Excessivedaytimesleepiness (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.
Excessivedaytimesleepiness (EDS) is a common symptom shared by recent lifestyle modification-induced sleep disorders. Literature shows increase in EDS among medical students worldwide. This study aims at estimating the prevalence of EDS among medical students in southern part of south India. Participants were healthy volunteers of male (65) and female (56) students between the age group 18-25yrs (n=121). EDS was diagnosed using Epworth Sleepiness Scale. Results showed that overall prevalence of EDS was to be 30.57%. Among this males were 52.06% and females were 47.10% showing that females had better sleep quality than males. The study concludes that
Abstract: Sleep disorders in patients with atopic dermatitis (AD) are common and can have a negative impact on the quality of life of the affected subjects. Very little data are available on the association between AD and excessivedaytimesleepiness (EDS) in adults. The objective of this study was to compare the prevalence of EDS in subjects with AD and those without AD, and to investigate the determinants of EDS in adults with AD. In this cross-sectional population-based study conducted from 2015 to 2018 in Cameroon, adult subjects aged at least 19 years were included by multi-level stratified random sampling. AD was defined as the presence of a chronic itchy dermatitis evolving intermittently over a period of at least 6 months and electively affecting certain areas (fronts of the elbows, back of the knees, front of the ankles, under the buttocks, around the neck, around the eyes or ears) during the last 12 months preceding the survey. EDS was defined by an Epworth score≥10. Logistic regression was used to investigate the independent association between EDS and AD. A difference was considered significant if p<0.05. A total of 8362 subjects (55.2% women) with median age (25 th -75 th percentiles) of 39 (27-54) years were included. There were 217 subjects (2.6%) with AD and 1022 subjects (12.2%) with EDS. The prevalence of EDS was higher in subjects with AD than in those without AD (22.1% vs. 12%, p<0.001). In multivariate analysis integrating potential confounders (area of recruitment, age, education level, body mass index, association with other allergic diseases), AD remained independently associated with EDS with an adjusted odds ratio (95% CI) of 2.18 (1.54-3.08). No independent associated factors to EDS were found in subjects with AD. There is an independent association between EDS and AD, and nearly one quarter of patients with AD has EDS in this setting. It is necessary to consider the systematic evaluation of EDS in subjects with AD to optimize their management.
Excessivedaytimesleepiness has been reported to be associated with poor sleep quality and psychiatric condi- tions [38, 39]. Poor sleep quality is reported to be associ- ated psychiatric conditions [40–42]. Furthermore, migraineurs were reported to have poor sleep quality and higher psychiatric comorbid conditions compared to non-headache controls [43–45]. In the present study, participants with migraine had an increased OR for EDS compared to non-headache controls in the univariable regression analysis. After adjusting for anxiety, depres- sion, short sleep duration, and poor sleep quality, mi- graine was no longer a significant predictor of EDS while poor sleep quality and depression maintained sig- nificant associations with EDS (Table 3). Previous case- controlled studies have demonstrated similar findings. EM and CM had increased ORs for EDS in a univariate analysis [15, 20]. However, after adjusting for poor sleep quality, drugs, and gender, EM and CM were no longer statistically significant. These findings suggest that a sig- nificant association between migraine and EDS in a uni- variable analysis may be attributable to poor sleep quality and/or depression among migraineurs rather than the migraine itself.
The purpose of this study was to assess factors associated with subjective sleep evaluation, chiefly excessivedaytimesleepiness (EDS) in obstructive sleep apnea syndrome (OSAS) adult outpatients under continuous positive airway pres- sure (CPAP) treatment. One thousand and forty-eight OSAS outpatients (mean age: 51.4% male: 90.5%) who were treated by CPAP were consecutively collected. Age, sex, CPAP compliance (CPAP usage as their device of nights with application-time of at least 4 hours per night objectively; %usage ≥ 4 h/d), and Japanese version of the Pittsburgh Sleep Quality Index (PSQI-J) of the patients showing EDS (Japanese version of the Epworth Sleepiness Scale; JESS ≥ 11) were compared cross-sectionally with those of the patients who did not show EDS (JESS < 11). Nineteen point two % of all patients showed EDS subjectively. Two hundred one patients were classified to an EDS(+) group and an 847 pa- tients were classified to EDS(–) group. Age and global PSQI-J scores were significantly different between the two groups. Logistic regression showed that EDS was significantly associated with global PSQI-J scores, but not with age. Among PSQI-J components, overall sleep quality, duration of sleep, sleep disturbance, and day dysfunction due to sleepiness were significantly higher in the EDS(+) group. Especially, 19.4% of patient in the EDS(+) group reported actual sleep time during the past month to be less than 5 hours/day. Although functional relationship should be further evaluated, insufficient sleep is the main factor associated with EDS in the OSAS patients under CPAP treatment.
Little is known about the precise relationship between headache and sleep problems, when these occur concur- rently. An association between EDS and different pain conditions has been reported [2, 3]. Pain may disturb sleep and give rise to EDS, but sleep loss and EDS may also contribute to pain. Some of these secondary Table 4 Prevalence (%) of excessivedaytimesleepiness (ESS >10) in people with secondary chronic headache
kidney disease, COPD and asthma) and by controlling for parameters known to reflect conditions in which excessivedaytimesleepiness may be present (e.g. BMI, neck circum- ference, Beck depression inventory score, included in the initial model). In OSAHS, excessivedaytimesleepiness is generally considered to be the consequence of intermittent nocturnal hypoxemia that leads to sleep fragmentation, hence poorer sleep quality. To attest for the possible influ- ence of reversible upper airway obstruction on daytime hy- persomnolence, significant polysomnography derived indices (AHI, oxygen desaturation index and obstructive apnea index) were also included in the model as well as (log) PSQI gauging perceived nocturnal sleep quality. Previ- ous studies have shown a poor association between ESS and PSQI as well as between PSQI, ESS and polysomnogra- phy measures  to the extent that it was suggested that these measures reflect distinct aspects of sleep. After con- trolling for causes other than altered circadian rhythm, we feel that ESS may be considered as an indicative parameter reflective of altered circadian rhythm in our explorative study. Nevertheless, characterization of the circadian rhythm by obtaining serial measurements of either salivary or serum melatonin or core body temperature could have added value at the cost of extra inconvenience for the patients and possibly have interfered with other measures e.g. polysomnography. However, alteration of the circadian rhythm in OSAHS has been established previously , allowing the speculative notion that altered irisin/BDNF axis may be causative for circadian misalignment in OSAHS, and thus, it may be suggested that excessive day- time sleepiness is a result of the deterioration of circadian pacemaker process. This alternative mechanism could account for the phenomenon of residual EDS as well as the excess risk of cardiovascular and all-cause morbidity and mortality in CPAP treated OSAHS patients. Measure- ments from a single timepoint may be considered as further limitation of the study, as serum BDNF levels are themselves circadian . Nevertheless, the current find- ings suggest a putative relationship between the subjective measure of excessivedaytimesleepiness and the alteration of the irisin/BDNF axis as reflected by the single measure- ment. Furthermore, this finding may contribute to teasing apart two parallel mechanisms underlying excessive day- time sleepiness e.g. one stemming from the mechanical obstruction of the airways and the other from the alter- ation of the circadian regulation.
Prevalence and Assessment of ExcessiveDaytimeSleepiness in Diabetic and Obese Patients 46 29.9), 62.3% of the patients were with EDS and 37.7% of the patients were without EDS. In the group of BMI ≥ 30 84.2% of the patients were with EDS and 15.8% of the patients were without EDS. Abdulbari Bener et al in their study found that obesity was significantly higher in diabetic females with higher chances of falling asleep during day time (51.7%)than in males(39.3%). 36 In the present study, among the subjects with EDS 40% of males and 56.4% of females were having BMI in the range of 25-29.9 (overweight) and 22.5% of males and 17.9% of females were having a BMI ≥30 (obese).Physical activity was significantly less in diabetic females(38.6%) compared to men (50.2%). 36 This result is also in accordance with the present study. In the group leading a sedentary lifestyle 59.5% were with EDS and 40.5% were without EDS. It clearly indicates a strong association of EDS with physical activity. Among the subjects with EDS, 77.5% of males and 89% of females were leading a sedentary life style.
2) Evaluation of excessivedaytimesleepiness using the Epworth Sleepiness Scale (ESS), a self-administered questionnaire with eight-item scale to assess the chance of falling asleep or dozing off during different daily life situations in an ordinary day. The method of scoring is identical in all questions. The patient gives the score of 0–3 for each situation where there is no chance, slight chance, moderate chance and high chance of dozing or falling asleep, respectively. The score obtained from the scale ranges from 0 to 24. A score ranging from 0 to 10 is defined as normal, while a score of 11–24 is consid- ered to be abnormal and indicative of excessivedaytime somnolence. 2,28–30
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. Excessivedaytimesleepiness was defined as Epworth Sleepiness Scale score > 10.
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 excessivedaytimesleepiness. 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.
DISCUSSION Our patient presented with excessivedaytimesleepiness, cataplexy (REM intrusion in wakefulness), and sleep paralysis. These symptoms, along with hypnagogic/hypnopompic hallucinations, characterize narcolepsy. Fragmented sleep at night is a newly recognized feature of narcolepsy. However, narcolepsy was unlikely given her normal sleep la- tency and HLA testing. Nocturnal sleep distur- bances, such as vivid nightmares, may be part of RBD, which may be the initial manifestation of nar- colepsy. 1 RBD, a parasomnia characterized by lack of
Methods: The Berlin questionnaire and the Epworth sleepiness scale; which respectively evaluate OSA and EDS symptoms, were administered to individuals hospitalized at an acute psychiatric treatment unit at the AUB-MC between the dates of January 2014 and October 2016. Additional data collected included general demographics, psychiatric diagnoses, and question- naires evaluating depression and anxiety symptoms. Statistical analyses utilizing SPSS were performed to determine the prevalence of OSA and EDS, as well as their respective associations with patient profiles.
ported cataplexy (the EDS group) might well have in- cluded some who had not yet developed cataplexy (which would have confirmed the diagnosis of narco- lepsy) or exhibited it in such a subtle form that it was not reported on enquiry. In clinical practice it is important to repeat assessments in such children to see whether more definitive diagnostic features emerge with time. At the time of the study, there was no convincing evidence that the children in the EDS group had another sleep disorder to account for their abnormal sleepiness. Their psycho- social problem profile was found to be closely similar to that of the narcolepsy group. This might suggest that the main disadvantage for children with narcolepsy is the excessivesleepiness that they share with the EDS group rather than something more specific to narcolepsy, such as exposure to the distressing experiences described ear- lier as part of the narcolepsy syndrome. In view of the low rate of comorbid conditions and current medication use in the clinical groups (and that both groups showed similar patterns), it seems unlikely that these biased the comparisons regarding the children’s psychosocial disad- vantages.
The results of our study have a number of clinical implications that must be addressed. First, they suggest that health care providers should screen hypertensive patients for sleep-related disorders, particularly EDS. One such screening tool is the Epworth Sleepiness Scale, which is a relatively easy survey that can be self-administered. Other validated self-administered tools are available as well. If necessary, health care providers should organize referral for a sleep study to ascertain the presence of obstructive sleep apnea, a well known independent risk factor for hypertension. 17–19 In
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.
able, as evidenced by the wide range of frequencies for reported sleepiness-related complaints among different studies. Therefore, efforts have been made to evaluate sleepiness more objectively, particularly for snoring chil- dren at risk for OSA. The results of such studies sug- gested that objective EDS, assessed with the multiple sleep latency test, was relatively infrequent (ie, 13%) in a cohort of children being evaluated for snoring, in which only a minority of children were obese. 21 Even
EDS was the outcome variable. It was de ﬁ ned as an Epworth Sleepiness Scale (ESS) score ≥ 10. The ESS is a scale used to measure sleep propensities in eight different situations of real-life: (1) sitting and reading, (2) watching television, (3) sitting, inactive in a public place, (4) as a passenger in a car for an hour without a break, (5) lying down to rest in the afternoon when circumstances permit, (6) sitting and talking to someone, (7) sitting quietly after a lunch without alcohol and (8) in a car while stopped for a few minutes in traf ﬁ c. The range of an item-score was 0 – 3 on the Likert scale: never doze (score=0), slight chance of dozing (score=1), moderate chance of dozing (score=2) and high chance of dozing (score=3). The ESS score is the sum of the eight item scores (range, 0 – 24); the higher scores indicate being more sleepy. 3
The study included 11 male volunteers (control group) and 26 male patients with moderate to severe OSA se- lected from the Cardiovascular Metabolism Center and the Sleep Clinic at the Universidade Federal de Sao Paulo (UNIFESP). Moderate to severe OSA was defined as an apnea-hypopnea index (AHI) > 15/h. The control group was composed of subjects with AHI < 5/h. We distributed the OSA subjects into 2 groups according to excessivedaytimesleepiness (non-EDS OSA and EDS OSA). All participants were asked to arrive at the labora- tory in the early morning after 12 h of fasting to provide a blood a sample.
divided into disturbances of sleep and wakefulness. Disturbances of sleep include insomnia, restless legs syndrome, rapid eye movement (REM) sleep behavior disorder, sleep apnea, and parasomnias. Disturbances of wakefulness include excessivedaytimesleepiness (EDS) and sleep attacks. Sleep disorders are a major cause of disability in PD patients, and may have a substantial impact on quality of life. This review will focus on the etiology and treatment of sleep disorders in PD.