale), and objective EDS (using Actigraphy) were selected as exposures. Key outcomes included POD during hospitalization (using Confusion Assessment Method-Severity), POCD at discharge, 1-month and 1-year after surgery (using Mini-Mental State Examination and Telephone Interview for Cognitive Status-40). We applied multiple logistic regression models to estimate the effect of moderate-to-high risk of OSA and moderate-to-high risk of OSA with EDS on PND. In the multivariate analysis, moderate-to-high risk of OSA was not associated with POD during hospitalization and POCD at discharge, 1-month, and 1-year after surgery (p > 0.05). However, the moderate-to-high risk of OSA with subjective EDS was related to POCD at discharge compared to the moderate-to-high risk of OSA or normal group (no moderate-to-high risk of OSA and no EDS) (p < 0.05). In addition, moderate-to-high risk of OSA with objective EDS was associated with POCD at discharge, 1-month, and 1-year postoperatively compared to the moderate-to-high risk of OSA or normal group (p < 0.05). Moderate-to-high risk of OSA with EDS, not moderate-to-high risk of OSA alone, was a clinically helpful predictor for POCD within 1-year after surgery and should be routinely assessed before surgery.

Obstructive sleep apnea and excessive daytime sleepiness among commercial motor vehicle drivers in Lusaka, Zambia.

Obstructive sleep apnea (OSA) is a risk factor for a major public health problem, car crashes, due to excessive daytime sleepiness (EDS). Commercial vehicle driving (CVD) is a hazardous occupation, having a high fatality rate worldwide. There have been no studies on EDS and OSA in Zambia despite the high rate of annual road traffic accidents (RTAs). We aim to determine the prevalence of EDS and OSA risk among CVDs in Lusaka, Zambia, to assess the impact of OSA on high RTA rates. This was a cross-sectional study. The STOP BANG questionnaire and the Epworth Sleepiness Scale were used. Consecutive sampling of drivers was done who were divided into low and high risk of OSA (HROSA). The risk factors associated with OSA in the bivariate analyses were subjected to a multivariate logistic regression model. One hundred thirty-six drivers participated in the study (all male) with a mean age of 48 ± 5 years. The prevalence of HROSA was 22.8% out of whom 67.7% also had a EDS. Only 9.6% of the total cohort had EDS without HROSA. Using Fisher's exact test, HROSA was significantly associated with older age (> 50 years, P < .001), obesity (body mass index >30, P < .001), neck circumference of > 40 cm (P = .032), and hypertension (P < .001). Snoring and EDS were significantly associated with RTAs (P < .0001 and P = .007, respectively). High risk of OSA and EDS are common among CMV drivers in Zambia and underdiagnosed. The risk factors for OSA are amenable to preventive interventions. Simpamba K, May JL, Waghat A, Attarian H, Mateyo K. Obstructive sleep apnea and excessive daytime sleepiness among commercial motor vehicle drivers in Lusaka, Zambia. J Clin Sleep Med. 2023;19(7):1191-1198.

Abstract 14839: Clinical, Polysomnographic and Echocardiographic Correlates of Excessive Daytime Sleepiness

Introduction: Excessive Daytime Sleepiness (EDS) has been associated with adverse CVD outcomes. However, the mechanisms of elevated CVD risk in persons with EDS remains uncertain. In this study, we examined polysomnographic and echocardiographic correlates of EDS in a population of adults who underwent both sleep and cardiac stress tests. Methods: We analyzed data from 264 participants who had an in-lab polysomnogram (PSG) and a cardiac stress test between 2016 and 2019. All patients completed the Epworth Sleepiness Scale (ESS) questionnaire. EDS was categorized into 3 groups no EDS (ESS&lt;10), non-severe EDS (ESS 10-14), and severe EDS (ESS ≥15). T90%, the percentage of sleep time spent with oxygen desaturation &lt; 90%, was categorized into severe (≥ 20%) and non-severe nocturnal hypoxemia (&lt;20%). We assessed the relationship between EDS and CV risk factors, and EDS and echocardiographic parameters of diastolic dysfunction such as the E/e’, E/A ratio, left atrial volume index, tricuspid regurgitation jet velocity, and systolic function (ejection fraction, EF). Results: The mean age (SD) of the participants was 59 (11) years, and 59% were female. In logistic regression analysis severe EDS was associated with &gt;3-fold odds of a history of stroke or TIA [a OR 3.2 (95%CI:1.2-8.2), P=0.017] and nearly 4 times the odds of severe nocturnal hypoxemia [aOR 3.8 (95%CI: 1.7-8.6, P=0.002] compared to those with no EDS. We found no other association between EDS and demographic or CV characteristics or PSG variables. In the subset of patients with available echocardiogram data (n=199 - 213), there was no association between EDS and EF or echocardiographic parameters of diastolic dysfunction. Conclusions: EDS is strongly associated with severe nocturnal hypoxia and a history of stroke or TIA in adults with OSA. Further studies are needed to characterize the relationship between EDS and CVD.

Correlating excessive daytime sleepiness with body mass index, waist circumference, and lipid profile in shift workers.

To determine the correlation between excessive daytime sleepiness and body mass index, waist circumference, and lipid profile of shift workers at Dr. Moewardi General Hospital, Surakarta. This cross-sectional study was carried out at the Dr. Moewardi Hospital, Surakarta, Indonesia between October 2018 and July 2019. The participants were recruited using purposive sampling. Multiple linear regression with backward elimination was performed to identify the odds ratios between Epworth Sleepiness Scale scores, anthropometric measurements, and lipid profiles. A p-value of <0.05 indicated statistically significant correlations. Of the 150 included participants, 127 (84.67%) were women. Statistical analyses revealed odds ratios of 2.38 (95% confidence interval [CI] 1.14-4.89, p=0.000) for daytime sleepiness severity and total cholesterol levels, and 2.45 (95% CI 1.36-4.98, p=0.020) for daytime sleepiness severity and high-density lipoprotein levels. Increased total cholesterol and decreased high-density lipoprotein levels increase the risk of excessive daytime sleepiness in shift workers.

The risk of increased daytime sleepiness and obstructive sleep apnea among the group of professional drivers

Introduction and purpose: Obstructive sleep apnea (OSA) is the most common clinical problem in the group of diseases classified as sleep breathing disorders. Professional drivers are a group that is particularly exposed to the consequences of OSA during the day. This is a very significant problem as chronic daytime sleepiness and falling asleep at the wheel are now recognized as one of the leading causes of road accidents caused by drivers.The aim of the study was to assess the risk of excessive daytime sleepiness and obstructive sleep apnea among the group of professional drivers. Material and methods: The research group consisted of 101 people employed as a professional driver. In order to assess excessive daytime sleepiness and the risk of obstructive sleep apnea, the Epworth sleepiness scale, the Berlin Questionnaire and the self-questionnaire were used. Results: Among 45 drivers (44.6%) had a high risk of OSA using the Berlin Questionnaire, and 56 drivers (55.4%) had a low risk of OSA. According to the Epworth sleepiness scale, it was found that 19.8% of drivers experienced mild daytime sleepiness and 13.9% were drivers with excessive daytime sleepiness require medical consultation. In drivers with a high risk of OSA, the relationship with increased excessive daytime sleepiness was confirmed in the Berlin Questionnaire (85.7%). Conclusions: Among professional drivers, the risk of developing obstructive sleep apnea increases due to risk factors. There is a relationship between excessive daytime sleepiness and risk factors for obstructive sleep apnea.

The Number of Monthly Night Shift Days and Depression Were Associated with an Increased Risk of Excessive Daytime Sleepiness in Emergency Physicians in South Korea.

This study aimed to report the prevalence and identify the factors associated with excessive daytime sleepiness (EDS) among emergency physicians in South Korea. We analyzed the Korean Emergency Physicians Survey data from 15 January to 26 February 2021. EDS was evaluated using the Epworth sleepiness scale, and a score of 11 or more indicated the presence of EDS. We conducted univariable and multivariable logistic regression analyses to verify the associated factors. A total of 1307 participants responded to the survey, and the response rate was 61.3%. Nine hundred fifty-four participants were included in the study. Two hundred ninety-three participants were classified as the EDS group, and six hundred sixty-one were classified as the non-EDS group. The prevalence of EDS was 30.7% (95% confidence interval (CI), 27.8–33.6%). Monthly night-shift days (odds ratio (OR) 1.106, 95% CI 1.028–1.191) and depression (OR 2.635, 95% CI 1.799–3.861) were significantly associated with an increased risk of EDS, and fair sleep quality (OR 0.560, 95% CI 0.318–0.985) was associated with a decreased risk of EDS. Almost one in three emergency physicians in South Korea suffer from daytime sleepiness. The number of monthly night-shift days and depression were associated with an increased risk of EDS.

Prevalence of sleep disorders in children with chronic kidney disease: a meta-analysis.

The reported prevalence of sleep disorders in children with chronic kidney disease (CKD) varies greatly. A quantitative meta-analysis to estimate the prevalence of sleep disorders among pediatric CKD patients may provide further information. The objective of this study is to estimate the prevalence of sleep disorders in children with CKD. The study protocol was registered on PROSPERO (registration number CRD42021268378). Two authors independently searched the PubMed, MEDLINE, EMBASE, and Cochrane review databases up to June 2021. Eligible studies include data of prevalence of sleep disorders in children with CKD. The prevalence of restless legs syndrome, sleep-disordered breathing, pediatric obstructive sleep apnea (i.e., apnea-hypopnea index &gt; 1 event/h in polysomnography), excessive daytime sleepiness, and insomnia/insufficient sleep was estimated using a random-effects model. Subgroup analyses were conducted to compare the prevalence of sleep disorders between children on dialysis and not on dialysis. This meta-analysis included 12 studies with 595 children (mean age: 12.9years; gender ratio: 55.6% boys; mean sample size: 49.6 patients). The prevalence of restless legs syndrome in children with CKD was 21% (95% confidence interval [CI], 14-30%). The prevalence of sleep-disordered breathing, pediatric obstructive sleep apnea, excessive daytime sleepiness, and insomnia/insufficient sleep was 22% (95% CI, 12-36%), 34% (95% CI, 19-53%), 27% (95% CI, 17-41%), and 14% (95% CI, 7-27%), respectively. Subgroup analysis revealed the pooled prevalence of excessive daytime sleepiness was significantly higher in children on dialysis than in children not on dialysis (43.3% vs. 11.2%; P = 0.018). Children on dialysis also had a high prevalence of other sleeping disorders, although the differences did not reach statistical significance. Children with CKD exhibited a 3.9-fold (95% CI, 1.37 to 10.93) increased risk of restless legs syndrome and a 9.6-fold (95% CI, 3.57 to 25.76) increased risk of excessive daytime sleepiness compared with controls. The selected papers are of small sample size, lack of a control group, and exhibit substantial heterogeneity. Sleep disorders are common in children with CKD. Our results indicate that while the prevalence rates of various sleep disorders were higher in children on dialysis than in children not on dialysis, the prevalence of excessive daytime sleepiness was statistically significant in children on dialysis. A higher resolution version of the Graphical abstract is available as Supplementary information.

Cross Sectional Study of the Community Self-Reported Risk of Obstructive Sleep Apnoea (OSA) and Awareness in Thessaly, Greece.

The purpose of this study was to investigate the self-reported risk of obstructive sleep apnea syndrome (OSAS) in the municipality of Thessaly, Greece, and the level of awareness of both the disease and its diagnosis. Inhabitants of Thessaly (254 total; 84 men and 170 women) were studied by means of questionnaires via a telephone-randomized survey. This comprised: (a) the Berlin questionnaire for evaluation of OSAS risk; (b) the evaluation of daytime sleepiness by the Epworth Sleepiness Scale; and (c) demographic and anthropometric data. The percentage of participants at high risk for OSA was 26.77%, and the percentage of people who were at high risk of excessive daytime sleepiness was 10.63%. High risk for OSAS was found to be 3.94%. No significant differences were found between high- and low-risk OSAS participants associated with age, smoking and severity of smoking. Regarding the knowledge of the community about OSAS, the majority of the sample was aware of the entity (64.17%), while fewer had knowledge about the diagnosis (18.50%) and polysomnography (24.80%). The high risk of OSA prevalence and the low awareness of the diagnosis of OSA highlights the need for the development of health promotion programs aiming at increasing the disease awareness in the general population in order to address OSA more effectively.

Narcolepsy genetic marker HLA DQB1*06:02 and excessive daytime sleepiness in Parkinson disease patients treated with dopaminergic agents.

To determine whether narcolepsy Human Leukocyte Antigen (HLA) risk allele DQB1*0602 is associated with excessive daytime sleepiness (EDS) and inappropriate sleep in patients with Parkinson disease (PD). EDS is a common and disabling non-motor manifestation of PD, affecting quality of life and driving performance. DQB1*0602 is an HLA risk allele for narcolepsy. It is present in 12-30% of the general population. We hypothesize that DQB1*0602 is associated with an increased risk of EDS and inappropriate sleep in PD patients. This was a cross-sectional observational study of 150 PD individuals on dopaminergic agents. Main outcome measures were DQB1*0602 status and the modified Epworth Sleepiness Scale. Individuals with dementia, loss of independence, narcolepsy and untreated sleep apnea were excluded. Confounding variables for EDS were assessed using Parkinson Disease Sleep Scale, Mayo Sleep Questionnaire, Unified PD Rating Scale, Hoehn and Yahr scale. DQB1*06:02 positive PD patients were approximately three times more likely to experience EDS and fall asleep inappropriately during activities that required sustained alertness (e.g. driving, eating, attending work etc.). Exploratory post hoc analysis showed a dopaminergic drug dose- and type- dependent effect on daytime sleepiness in DQB1*06:02 positive individuals. No significant differences were found in confounding variables. PD individuals are more likely to experience EDS and fall asleep inappropriately during activities if DQB1*0602 positive. Genetic vulnerability may explain EDS risk in PD.

Sleep duration and sleep efficiency in UK long-distance heavy goods vehicle drivers

ObjectivesTo profile sleep duration and sleep efficiency in UK long-distance heavy goods vehicle (HGV) drivers and explore demographic, occupational and lifestyle predictors of sleep.MethodsCross-sectional analyses were carried out on 329...

Relationship Between Body Mass Index and Excessive Daytime Sleep Among Mass Transit Bus Drivers in the South-East, Nigeria

Background: On April 25, 2008 the United Nations (UN) declared a decade (2011-2020) of Action on Road Safety’ in an effort to reduce the incidence of road traffic accidents (RTAs). RTA has been linked to Excessive Daytime Sleepiness (EDS) by several studies. Nigeria has been indicted as one of the most notorious countries for bad roads leading to RTAs. Bad road coupled with EDS is a bad omen for road users. Risk for EDS has been said to be increased by factors such as obesity. Obesity is measured by Body Mass Index (BMI). Although study exists in Nigeria that linked RTAs to EDS, none has linked EDS to specific factors such as BMI. The current study attempts to fill the gap and to create an empirical basis for targeted public health measures against EDS and RTAs. Aim: The objective of the study was to determine the relationship between the Body Mass Index (BMI) and Excessive Daytime Sleepiness (EDS) among Mass Transit Bus Drivers (MTBDs) in the South East, Nigeria. The study had one Null hypothesis (H0.) that there is no significant relationship between BMI and the risk of Excessive Daytime Sleepiness (EDS) among the Mass Transit Bus Drivers (MTBDs) in South-East, Nigeria. Method: A cross-sectional analytical study design was used. The target population was all the bus drivers employed by seven major registered mass transit companies in South-East, Nigeria. A multistage sampling technique was used to select participants for the study using arbitrary fixed inclusion criteria. The instrument, a questionnaire used for data collection, was explicitly designed for the study. The instrument was pre-tested at Ifesinachi Park, Nsukka, and validated by experts. A Cronbach alpha reliability coefficient of 0.8 was obtained. Ethical approvals were obtained from the ethics and research committee of Ebonyi State University and the mass transit companies. Five research assistants were used to collect data. Data was collected from 401 MTBDs. Findings: Analysis of variance (ANOVA) was used to test the hypothesis. The findings among other things established a significant relationship between BMI and EDS (P&lt;0.05). Conclusion: The study concluded that there is a positive significant relationship between BMI and EDS. Based on the findings, it was among other things recommended that nutrition education with proper Behaviour Change Communication (BCC) materials be provided for the MTBDs.

Association of TNF-α (-308G/A) Gene Polymorphism with Circulating TNF-α Levels and Excessive Daytime Sleepiness in Adults with Coronary Artery Disease and Concomitant Obstructive Sleep Apnea.

Obstructive sleep apnea (OSA) is common in patients with coronary artery disease (CAD), in which inflammatory activity has a crucial role. The manifestation of OSA varies significantly between individuals in clinical cohorts; not all adults with OSA demonstrate the same set of symptoms; i.e., excessive daytime sleepiness (EDS) and/or increased levels of inflammatory biomarkers. The further exploration of the molecular basis of these differences is therefore essential for a better understanding of the OSA phenotypes in cardiac patients. In this current secondary analysis of the Randomized Intervention with Continuous Positive Airway Pressure in CAD and OSA (RICCADSA) trial (Trial Registry: ClinicalTrials.gov; No: NCT 00519597), we aimed to address the association of tumor necrosis factor alpha (TNF-α)-308G/A gene polymorphism with circulating TNF-α levels and EDS among 326 participants. CAD patients with OSA (apnea–hypopnea-index (AHI) ≥ 15 events/h; n = 256) were categorized as having EDS (n = 100) or no-EDS (n = 156) based on the Epworth Sleepiness Scale score with a cut-off of 10. CAD patients with no-OSA (AHI < 5 events/h; n = 70) were included as a control group. The results demonstrated no significant differences regarding the distribution of the TNF-α alleles and genotypes between CAD patients with vs. without OSA. In a multivariate analysis, the oxygen desaturation index and TNF-α genotypes from GG to GA and GA to AA as well as the TNF-α-308A allele carriage were significantly associated with the circulating TNF-α levels. Moreover, the TNF-α-308A allele was associated with a decreased risk for EDS (odds ratio 0.64, 95% confidence interval 0.41–0.99; p = 0.043) independent of age, sex, obesity, OSA severity and the circulating TNF-α levels. We conclude that the TNF-α-308A allele appears to modulate circulatory TNF-α levels and mitigate EDS in adults with CAD and concomitant OSA.

The trajectories and associations of eveningness and insomnia with daytime sleepiness, depression and suicidal ideation in adolescents: A 3-year longitudinal study

BackgroundEveningness and insomnia are highly comorbid and closely related to psychopathology in adolescents. We aimed to prospectively investigate the trajectories and associations of eveningness and insomnia with daytime functioning, depression and suicidal risk in adolescents. MethodsA 3-year longitudinal study was conducted among 414 Chinese adolescents. The associations of eveningness and insomnia with daytime functioning, depression and suicidal ideation were analyzed using logistic regressions. ResultsThe prevalence rates of eveningness were similar at baseline and follow-up (19.3% vs 22.5%; p = 0.27), while the prevalence of insomnia increased at follow-up (29.2% vs 40.8%; p < 0.001). Among those eveningness adolescents (n=80) at baseline, 46.2% remained as stable evening-type at follow-up, and among those insomnia adolescents (n=121) at baseline, 64.5% had persistent insomnia at follow-up. Logistic regressions showed that stable, incident, and resolved eveningness were associated with excessive daytime sleepiness (EDS) at follow-up, while only persistent and incident insomnia increased the risk of EDS. Persistent and incident insomnia, as well as stable eveningness were independently associated with depression at follow-up. Persistent and incident insomnia, but not eveningness, were associated with suicidal ideation. LimitationsThe outcome assessments were based on self-reported questionnaires and the sample size is modest. ConclusionsPersistent eveningness and insomnia are significantly associated with greater risks of EDS and depression in adolescents, while both persistent and incident insomnia, but not eveningness, increased the risk of suicidal ideation. These findings underscore the importance of addressing sleep and circadian factors in the management of adolescent mood and daytime functioning.

Excessive Daytime Sleepiness is Associated With Malnutrition, Dysphagia, and Vitamin D Deficiency in Older Adults

ObjectivesBoth excessive daytime sleepiness (EDS) and nutritional deficiencies are common and can cause similar negative consequences, such as falls, and cognitive impairment in older adults, but there is no study investigating the relationship between the two. The aim of this study is to investigate the relationship between malnutrition/micronutrient deficiency and EDS in patients with and without dementia. DesignCross-sectional study. Setting and ParticipantsA total of 800 outpatients (243 of whom had dementia), aged ≥65 years, were included. MethodsAll patients underwent comprehensive geriatric assessment. Mini Nutritional Assessment (MNA) scores >23.5, 17-23.5, or <17 were categorized as well-nourished, malnutrition risk, and malnutrition, respectively. Eating Assessment Tool score of ≥3 was accepted as dysphagia. Serum vitamin B12, vitamin D, and folate deficiencies were also evaluated. The Epworth Sleepiness Scale score of ≥11 points indicated EDS. ResultsThe mean age was 79.1±7.5 years. The prevalence of EDS was 22.75%. In patients with dementia, those with EDS had significantly lower MNA scores and more frequent dysphagia (P < .05). In patients without dementia, those with EDS have lower MNA scores than those without EDS; malnutrition, dysphagia, and vitamin D deficiency were higher (P < .05). In multivariable analysis adjusted for age, gender, living status, ischemic heart disease, cerebrovascular events, polypharmacy, dementia, and insomnia, the association between EDS and malnutrition [odds ratio (OR) 1.73, 95% confidence interval (CI) 1.37-2.20], dysphagia (OR 2.01, 95% CI 1.33-2.88), and vitamin D deficiency (OR 2.0, 95% CI 1.12-3.55) persisted. Conclusions and ImplicationsThere is a significant relationship between EDS and malnutrition risk, dysphagia, and vitamin D deficiency in older adults. Therefore, when examining an older patient with EDS, dysphagia, malnutrition, and vitamin D levels should be evaluated, or EDS should be investigated in an older patient with malnutrition, dysphagia, and vitamin D deficiency. Thus, it will be possible to manage all these conditions more effectively.

Associations of frequent pain symptoms with excessive daytime sleepiness in adolescents: a longitudinal study.

Pain symptoms, sleep disturbance, and daytime sleepiness are common in adolescents. This study examined the cross-sectional and prospective associations between pain symptoms and excessive daytime sleepiness (EDS) in a large sample of adolescents. Participants were 7,072 adolescents (mean age = 14.58 years) in a follow-up study of behavior and health in Shandong, China. A self-administered structured questionnaire was used to assess pain symptoms (headache, stomachache, and other general pain), body weight and height, sleep, anxiety/depression, substance use, and family environment in November-December in 2015 and 1 year later. The Chinese adolescent daytime sleepiness scale was used to measure daytime sleepiness. Of the sample, 19.8% and 23.2% had moderate or severe EDS at baseline and at 1-year follow-up, respectively. The prevalence and 1-year incidence rates of EDS significantly increased with the frequencies of pain symptoms. Frequent pain was significantly associated with increased risk of EDS at baseline (odds ratio = 2.01, 95% confidence interval = 1.56-2.59), incident EDS (odds ratio = 1.41, 95% confidence interval = 1.03-1.93), and persistent EDS (odds ratio = 2.17, 95% confidence interval = 1.52-3.09) while adjusting for adolescent and family covariates, including anxiety/depression, nocturnal sleep duration, insomnia symptoms, frequent snoring, body mass index, and hypnotic use. Similar associations were observed across headache, stomachache, and other pain. Frequent pain is significantly and independently associated with increased risk of EDS. Our findings suggest that assessing and treating pain symptoms is important to improve healthy sleep and reduce risk of EDS in adolescents. Further research is needed to understand the underlying psychological and neurobiological mechanisms between pain and daytime sleepiness in adolescents. Liu X, Liu Z-Z, Yang Y, Jia C-X. Associations of frequent pain symptoms with excessive daytime sleepiness in adolescents: a longitudinal study. J Clin Sleep Med. 2021;17(12):2415-2423.

Risk of Excessive Daytime Sleepiness Associated to Major Depression in Adolescents.

Given the limited data currently available in the literature, the aim of this study was to investigate the risk of excessive daytime sleepiness (EDS) associated with major depression in a large sample of adolescents. The clinical and polysomnographic data of 105 adolescents recruited from the database of the Erasme Hospital sleep laboratory were analysed. A score > 10 on the Epworth Sleepiness Scale was used as cut-off for the diagnosis of EDS. The status (remitted or current) and the severity (mild to moderate or severe) of major depressive episodes were determined based on the diagnostic criteria of the DSM-IV-TR during a systematic psychiatric assessment. Logistic regression analyses were performed to determine the risk of EDS associated with major depression in adolescents. The prevalence of EDS was 34.3% in our sample of adolescents. After adjusting for the main confounding factors associated with EDS, multivariate logistic regression analysis demonstrated that unlike mild to moderate major depression, remitted major depression and severe major depression were risk factors for EDS in adolescents. In our study, we have highlighted that in adolescents, the EDS could be both residual symptom and severity marker of major depression, which seems to justify a systematic psychiatric assessment in adolescents with EDS complaints in order to allow better management of this problem in this particular subpopulation.