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Submitted on January 6, 2005
Accepted on May 16, 2005
Sleep Research & Treatment Center, Departments of Psychiatry and Health Evaluation Sciences, Penn State University College of Medicine and Department of Psychiatry, Autonomous University, Madrid, Spain
* To whom correspondence should be addressed. E-mail: eob1{at}psu.edu.
Context: Excessive daytime sleepiness (EDS) is commonly considered a cardinal sign of sleep apnea, however, the mechanism underlying the association is unclear.
Objective: The purpose of this study was to assess the association between the complaint of EDS and sleep apnea considering a wide range of possible risk factors in a population sample.
Design & Setting: We examined this question in the Penn State Cohort (a random sample of 16,583 men and women from Central Pennsylvania, ranging in age from 20 to 100 yr). A random subset of this cohort (n = 1,741) was further evaluated for one night in the sleep laboratory.
Main outcome measure: Complaint of EDS.
Results: The final Logistic Regression model indicated depression was the most significant risk factor for EDS followed by BMI, age, typical sleep duration, diabetes, smoking and finally sleep apnea. The strength of the association with EDS decreased with increasing age, whereas the association of depression with EDS was stronger in the young. EDS is more prevalent in the young (<30 yr), suggesting the presence of unmet sleep needs and depression, and in the very old (>75 yr) suggesting increasing medical illness and health problems. EDS was associated with a reduced report of typical sleep duration without any association with objective polysomnographic measures.
Conclusions: It appears that the presence of EDS is more strongly associated with depression and metabolic factors than with SDB or sleep disruption per se. Our findings suggest that patients with a complaint of EDS should be thoroughly assessed for depression and obesity/diabetes independent of whether SDB is present.
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