Methods: The study was a postal survey of a random age and gender-stratified sample of 40,000 persons aged 20 to 80 years old drawn by the National Population Register in Norway. The questionnaire included questions about migraine, headache, the Epworth sleepiness scale (ESS) and various comorbidities. EDS was defined as ESS > 10. The association of EDS and migraine/headache were analysed by bivariate and multivariable logistic regression analyses. Results: A total of 21,177 persons responded to the ESS and were included in the analyses. The odds ratio (OR) for EDS was increased for migraineurs (1.42 (95% CI 1.31 ─ 1.54), p < 0.001) compared to non-migraineurs; however, this finding was not significant after adjustment for a number of possible confounders. EDS increased with increasing headachefrequency, with an OR of 2.74 (95% CI 2.05 ─ 3.65), p < 0.001) for those with headache on >179 days per year compared to those without headache in multivariable analysis.
The association between EDS and several common neurological diseases such as Parkinson’ s disease, epi- lepsy, and migraine has been previously reported. A case-controlled study from Italy noted that subjects with episodic migraine (EM) showed an increased odds ratio [14 % vs. 5 %; odds ratio (OR) = 3.1; 95 % confidence interval (CI) 1.1–8.9] for EDS compared to age- and sex- matched healthy controls . Another case-controlled study showed a positive association between EDS and chronic migraine (CM) . A case-series study in the United States showed that a significant proportion of participants with migraine also had EDS . A community-based study in Norway showed increased ORs (OR = 3.3, 95 % CI 1.0–10.2) for EDS among migraineurs compared to headache-free individuals . However, previous reports regarding the association between EDS and migraine were predominantly clinic- based studies and the association between them has seldom been examined in the generalpopulation. In addition, the clinical characteristics of migraine associ- ated with EDS have not yet been reported.
with AD . The main sleep disorders observed during AD are insomnia, difficulty falling asleep, night awakenings and early awakenings and non-restorative sleep . Excessivedaytimesleepiness (EDS) is a major consequence of sleep disturbances that may be responsible for a decrease in quality of life and in driving or workplace accidents [5, 6]. In studies of sleep disorders and atopic dermatitis, very few studies have examined EDS in adults. In the recent systematic review done by Jeon et al. the specific evaluation of EDS was not found in most of the 39 included studies . Moreover, we did not find any study done in Africa on the association of AD and EDS. Thus, the objective of this study was to compare the prevalence of EDS in subjects with AD and those without AD, and to investigate for factors associated to EDS in AD subjects in the general adult population in Cameroon.
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 generalpopulation [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 generalpopulation and is one of the major risk factors for cardiovascular mortality and morbidity . Studies of the relationship between EDS and hypertension in the generalpopulation 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.
independent variables in multivariable analysis to three. All logistic regression models were estimated using pe- nalized likelihood to reduce small-sample bias in max- imum likelihood estimation [20, 21]. We conducted (1) bivariate analysis with type of chronic headache, i.e. CPTH/CER or HACRS, medication overuse (yes or no), and a propensity score (the propensity for having HACRS compared to CPTH/CER in a multivariable logistic regression model with age, sex, headache fre- quency, and concomitant migraine as independent variables), and (2) multivariable analysis forcing all three independent variables into the model. The results are presented with odds ratios (ORs) with 95% CIs.
population used CPAP for less than 4 hours, partly due to the short-term design of the study. This suggested that their adherence to CPAP was poor, and the full effect of CPAP on judo performance could not be described, although ESS and performance were still improved. Similar results have been reported in a previous study which showed that even patients with poorer CPAP adherence experienced improvements in ESS scores. 27
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.
Pregnant women who took part in a study on sleeping disorders and restless legs during pregnancy  were recruited at a Swedish antenatal care clinic (ACC) in the year 2007. The Swedish antenatal care program reaches almost 100 % of all pregnant women and is free of charge . Women with diabetes mellitus, neurological disease, drug abuse, hypertension or poor knowledge of the Swedish language were excluded. After receiving written and oral information 351 women participated in this study. Written informed consent was obtained from each participant. In the 3rd trimester of pregnancy the contributing women were given the Epworth Sleepiness Scale (ESS) and an additional questionnaire about their sleep. At the routine postpartum check-up visit around ten weeks after delivery, the women were also screened for PPD as part of the normal routine.
All questionnaires were scanned using TeleForm v9. The statistical analyses were performed using SPSS Base Sys- tem for Windows 15.0. The 95% CI were calculated with the Vassar Collage statistics web-page . v 2 test with 5% level of significance was used. Non-linear regression analysis was applied to explore the trends in the prevalence of different headachefrequency, age and gender groups. Headachefrequency can be considered as a count or ordinal variable. Firstly, the Poisson regression model was explored, when modeling the differences in headache fre- quency. Although the assumptions for the Poisson regression model were reasonable, the fit was rather poor in this model. Secondly, the ordinal logistic regression model was considered. However, the assumption of parallel lines was not met, and this model was rejected. Thus, the multinomial logistic regression model was estimated to
either case, this must be done in a culturally and linguistically appropriate manner when targeting minority communities. Second, overall management of hypertension should include newly identified comorbid conditions including sleep-related problems and not solely the traditional conditions like diabe- tes and chronic kidney disease. Third, behavioral interven- tions that seek to address adherence status should include adherence to both prescribed sleep and hypertension regi- mens. Finally, studies may also wish to look at mechanistic factors that may be common to both daytimesleepiness and adherence, such as stress, especially in low-income com- munities such as the ones sampled in this study. 37
Clomipramine is a serotonergic reuptake inhibitor often results in substantial REM suppression. Declining severity and frequency of cataplexy at doses of 25-75mg and at low dose of 10-20mg daily are more effective. Adverse effects exist of anticholinergic effects including dry mouth, sweating, constipation, tachycardia, weight increase, hypotension, difficulty in urinating, and impotence. Rebound cataplexy may occur on withdrawal of TCAs causes increased in number and severity of cataleptic attacks. 
Excessivedaytimesleepiness could lead to fatigue and substantially impair attention and hence academic achievement; The Kingdom of Saudi Arabia is a vast country with ethnic, culture and environmental diversity, furthermore different medical school use different curricula and timetables, so the studies conducted in the Western World and other region of Saudi Arabia may not apply to Tabuk. No researchers have studied the excessivedaytimesleepiness among medical students in Tabuk, Saudi Arabia, thus we conducted this research to assess the daytimesleepiness and related factors among medical students, Medical College, University of Tabuk.
A total of 200 pre-final and final year students were invited to participate in the study and 157 students reverted, out of which there were 76(48.4%) male students and 81 (51.6%) female students. In the present study 61 (38.8%) of them had PSQI score of >6, which implies that they had sleep disorder, out of which 20 were males and 41 were females. By applying EPSS, 27 students had excessive day time sleepiness with scores ranging from 11-24, out of which 7 were males and 20 were females, suggesting females students had more preponderance for sleep disorders. It was also noticed that 96 students out of which 57 students with normal BMI and 39 overweight students (obese included) were not having any sleep disorders(PSQI score equal to less than 5). 61(38.8%) students out of which 26 had normal BMI had sleep disorders and 35 overweight students (obese included) had some sort of sleep disorder. (Table 1). This shows a association between increased BMI and an increased propensity to sleep disorders (p=0.04).
Our initial hypothesis was that the sociodemographic and clinical variables impact sleep quality. The impact of sociodemographic (age, gender, and employment status) and clinical variables (duration of epilepsy, seizure type and frequency, and type and kind of treatment) on sleep disorders was analyzed. This study did not demonstrate any correlation between sleep quality and demographic or clinical factors, or selected factors affecting sleep and conditions conducive to sleeping (in all cases, P.0.005). Hypothesis is rejected.
AHI: Apnea hypopnea index; BMI: Body mass index; CPAP: Continuous positive airway pressure; EDS: Excessivedaytimesleepiness; ES: Effect size; ESS: Epworth sleepiness scale; HRQoL: Health related quality of life; MCS: SF-12 Mental Component Summary; OSA: Obstructive Sleep Apnea; PCS: SF- 12 Physical Component Summary; PGWBI: Psychological General Well- Being Index; SF-12: 12-Item Short-Form Health Survey; T0: Before first visit and nocturnal diagnostic examination; T1: The morning after CPAP titration; TSat90: Percent study-time at less than 90% oxygen saturation
Results: The study population consisted of 299 boys (51.6%) and 280 (48.3%) girls with a mean age of 4.1 years (SD 0.8). The mean body mass index (BMI) of the children was 15 (SD 2.1). The average sleep duration among the children was 10:54 h/day (SD 00:48). They went to bed late (23:18 h SD 00:48) and woke early (09:26 h; SD 01:00). Daytimesleepiness was reported by 6.9% of the participants. The incidence of awakening during the night, sleep-disordered breathing and snoring was 13.9%, 1.2% and 2.7%, respectively. Most of the children shared a room with their parents (87%) (P > 0.05).
Based on her sleep habits, and the sleep study findings, she also has DSPS, the most common type of circadian rhythm sleep disorder seen in adoles- cents. This is characterized by sleep and wake times that are later than desired, often resulting in daytimesleepiness when conventional waking times are enforced. 4
Inclusion criteria for the study were: 1) Egyptian ethnicity; 2) patients who had been referred for snoring, fatigue, and/or daytimesleepiness and diagnosed as OSA with AHI > 5 and admitted to intensive care units. 3) Ability to give written consent or the availability of patients' guardians to give consent to participate in this study; and 4) ability to have informed knowledge of the patients’ earlier and current cognitive functioning. Exclusion criteria included: 1) Previous treatment for sleep apnea with CPAP, corrective airway surgery or a mandibular advancement device; 2) refusal to perform maintenance wakefulness test; 3) the presence of cardiovascular risk factors (hypertension, diabetes, dyslipidaemia ---etc ,and 4) presence of a mental, neurological or physical impairment severe enough to participate and complete the questionnaires.
Therefore, impairment of appetite regulation might be a consequence of short sleep duration or due to leptin and insulin resistance (the hallmarks of obesity and T2DM) and be exacerbated by OSA. To explore the association between the sleep–wake cycle, appetite and metabolism, it is necessary to consider the role of the neuropeptides called orexins, orhypocretins. Orexin A and orexin B are excitatory neuropeptides found in the lateral hypothalamus and perifornical area. They are both stimulated by ghrelin, promote wakefulness, and increase appetite and SNS activity. Moreover, besides the down regulation of satiety, the promotion of short sleep time, and the stimulation of the HPA axis by increased SNS activation, ghrelin promotes adipogenesis and decreases energy expenditure, fat catabolism and lipolysis. Therefore, this might be one of the main reasons why individuals with short sleep duration are prone to gain weight and increase the risk of developing OSA and T2DM. 63,64
onstrated increased Epworth Sleepiness Scale scores, and tiredness and falling asleep in school, during car travel, or while watching television were noted fre- quently (D.G., unpublished observations, 2007). There- fore, we hypothesized that habitually snoring, obese children would be more likely to display increased sleep propensity (as measured with the multiple sleep latency test), compared with nonobese children with similar degrees of respiratory disturbance during sleep.