Impact Of Excessive Daytime Sleepiness Research Articles

Excessive Daytime Sleepiness in Hypertensive Patients: The Role of Major Depressive Disorder.

There is a special relationship between major depressive disorder and excessive daytime sleepiness. However, given the negative impact of excessive daytime sleepiness on life quality and cardiovascular outcome in hypertensive patients, the objective of this study was to investigate the potential role played by major depressive disorder in the occurrence of this complaint for this particular subpopulation. Data from 1404 hypertensive patients recruited from the Sleep Unit's polysomnographic recordings database were analyzed. A score >10 on the Epworth Sleepiness Scale was used to define excessive daytime sleepiness in this study. Logistic regression analyses were performed to investigate the risk of excessive daytime sleepiness associated with major depressive disorder in hypertensive patients. Excessive daytime sleepiness was frequent (40.0%) in our sample of hypertensive patients. After adjustments for major confounding factors, multivariate logistic regression analyses demonstrated that unlike remitted major depressive disorder, only current major depressive disorder was associated with a higher risk of excessive daytime sleepiness in hypertensive patients. Given this potential implication of current major depressive disorder in the occurrence of excessive daytime sleepiness for hypertensive patients, it is therefore essential to achieve the complete remission of this psychiatric disorder to avoid negative consequences associated with this complaint in this particular subpopulation.

Impact of excessive daytime sleepiness on attention impairment in obstructive sleep apnea: a cross-sectional observational study.

This study aims to examine the relationship between excessive daytime sleepiness (EDS) and attention impairment in Chinese individuals with obstructive sleep apnea (OSA). A total of 1996 OSA patients with an apnea-hypopnea index (AHI) of ≥ 5 events per hour were included in this study. EDS was measured using the Epworth Sleepiness Scale (ESS), while cognitive function was assessed using the Mini-Mental State Examination (MMSE) and the Montreal Cognitive Assessment (MoCA). OSA patients with EDS demonstrated higher body mass index (BMI), comorbidities of hypertension and diabetes, decreased N3 sleep, increased AHI and ODI, as well as lower minimum oxygen saturation. Despite no significant differences in total cognitive scores assessed by MMSE and MoCA, individuals with comorbid sleepiness exhibited more evident attention deficits in the subdomains of MoCA. Stratified analysis indicated that regardless of age, educational level was the primary factor influencing attention in the AHI < =20 group. In the AHI > 20 group, attention impairment in patients younger than 40 remained significantly associated with education level, whereas for individuals aged 40 and above, attention deficits were associated with education level, age, and daytime sleepiness. The interaction analysis indicated that OSA severity modulated the impact of sleepiness on attention in patients aged 40 and above. A significant correlation was observed between EDS and attention deficits in Chinese individuals diagnosed with OSA, with a particular emphasis on patients aged 40 and above. The severity of OSA modulates the impact of sleepiness on attention in patients aged 40 and above.

0502 Impact of Excessive Daytime Sleepiness on Day-to-day Experience of Patients Suffering from Obstructive Sleep Apnea

0502 Impact of Excessive Daytime Sleepiness on Day-to-day Experience of Patients Suffering from Obstructive Sleep Apnea

Examining the impact of excessive daytime sleepiness on utility scores in patients with obstructive sleep apnoea and/or narcolepsy in five European countries

BackgroundExcessive daytime sleepiness (EDS) is a cardinal symptom of narcolepsy and affects many patients with obstructive sleep apnoea (OSA). EDS is associated with reduced quality of life, increased accident risk, and poor workplace performance. Given the impact of EDS, the ability to predict health-related utility from sleepiness is valuable for examining the cost effectiveness of novel treatments. The aim of this study was to examine the association between EDS and EQ-5D in patients with OSA and/or narcolepsy by modelling EQ-5D utility scores from Epworth Sleepiness Scale (ESS) scores.MethodsData were obtained from the Europe 2016/2017 National Health and Wellness Survey, an online, general population survey, designed to represent the age and gender composition of each country’s adult population. Analyses included 2,348 patients self-reporting symptomatic and diagnosed OSA (n = 2,277), narcolepsy (n = 48), or both (n = 23). Multivariable models were used to examine ESS as a predictor of EQ-5D utility while adjusting for covariates of interest. Results were validated following the National Institute for Health and Care Excellence Decision Support Unit guidelines for predictive modelling.ResultsUtility decreased as EDS severity increased (no EDS: 0.711 ± 0.251, mild: 0.685 ± 0.261, moderate: 0.643 ± 0.268, severe: 0.559 ± 0.323). Whereas participants with only OSA or only narcolepsy did not differ in utility, those with both conditions had lower scores (0.685 ± 0.266 and 0.627 ± 0.325 vs. 0.439 ± 0.340, respectively). Piecewise linear regression identified a single breakpoint at ESS score of 11.29. In the final model, for each point increase in ESS score, the corresponding decrease in EQ-5D utility was larger among patients with ESS scores ≥ 12 compared to patients with ESS scores ≤ 11 (model slopes: -0.0131 vs. -0.0026, respectively). Findings from the validation sample confirmed these results.ConclusionsThis study demonstrates the impact of sleepiness on quality of life (QoL) and its negative impact irrespective of sleep condition (OSA or narcolepsy). The breakpoint identified is relatively consistent with the established ESS cutoff score ≥ 11, which demarcates pathological sleepiness. Furthermore, as EDS severity worsens (increases) on the ESS, the impact on QoL is greater.

Exploring the impact of excessive daytime sleepiness caused by obstructive sleep apnea on patient and partner quality of life: a time trade-off utility study in the UK general public.

This study aimed to quantify the impact of excessive daytime sleepiness (EDS) on patient and patient's partner health-related quality of life in the form of utility values typically used in health economic evaluations. A time trade-off study was conducted in a UK general population sample (representing a societal perspective) to elicit utility values, measured on a 0 to 1 scale, for health states with varying obstructive sleep apnea-associated EDS severity. In a time trade-off study, health states are described, and participants "trade off" time in a specific higher severity state for a shorter amount of time in full health. Overall, the sample consisted of 104 participants, who were interviewed and took part in the time trade-off exercise to elicit utility values for patient and partner residual EDS health states. The average utility score declined with increasing obstructive sleep apnea-associated EDS severity for both patient (no EDS, 0.926; mild EDS, 0.794; moderate EDS, 0.614; severe EDS, 0.546) and partner (no EDS, 0.955; mild EDS, 0.882; moderate EDS, 0.751; severe EDS, 0.670) health states. These results demonstrate the high impact that EDS in obstructive sleep apnea is estimated to have on patient and partner health-related quality of life. Tolley K, Noble-Longster J, Mettam S, etal. Exploring the impact of excessive daytime sleepiness caused by obstructive sleep apnea on patient and partner quality of life: a time trade-off utility study in the UK general public. J Clin Sleep Med. 2022;18(9):2237-2246.

Complaints of daytime sleepiness, insomnia, hypnotic use, and risk of dementia: a prospective cohort study in the elderly

BackgroundSleep disturbances are common in elderly and occur frequently in dementia. The impact of excessive daytime sleepiness (EDS), insomnia complaints, sleep quality, and hypnotics on the risk of all-cause dementia, Alzheimer disease (AD), and dementia with vascular component (DVC) remains unclear, as does the association between sleep profile and plasma β-amyloid levels.MethodsAnalyses were carried out on 6851 participants aged 65 years and over randomly recruited from three French cities and free of dementia at baseline. A structured interview and self-questionnaire assessed sleep complaints (EDS, insomnia complaints, sleep quality) and medications at baseline. Incident cases of dementia were diagnosed systematically over a 12-year period. Multivariate Cox models were used to estimate the risk of dementia associated with the sleep complaints considered individually and globally. Plasma β-amyloid levels were measured by an xMAP-based assay technology in 984 subjects.ResultsAfter adjustment for socio-demographic characteristics, lifestyle, APOE-ε4, cardiovascular factors, and depressive status, EDS had a higher risk of all-cause dementia (HR = 1.21; 95%CI = [1.01–1.46]) and DVC (HR = 1.58; 95%CI = [1.07–2.32]) but not AD. Persistent use of hypnotics increased the risk for all-cause dementia, specifically AD (HR = 1.28; 95%CI = [1.04–1.58]), but not DVC. No association was found for insomnia complaints and sleep quality taken as individual factors or combined with EDS on the risk of dementia. No association was found between β-amyloid, sleep complaints, and incident dementia.ConclusionsThe results suggest a deleterious role of EDS and hypnotics on dementia. Further studies are required to elucidate the mechanisms involved in these associations and whether its management can prevent the risk of dementia.

Socioeconomic and humanistic burden of illness of excessive daytime sleepiness severity associated with obstructive sleep apnoea in the European Union 5

Objective/BackgroundEvaluate the impact of excessive daytime sleepiness (EDS) severity on burden of illness among adults with obstructive sleep apnoea (OSA) in European Union 5 (EU5) countries (France, Germany, Italy, Spain, United Kingdom). Patients/MethodsThis retrospective observational study used data from the 2017 EU5 National Health and Wellness Survey, a self-administered, internet-based, non-screening survey. Respondents who self-reported both having experienced OSA in the last 12 months and having had their OSA diagnosed by a physician were considered to have OSA. Respondents completed the Epworth Sleepiness Scale (ESS) and were consequently categorised into 4 groups: OSA-with-EDS (ESS >10) subdivided by EDS severity (mild [ESS = 11–12], moderate [ESS = 13–15], severe [ESS = 16–24]), and OSA-without-EDS (ESS ≤10). Bivariate and multivariable analyses examined group differences in health-related quality of life (HRQoL), work productivity and activity impairment, and health care utilisation. ResultsThe analysis included 2008 respondents with OSA: n = 661 (32.9%) with EDS (29.5% mild, 34.5% moderate, 36.0% severe) and n = 1347 without EDS. Compared with the OSA-without-EDS group, the OSA-with-EDS subgroups generally had higher rates of obesity, depression, and other reported comorbidities. Greater severity of EDS was associated with worse self-reported HRQoL (all domains, P < 0.001) and work productivity and activity impairment (absenteeism, P = 0.031; presenteeism, overall work impairment, and non–work activity impairment, P < 0.001), as well as increased numbers of health care provider visits (P < 0.001). ConclusionsCompared to patients with OSA but without EDS, those with EDS had substantially higher socioeconomic and humanistic burden of disease, which was more profound among those reporting greater EDS.

Longitudinal association between daytime sleepiness and cognitive decline in dementia: A study protocol

IntroductionDementia is a major cause of disability worldwide. About 25%-40% of patients with mild to moderate dementia are affected by sleep-awake cycle disturbances, including increased daytime sleepiness and insomnia. However, little is known about the specific impact of excessive daytime sleepiness on the cognitive decline of dementia patients.ObjectivesTo evaluate the impact of daytime sleepiness on the cognitive decline of dementia patients. Additionally, longitudinal associations with functional impairment and neuropsychiatric symptoms will be explored.MethodsA longitudinal study will be conducted in a psychogeriatric consultation. Patients will be consecutively invited according to predefined eligibility criteria. Those aged ≥65 years, with dementia diagnosis or Mini-Mental State Examination (MMSE) &lt;24, and with a knowledgeable caregiver, will be included. The exclusion criteria are: a caregiver &lt;18 years, terminally ill, incapable to communicate or with a known diagnosis of insomnia, sleep related respiratory disorders, central hyperinsomnia, restless legs syndrome or sleep paralysis. Participants will undergo an assessment with a comprehensive protocol including: Montreal Cognitive Assessment (MoCA), Barthel and Lawton Index, Epworth Sleepiness Scale (ESS), Neuropsychiatric Inventory (NPI) and Global Deterioration Scale (GDS). Participants will be re-assessed 6 months after the initial evaluation. The Health Ethics Committee of Hospital Universitário de São João granted the study authorization (nº 260/2020).ResultsFindings will be disseminated via publication in peer-reviewed journals and presentations at national and international scientific conferences.ConclusionsThis study will address key questions on the relation of daytime sleepiness and dementia outcomes, in order to undertake corrective and preventive non-pharmacological and pharmacological approaches.

PMU101 Examining the IMPACT of Excessive Daytime Sleepiness on Utility Scores in Patients with Obstructive SLEEP Apnea and Narcolepsy in the EU5

To examine the association between excessive daytime sleepiness (EDS) and EQ-5D in patients with obstructive sleep apnea (OSA) and/or narcolepsy to predict EQ-5D utility from EDS scores. Data were obtained from the EU5 2016 and 2017 National Health and Wellness Survey, an online, general population survey, using stratified random sampling based on age and sex for each country. Analyses included 2,348 patients self-reporting symptomatic and diagnosed OSA (n=2,277), narcolepsy (n=48), or both (n=23). The Epworth Sleepiness Scale (ESS), a patient-reported outcome, was used to determine EDS severity, with a score of ≤10 being ‘normal’, 11-12 mild, 13-15 moderate and 16+ severe. Piecewise linear regression was used to identify segments of ESS in predicting EQ-5D utility, while controlling for covariates. Model equation was validated following the National Institute for Health and Care Excellence Decision Support Unit guidelines for predictive modeling. Nominal P-values were reported. Utility decreased as EDS severity increased (normal: 0.711±0.251, mild: 0.685±0.261, moderate: 0.643±0.268, severe: 0.559±0.323). Patients with only OSA or narcolepsy did not differ in utility scores, but those with both conditions had lower scores (0.685±0.266 vs. 0.627±0.325 vs. 0.439±0.340, respectively, p<0.001). Piecewise linear regression identified a single breakpoint at ESS score 11.29 with a change of -0.0107 in slope (p=0.003). The final model, with a breakpoint at 11, yielded slopes of -0.0026 (p=0.11) and -0.0131 (p<0.001) for ESS scores 0-11 and 12-24, respectively. Results from the validation sample supported these findings. This study demonstrates the burden of sleepiness on quality of life (QoL) and its negative impact irrespective of sleep condition (OSA or narcolepsy). The breakpoint identified is relatively consistent with the established cutoff of scores ≤10 representing normal sleepiness and scores ≥11 representing pathological sleepiness. Increasing severity of sleepiness has a greater impact on QoL in the pathological range on the ESS.

Is the Epworth Sleepiness Scale a useful tool for screening excessive daytime sleepiness in commercial drivers?

The significant social and economic impact of excessive daytime sleepiness makes sleep evaluation a primary medical need in commercial drivers. However, the best screening tool is still matter of debate. In our cohort of 221 commercial drivers, only ten (4.5%) had Epworth Sleepiness Scale scores indicative of excessive daytime sleepiness. These findings and the lack of concordance in estimating excessive daytime sleepiness among commercial drivers in previous studies using the same psychometric measure indicate that the Epworth Sleepiness Scale is not a reliable tool. This may be due to the low internal consistency of the scale in non-clinical samples and the possible intentional underscoring of sleepiness due to a perceived threat of driver’s license suspension. Moreover, the reliability of the Epworth Sleepiness Scale results may be strongly influenced by the administration setting. The clinical application of inexpensive less time-consuming new tools like performance tests should be considered for the objective evaluation of excessive daytime sleepiness in commercial drivers.

Prevalence, Risk Factors, and Impact of Excessive Daytime Sleepiness in an Elderly Korean Population

Excessive daytime sleepiness (EDS) is defined as the inability to stay awake and alert during major waking episodes of the day, resulting in unintended lapses into drowsiness or sleep, based on the second edition of International Classification of Sleep Disorders.1 EDS is one of the most disabling conditions caused by poor nocturnal sleep and is common in the elderly. Up to 30% of older people globally experience EDS.2 EDS can lead to poorer occupational and social functioning,3 and is strongly related to an increased risk of vehicular and occupational accidents.4 EDS also reduces cognitive functions in the elderly.5 Despite these adverse effects of EDS, the accurate representations of the burden of EDS in elderly Koreans are unclear. While several population-based studies of EDS in elderly people have been conducted in other countries,6-9 to our knowledge no study has evaluated EDS in older adults in Korea. The causes of EDS are multifaceted, with various risk factors. A number of studies of older adults have examined contributory factors associated with EDS in the elderly. EDS often occurs because of severe sleep-disordered breathing, subjective poor sleep quality, increased rapid eye movement sleep, pain, and use of sedating medications.10 Risk factors for EDS are nighttime awakening, depression, snoring, non-use of sleeping pills, and limitations in mobility.11 Accumulating evidence suggests that sleep is pivotal for memory consolidation, maintaining Received: October 21, 2014 Revised: November 28, 2014 Accepted: December 24, 2014

Impact of excessive daytime sleepiness on the safety and health of farmers in Saskatchewan.

Sleep disorders may negatively impact the health and well-being of affected individuals. The resulting sleepiness and impaired cognitive functioning may also increase the risks for injury. To examine the relationship between daytime sleepiness, defined as an Epworth Sleepiness Scale score >10, and self-reported sleep apnea, as potential determinants of farming-related injury and self-perceived physical health. Phase 2 of the Saskatchewan Farm Injury Cohort Study (2013) involved a baseline survey that included 2849 individuals from 1216 farms. A mail-based questionnaire was administered to obtain self-reports regarding sleep, demographics, farm injuries and general physical health. Multilevel logistic regression was used to quantify relationships between excessive daytime sleepiness and health. The prevalence of excessive daytime sleepiness was 15.1%; the prevalence of diagnosed sleep apnea was 4.0%. Sleepiness was highest in the 60 to 79 (18.7%) and ≥80 (23.6%) years of age groups, and was higher in men (19.0%) than in women (9.3%). Injuries were reported by 8.4% of individuals, and fair or poor health was reported by 6.2%. Adjusting for confounding, individuals with excessive daytime sleepiness appeared more likely to experience a farming-related injury (OR 1.34 [95% CI 0.92 to 1.96]) and were more likely to report poorer physical health (OR 2.19 [95% CI 1.45 to 3.30]) than individuals with normal daytime sleepiness. Excessive daytime sleepiness, a potentially treatable condition, appeared to be common in farmers and to negatively affect their health. Sleep disorder diagnosis and treatment programs did not appear to be used to their full potential in this population.

Daytime sleepiness, sleep disturbance and functioning impairment in bipolar disorder.

To verify the prevalence and clinical impact of excessive daytime sleepiness (EDS) in outpatients with bipolar disorder. Eighty-one outpatients with bipolar disorder and 79 healthy control subjects were recruited. Patients were required not to be acutely manic or depressed. We used the Epworth Sleepiness Scale, the Pittsburgh Sleep Quality Index and the Functioning Assessment Short Test to assess sleepiness, sleep problems and functioning, respectively. Patients had a higher prevalence of sleepiness (40%) than the control group (18%). Sleepiness and sleep disturbance had independent impacts on disability in the multivariable model. This study suggests that EDS is a relevant clinical dimension in patients with bipolar disorder. It is a frequent symptom that often overlaps with other sleep disturbances. This study also reveals that once present it has the potential to increase functional impairment.

Excessive daytime sleepiness and on-road driving performance in patients with Parkinson's disease

The impact of excessive daytime sleepiness (EDS) on road test performance was examined in patients with Parkinson's disease (PD). Twenty-one patients with PD completed the Epworth Sleepiness Scale (ESS) and an on-road driving test. Five participants had EDS according to their self-report on the ESS. Neither EDS nor PD medications were associated with on-road driving performance. These findings suggest that in this pilot study EDS did not impair PD patients' driving skills on a formal driving evaluation.

The Natural History of Health and Symptoms in Narcolepsy: A to-year Longitudinal Study

This longitudinal study investigated, over a 10-year period, reported changes in people with narcolepsy (a disorder of excessive daytime sleepiness). The issues of the functional impact of symptoms; stimulant medication status; body mass index, and concomitant illnesses were examined. The study also documented, using retrospective report, environmental factors influencing narcolepsy severity, and reported time of worst symptom severity following narcolepsy onset. In 1991, 127 people with diagnosed narcolepsy and cataplexy completed a wide-ranging questionnaire. In 2001, attempts were made to recontact these participants and 67 were traceable. Of these, 47 people, (18 males, 29 females; mean age 61.76 years, age range 31-86 years) returned a revised questionnaire. The reported impact of excessive daytime sleepiness (EDS) on the ability to carry out day-to-day activities showed minor increases in severity over the 10-year period in this older narcolepsy sample, and this could not be attributed to major changes in medication status. It is argued that the underlying severity of EDS does not increase with time, but rather that the interaction of EDS with the ageing process increases its detrimental impact. Improvements in the functional impact of sleep paralysis, hallucinations and automatic behaviour were reported. There was no evidence that any narcolepsy symptom became substantially worse with time for most people with the disorder. The influence of environmental factors on symptoms was inconsistent within the group. The elevated body mass index, stable over time, suggested that excess weight may be a trait often associated with narcolepsy, possibly linked to hypocretin deficiency.