Excessive daytimesleepiness (EDS) is a common clinical problem. It is one of the main consequences of sleep disorders and it is associated with a reduction of the quality of life, road accidents and workplace accidents [1, 2]. EDS is an inability to maintain vigilance and alertness during major period of the day when subject is expected to be awake, with sleep occurring unintentionally or at inappropriate times and this almost daily . Its prevalence is estimated between 10 and 20% in the general population [4–12] and reaches 68% in some groups of patients . The independent association between EDS and hypertension is found in several studies including patients with sleep apnea syndrome (SAS) [13–16]. Hypertension is a common condition in the general population and is one of the major risk factors for cardiovascular mortality and morbidity . Studies of the relationship between EDS and hypertension in the general population regardless of association with SAS are scarce. In a prospective cohort study carried out in a relatively healthy adult population, Goldstein et al. found a high risk of developing hypertension in subjects with EDS . Otherwise, in a recent prospective cohort study in Brazil, Drager et al. did not find any association between hypertension and EDS . Moreover, in a group of subjects recruited from a sleep laboratory in China, normotensive subjects had a more severe SDE than hypertensive subjects with OSA . The factors associated with EDS in hypertensive subjects are obesity, type 2 diabetes and uncontrolled hypertension . In this light, we carried out this study having as objective to investigate the association between the EDS and hypertension, and to determine the factors associated with the EDS in the subjects having hypertension in the general adult population of Cameroon.
reporting by our participants of their EDS. Despite most patients in this study sleeping less than 7 to 8 hours per day, there was no significant association between reported sleep time and EDS. A possible explanation for this finding may be habituation to chronic EDS in this patient population. Objec- tive measures of EDS, such as polysomnography with mean sleep latency testing, would be able to further quantify daytimesleepiness in this patient population. The relatively lower prevalence of EDS could also potentially be attributed to posi- tive behavioral changes, and improved sleep hygiene that the participants are exposed to during their stay at the psychiatric unit. Switching or adjusting the patients’ psychotropic medica- tions during hospitalization might also have contributed to the lower prevalence of EDS in this sample. In a previous study, patients with substance abuse were found to be at a very high risk of experiencing sleep disorders. 40 Even though EDS in
Background: Previous studies have shown that migraine and sleep disturbances are closely associated. Excessive daytimesleepiness (EDS) is a common symptom of various types of sleep disturbance. Findings from clinic-based studies suggest that a high percentage of migraineurs experience EDS. However, the prevalence and clinical impact of EDS among migraineurs at the population level have rarely been reported. The objective of this study was to investigate the prevalence and impact of EDS among migraineurs using a population-based sample in Korea. Methods: We selected a stratified random sample of Koreans aged 19 to 69 years and evaluated them using a semi-structured interview designed to identify EDS, headache type, and the clinical characteristics of migraine. If the score on the Epworth Sleepiness Scale (ESS) was more than or equal to 11, the participant was classified as having EDS. Results: Of the 2,695 participants that completed the interview, 143 (5.3 %) and 313 (11.6 %) were classified as having migraine and EDS, respectively. The prevalence of EDS was significantly higher in participants with migraine (19.6 %) and non-migraine headache (13.4 %) compared to non-headache controls (9.4 %). Migraineurs with EDS had higher scores on the Visual Analogue Scale (VAS) for headache intensity (6.9 ± 1.8 vs. 6.0 ± 1.9, p = 0.014) and Headache Impact Test-6 (59.8 ± 10.2 vs. 52.5 ± 8.2, p < 0.001) compared to migraineurs without EDS.
EDS is „sleepiness in a situation when an individual would be expected to be awake and alert‟ . EDS is characterized by persistent daytimesleepiness even after adequate quantity of night sleep, which may be due to disturbances in sleep like snoring, sleep apnea, restless leg movements etc., which compels the individual to nap repeatedly during daytime. This leads to many complications like impaired memory and cognition, decreased work performance, increased chances of vehicular accidents etc., Epidemiological studies have shown prevalence of EDS to be 12% in Americans  and 2.5% in Japanese . Among Koreans EDS was found to be 4.5% in men and 3.2% in females .
Of all subjects who were approached to join the study, only 1 family refused. A total of 203 consecu- tive children were recruited; 23 were excluded. Among the patients with S-SDB, 18 were excluded. Seventeen of these children failed to undergo a sleep study, and 1 had a sleep study done at another institution. Among the control subjects, 5 were ex- cluded because of an OSAS score ⬎⫺ 1. Therefore, 108 patients with S-SDB and 72 control subjects com- posed the study population. The 2 groups were not statistically different on the basis of age, gender, race, and type of insurance (Table 1). The type of insur- ance was used as a surrogate measure of socioeco- nomic status. Snoring was present in all but 1 of the patients with S-SDB. Twenty-two patients had a his- tory of daytimesleepiness by parental report.
This study shows an association between high preva- lence of depressive symptoms in the postpartum period and high ESS score, daytimesleepiness, morning fatigue and restless legs symptoms in last trimester of preg- nancy. There is evidence that disturbed sleep precedes depressive symptoms in the general population  and that poor sleep quality in early pregnancy might contrib- ute to antepartum depressive symptoms during preg- nancy . Therefore it is likely that poor sleep already during pregnancy increases vulnerability for develop- ment of PPD. This is of importance as PPD is a common condition causing severe suffering for the new mother and her family, and all possibilities to prevent this is valuable. Almost all Swedish pregnant women have regu- lar contacts with the ACC which enables regular screening for disturbed sleep, and information and counselling about good sleep as prevention for later depression. There is evi- dence that sleep educational programs might decrease Table 2 Background on studied women including unadjusted and adjusted odds ratio for EPDS ≥ 10
This study was approved by the Ethics Committee of the Niigata University School of Medicine. We per- formed a single-hospital prospective study on patients with probable MSA  who were admitted to our hos- pital between 2005 and 2011. Written informed consent was obtained from all participants. A patient’s degree of daytimesleepiness was assessed using the Japanese version of the ESS . Possible scores ranged from 0 for the lowest degree of sleepiness and 24 for the highest degree of sleepiness. EDS was defined when the ESS score was greater than 10 . Patients who had not experienced the situations included in the questionnaire because of disease progression were asked to estimate their answers. Assessments were also performed with the Unified Multiple System Atrophy Rating Scale (UMSARS)  and cognitive function tests, including the Mini-Mental State Examination (MMSE)  and Frontal Assessment Battery (FAB) . All patients underwent standard PSG.
Excessive DaytimeSleepiness [EDS] is defined in International Classification of Sleep Disorders based on the behaviour of falling asleep, including difficulty maintaining alertness or wakefulness and unintentionally falling asleep. 2 Excessive daytimesleepiness is one of the most common sleep-related patient symptoms affecting about 20 percent of the world population. Persons with excessive daytimesleepiness are at risk of road traffic accidents and have poorer health than comparable adults. The most common causes of excessive daytimesleepiness are sleep deprivation, diabetic mellitus, obesity, obstructive sleep apnea and sedating medications. Other potential causes of excessive daytimesleepiness consist of certain medical and psychiatric conditions and sleep disorders, such as narcolepsy. 3
Numerous studies in the general population have demon- strated that poor or reduced amounts of nocturnal sleep and excessive daytimesleepiness adversely affect a variety of quality of life and functional health status indicators [15,46-50]. Both problems have also recently been associ- ated with cardiovascular disease [46-49], the most com- mon cause of death in the HD population . However, although sleep disorders and excessive daytimesleepiness  are very prevalent in the HD population, limited information is available with regard to the extent to which these problems affect life quality. Previous reports suggest that poor subjective sleep[52,53] and sleep-related breathing disorders  have adverse effects, but the scope of these studies with regard to sleep measures is lim- ited. Thus, we examined how quality of life is related to both subjective and objective measures of nocturnal sleep and daytimesleepiness in a sample of stable HD patients. Perhaps the most important finding of this study is that selected indicators of poor nocturnal sleep and increased daytimesleepiness are associated with reduced quality of life. Sleep complaints that characterize insomnia [52,55], including difficulty initiating sleep, early morning awak- enings, and feeling unrefreshed in the morning, are partic- ularly important. A recent study by Williams et al. , also noted that complaints of insomnia were associated with pain, depression, and decreased physical functioning. These findings suggest that the assessment and treatment of insomnia-related complaints should be included in any overall plan of care designed to optimize quality of life as well as other important clinical out- comes. Numerous pharmacological and/or cognitive behavioral techniques are efficacious for treatment of insomnia but controlled clinical trials designed to evalu- ate their effectiveness in HD patients remain to be con- ducted [56-59].
No matter what the age is, sleeping well is essential for physical health and emotional wellbeing. For the elderly good night sleep is especially important because it helps improve concentration and memory formation, allows the body to repair any cell damage that occurred during the day and refreshes the immune system which in turn helps to prevent disease. So the present study was undertaken to evaluate the effectiveness of sleep intervention statergies on sleep quality and daytimesleepiness of the elderly people residing in oldage homes.Quasi experimental design with non equivalent pretest and posttest control group design was adopted for this study.Samples were the elderly people in the age group of 60 – 80 years who fit the inclusion criteria. Samples size was 60. Tools used were Epworth DaytimeSleepiness scale to assess the daytimesleepiness and Pittsburgh Sleep Quality to assess the sleep quality of the elderly. The sleep intervention strategies which included were structured teaching program on sleep hygiene, aerobic exercises and aromatherapy were administered for 5 weeks to the experimental group. Both descriptive and inferential statistics were used and the study findings were as follows:
Headache and sleep complaints are prevalent in the general population and often coexist in the same subject . Exces- sive daytimesleepiness (EDS) is associated with neuro- logical disorders and pain [2, 3]. Only a few studies have investigated EDS in headache [4–10], and the results are not uniform, possibly due to differences in methods and patient populations [4–10]. We have previously reported on the prevalence of EDS in primary chronic headaches in the general population .
The present study defined EDS as ESS > 10, in line with the recommendation of the developer of the ESS , recent epidemiological studies [33–35] and a recent population-based study of headache and sleep . In contrast, for unknown reasons, most previous studies of the association of migraine or headache frequency with EDS defined EDS as ESS ≥10 [17–21], which would lead to a higher prevalence of EDS. The ESS is widely used in evaluating subjective daytimesleepiness [25, 36]. How- ever, the ESS has been criticized because it shows little association with objective measures, such as the multiple sleep latency test (MSLT) [37–39]. The large number of participants in this study precluded the use of MSLT for more comprehensive assessment of daytimesleepiness.
Methods: Data for this study were from a 2012 – 13 baseline assessment of the First Nations Lung Health Project, in collaboration between two Cree First Nation reserve communities in Saskatchewan and researchers at the University of Saskatchewan. Community research assistants conducted the assessments in two stages. In the first stage, brochures describing the purpose and nature of the project were distributed on a house by house basis. In the second stage, all individuals age 17 years and older not attending school in the participating communities were invited to the local health care center to participate in interviewer-administered questionnaires and clinical assessments. Excessive daytimesleepiness was defined as Epworth Sleepiness Scale score > 10.
We used the Epworth Sleepiness Scale to assess the sever- ity of daytimesleepiness. This is a self-reported eight-item questionnaire using a Likert-type scale in which the respon- dent indicates a number ranging from 0 (would never doze or sleep) to 3 (indicating a high chance of dozing or sleep- ing) based on a given situation including sitting and read- ing, watching television, or sitting and talking to someone. Respondents who scored greater than 10 would be considered sleepy. Validation studies show satisfactory test-retest reli- ability (R = 0.82) and a Cronbach’s alpha of 0.88. 27
Background: Daytimesleepiness impairs academic performance in college students. Napping is a counter to daytimesleepiness, but often causes sleep inertia on waking up. Caffeine absorption from beverages peaks 30 minutes after their ingestion presenting a window of opportunity to have a short nap such that the time of waking up is in synchrony with onset of action of caffeine; thereby abolishing post-nap inertia and achieving synergistic mitigation of fatigue. Objective of this study to assess effect of nap, coffee, ‘coffee and nap’ and ‘wakeful break without coffee’ on daytimesleepiness using Psychomotor Vigilance Tests (PVTs) and Karolinska Sleepiness Scale (KSS) score.
Background: Patients with Parkinson’s disease (PD) or Parkinsonian syndromes often report excessive daytimesleepiness (EDS). The aim of this study was to evaluate the effects of the psy- chostimulant modafinil on elderly, institutionalized, severely impaired PD patients with EDS. Method: A three-week open study on ten institutionalized PD patients scoring 10 points on the Epworth Sleepiness Scale (ESS) with modafinil eventually on 100 mg twice a day. Patients were assessed at the start, week 1, and week 3 with ESS, Clinical Global Impression (CGI) scale severity of PD and appetite.
The most important finding of this study is to show the negative effects of a selective education system with regard to academic stress on senior high school adolescents in Taiwan. We found a relatively high proportion of fatigue, sleep problems, daytimesleepiness, and depression among the senior high school students, and demonstrated the asso- ciation between fatigue and other factors. Senior students under the highest level of academic stress had the worst mental and emotional fatigue scores, which were possibly related to cognitive performance and depression. Dramatic differences of less fatigue and better mental status were found in the students under less academic stress. In spite of the limitations, we still believe that our findings are useful to understand the similarities and differences in fatigue and mental status among adolescents in other Asian countries.
Background: Epworth sleepiness scale (ESS) has been used widely in the assessment of daytimesleepiness for research and clinical purposes. Hence, this study was done to translate the ESS in Tamil and to assess the construct validity and reliability of the Tamil version among adolescents in rural Puducherry, South India. Materials and Methods: Translation of the ESS by native language experts and pilot tested with subsample of adolescents. Final Tamil version was administered among 789 Tamil‑speaking adolescents in the selected villages of rural Puducherry (union territory in South India). Construct validity was assessed by exploratory factor analysis through principal component method. Confirmatory factor analysis was done to obtain the goodness‑of‑fit. Reliability of questionnaire was assessed through Cronbach’s alpha coefficient. Results: Two factor structures were obtained with Eigenvalues of 3.49 and 1.09, respectively. Both factors accounted for about 57.4% of the variance. Two‑factor model assessed by confirmatory factor method found Chi‑square value of 215.57 (P < 0.001). Goodness‑of‑fit revealed acceptable comparative fit indices (0.91). The reliability coefficient (Cronbach’s alpha) for complete ESS was 0.81. Factor‑based analysis showed that the Cronbach’s reliability coefficient was 0.83 and 0.75 for the first and second factor, respectively. Conclusion: Our study concludes that the ESS questionnaire is internally valid and consistent with good reliability coefficient for application in Tamil‑speaking rural adolescents. However, further research can be done to content validate the questionnaire with standard diagnostic tool.
The average daytimesleepiness reported by the study participants was not clinically significant and even in pa- tients with moderate to severe OSA sleepiness was not alarming to make OSA diagnosis available prior to our study. This is in line with a very recent German population-based study that the proportion of sleepy (ESS ≥ 10) patients within the OSA group is relatively low (15%) . In line with this, unlike OSA, sleepiness was determined by environmental factors. We did not intend to evaluate these factors, but they may include poor sleep hygiene, work shifts, diet and medications.
Case presentation: Our patient presented at two years of age with hypersomnia and narcoleptic episodes with cataplectic features. Initial polysomnograph testing revealed adequate sleep efficiency, but increased sleep fragmentation especially during rapid eye movement sleep. The narcoleptic episodes continued and a repeat polysomnograph at age five years confirmed features consistent with narcolepsy. Further sleep studies at six years, including a multiple sleep latency test, demonstrated signs of excessive daytimesleepiness. Treatment with modafinil was initiated at age seven years six months due to persistent hypersomnia and narcoleptic symptoms. Two polysomnograph studies were performed following treatment with modafinil, at age eight years six months and nine years three months. These studies showed excellent sleep efficiency and improvement of rapid eye movement sleep parameters, supporting the beneficial effects of long-term modafinil therapy.