The Longitudinal Impact of Excessive Daytime Somnolence on Motor and Nonmotor Symptoms of Parkinson's Disease in a Southeast Asian Cohort.

OBJECTIVE: Sleep-wake disturbances, such as excessive daytime somnolence (EDS), are nonmotor symptoms of Parkinson's disease (PD) and significantly affect the quality of life. This study aimed to examine the relationship between EDS and motor and nonmotor symptoms of PD. METHODS: Eighty-two patients with idiopathic mild PD were followed up twice a year for 2 years and assessed on sleep, mood, anxiety, cognition, function, and disease severity. Data were analyzed retrospectively, comparing motor and nonmotor outcomes between those with EDS and those without. RESULTS: At baseline, 27.9% had EDS and were similar in demographic and clinical characteristics to those without; 10% had persistent EDS during the first year of follow-up. Excessive daytime somnolence had a significant main effect on mood and anxiety as shown by consistently higher scores on the Geriatric Depression Scale (P = .022) and Hospital Anxiety and Depression Scale-Anxiety subscale scores (P = .011) throughout duration of follow-up. The group with persistent EDS showed greater rate of worsening Frontal Assessment Battery scores by the end of first-year follow-up (P = .025) and greater rate of worsening Apathy Scale scores by the end of 2-year follow-up (P = .002). No significant effects of EDS on motor symptoms and disease severity were found. CONCLUSIONS: In a Southeast Asian cohort of patients with PD, EDS had a negative longitudinal impact on mood, anxiety, apathy, and cognitive function but no impact on motor symptoms and disease severity. Excessive daytime somnolence is thus a potential therapeutic target to improve nonmotor outcomes.

Sleep Disorders and Symptoms in Blacks with Metabolic Syndrome: The Metabolic Syndrome Outcome Study (MetSO).

Introduction: Sleep disturbance is a major public health issue and is comorbid with the cluster of conditions associated with metabolic syndrome (MetS). Our study explored the presence of sleep disturbance, including daytime sleepiness, the risk for obstructive sleep apnea (OSA), and insomnia symptoms, in a cohort of adult Black men and women with MetS. Methods: Patients (n=1,013) from the Metabolic Syndrome Outcome Study (MetSO), 2009-2012, met criteria for MetS based on guidelines from the National Cholesterol Education Program's Adult Treatment Panel and provided sociodemographic data and the Apnea Risk Evaluation System (ARES) questionnaire to assess OSA risk, sleep characteristics, and physician-reported diagnosis of a sleep disorder. Results: Prevalence of the components of MetS included: diabetes (60%); obesity (67%); hypertension (94%); and dyslipidemia (74%). Based on the ARES, 49% were at risk for OSA. Of all study patients, slightly more than half (53%) reported feeling sleepy during the day, and 10% reported an insomnia diagnosis. The most common sleep disturbance reported by 46% of the patients was early morning awakenings (EMA). This was closely followed by 42% who reported difficulty staying asleep (DSA) and 38% reporting difficulty falling asleep (DFA). Seventy percent reported short sleep (≤ 6 hours), whereas a minority (19%) reported long sleep (≥ 9 hours). Only 12% used sleep aids. Women, compared with men, reported greater daytime sleepiness, greater DFA, and greater DSA (57% vs 45%; 41% vs 32.4%; 45% vs 37%), respectively. Conclusion: Blacks with MetS reported insomnia symptoms and insomnia disorder, use of sleep aids, feeling sleepy during the day, and inadequate sleep durations. The presence of these sleep characteristics suggests that patients with MetS should be referred for further sleep assessment.

Sleep duration and quality, and risk of gestational diabetes mellitus in pregnant Chinese women.

AIMS: To examine the association between sleep disturbances during pregnancy and risk of gestational diabetes mellitus. METHODS: From 2010 to 2012, 12 506 women in Tianjin, China, were screened using a 50-g 1-h glucose challenge test at 24-28 weeks' gestation. Those with glucose challenge test values of ≥ 7.8 mmol/l were invited to further undergo a 75-g 2-h oral glucose tolerance test. Gestational diabetes was determined according to the International Association of Diabetes and Pregnancy Study Group's definition. Self-reported sleep duration and sleep quality during pregnancy was documented using a modified questionnaire. Logistic regression was used to obtain odds ratios and 95% CIs. RESULTS: A total of 919 women (7.3%) had gestational diabetes. Sleep duration was found to have an approximate J-shaped association with gestational diabetes risk after adjusting for covariates. Compared with a sleep duration of 7-9 h/day (43% of 12 506 women), the adjusted odds ratios for sleep duration of ≥ 9 h/day (55%) and < 7 h/day (2%) for gestational diabetes were 1.21 (95% CI 1.03-1.42) and 1.36 (95% CI 0.87-2.14), respectively. Compared with good sleep quality (37.9% of 12 506 women), the adjusted odds ratios of moderate (59.9%) and poor sleep quality (2.2%) for gestational diabetes were 1.19 (95% CI 1.01-1.41) and 1.61 (95% CI 1.04-2.50), respectively. CONCLUSION: In pregnant Chinese women, poor sleep quality, and shorter and longer duration of sleep during pregnancy were independently associated with an increased risk of gestational diabetes.

Perceived racial discrimination as an independent predictor of sleep disturbance and daytime fatigue.

Perceived discrimination is a potential cause of racial and ethnic disparities in health. Disturbed sleep may serve as a mechanism linking perceived racism with health consequences. This study investigates data from 7,148 adults from Michigan and Wisconsin who participated in the 2006 Behavioral Risk Factor Surveillance System. Hierarchical logistic regression analyses explored associations between perceived racial discrimination and self-reported sleep disturbance and daytime fatigue. Sleep disturbance and daytime fatigue were reported in 19% and 21% of the sample, respectively. Black/African American respondents (21%) report perceiving worse experiences, compared to people of other races, when seeking health care at higher rates than non-Hispanic White respondents (3%). Results from logistic regression models show that perceived racial discrimination is associated with increased risks of sleep disturbance (odds ratio [OR] = 2.62, p < .0001) and daytime fatigue (OR = 2.07, p < .0001). After adjustment for all covariates, perceived discrimination remains a significant predictor of sleep disturbance (OR = 1.60, p = .04). The interaction between perceived racism and race (Black/African American vs. non-Hispanic White) was nonsignificant. This population-based research adds to the growing body of data, suggesting that perceived racism may impact health via its influence on sleep-wake behaviors.

Associations Between Trauma, Sleep, and Cognitive Impairment Among Latino and Asian Older Adults.

BACKGROUND/OBJECTIVES: Trauma survivors with chronic post-traumatic stress disorder (PTSD) have been found to have cognitive impairment. But little is known about these outcomes among Latino and Asians who comprise more than 80% of the U.S. immigrant population. They also experience disparities in PTSD and dementia care albeit increased exposure to trauma. This study aimed to (1) examine the association between trauma exposures and PTSD with cognitive impairment in a sample of Latino and Asian older adults; and (2) assess whether sleep quality attenuated the PTSD-cognitive impairment association. DESIGN: Cross-sectional secondary analysis of baseline data from the Positive Minds-Strong Bodies randomized controlled trial on disability prevention. SETTING: Community-based organizations serving minority or immigrant older adults in Massachusetts, New York, Florida, or Puerto Rico. PARTICIPANTS: Hispanic/Latino and Asian/Pacific Islander adults aged 60 or older eligible per randomized controlled trial screening for elevated mood symptoms and minor-to-moderate physical dysfunction (n = 134 and n = 86, respectively). MEASUREMENTS: Neuropsychiatric measures were cognitive impairment (Mini Montreal Cognitive Assessment (MoCA)), PTSD (Posttraumatic Stress Disorder Checklist for Diagnostic and Statistical Manual-5), trauma exposure (Brief Trauma Questionnaire), depression (Patient Health Questionnaire-9), generalized anxiety (Generalized Anxiety Disorder Scale-7), and daytime sleepiness (Epworth Sleepiness Scale). RESULTS: Mean age was 72.8 years and 77.5 years for the Latino and Asian groups, respectively. The Asian group was 100% immigrant, whereas 70.2% (n = 92) of the Latino group was foreign-born. In unadjusted models, higher Posttraumatic Stress Disorder Checklist for Diagnostic and Statistical Manual-5 scores were associated with decreased odds of normal cognitive functioning (MoCA ≥25) in the Asian group (odds ratio (95% confidence interval) = .93 (.87, .99)), but not the Latino group (odds ratio (95% confidence interval) = .99 (.95, 1.05)). This association remained significant after adjusting for covariates. Daytime sleepiness did not moderate the association between PTSD and cognitive functioning in the Asian group. CONCLUSION: Higher PTSD symptoms were associated with cognitive impairment in Asian, but not Latino, older adults. Clinicians serving older Asians should integrate trauma and cognitive screening to ensure this growing, underserved population receives appropriate evidence-based treatments.

Association of self-reported nasal blockage with sleep-disordered breathing and excessive daytime sleepiness in Pakistani employed adults.

PURPOSE: To assess prevalence of self-reported nasal congestion and its association with sleep-disordered breathing (SDB) and excessive daytime sleepiness (EDS) in Pakistani adults employed at a medical university. METHODS: All full-time employees of a medical university (n=3,470) were delivered a questionnaire that elicited demographic data, symptoms of nasal blockage and SDB and Epworth Sleepiness Scale score. Overnight pulse oximetry was performed on self-reported snorers and a random sample of non-snorers. Supervised polysomnography was performed on subjects with oxygen desaturation index >5/h. Logistic regression analysis was used to assess the association of nasal blockage with SDB and EDS. RESULTS: Of 2,497 (72%) responders, 45.2% reported nasal congestion. Self-reported nasal blockage was significantly associated with an increased risk of SDB symptoms: snoring (odds ratio [OR] 1.9), witnessed apnoea (OR, 2.2) and unrefreshing sleep (OR, 1.7). Those with nasal blockage had higher Epworth Sleepiness Scale score (5.5 ± 3.6 vs. 3.9 ± 3.3, p<0.001) compared with those without nasal blockage. Nasal blockage was associated with increased risk of doziness in seven out of eight items of Epworth Sleepiness Scale score. Oxygen desaturation index and apnoea-hypopnoea index were similar between subjects with and without self-reported nasal blockage. CONCLUSION: Self-reported nasal blockage is a common symptom in employed Pakistani adults. Self-reported nasal blockage is significantly associated with symptoms of SDB and EDS but not with respiratory variables on overnight sleep monitoring.

Prevalence and associated risk factors of sleep-disordered breathing symptoms in young and middle-aged Pakistani employed adults.

PURPOSE: The objective of this study was to evaluate the prevalence of self-reported sleep-disordered breathing (SDB symptoms and its associated risk factors in Pakistani employed adults. METHODS: Full-time employees (n = 3470) of a medical university were evaluated. Self-administered questionnaire elicited information about demographic data, symptoms of SDB, smoking and alcohol use, presence of nasal congestion, family history of snoring, and included the Epworth Sleepiness Scale. Prevalence of self-reported snoring and of combined SDB symptoms (snoring plus at least one other SDB symptom) was evaluated. Regression analyses were used to assess risk factors associated with self-reported snoring and combined SDB symptoms. RESULTS: Among the 2,497 (72%) responders, prevalence of self-reported snoring was 32%, and combined SDB symptoms 25%. A higher prevalence of snoring and combined SDB symptoms in male gender diminished with age. In univariate analysis, the odds of snoring was higher with age >or=35 yrs (odds ratio (OR) 2.6, confidence interval (CI) 2.2-3.2), body mass index >or=23 (OR 2.6, CI 2.2-3.1), and collar size above 40 cm (OR 2.7, CI 2.3-3.3). Self-reported nasal blockage (OR 1.9, CI 1.6-2.2) and family history of snoring (OR 2.9, 2.5-3.5) were other risk factors. In logistic regression analysis, significant risk factors for SDB symptoms were age, body mass index, collar size, nasal blockage, and family history of snoring. Male gender, smoking and alcohol were not significant risk factors for SDB symptoms. CONCLUSION: The prevalence of SDB symptoms in Pakistani employed adults was comparable to Western populations. However, male gender and smoking were not significant risk factors for SDB symptoms.

Race and ethnic variation in excessive daytime sleepiness: the multi-ethnic study of atherosclerosis.

This cross-sectional study utilized data from the Multi-Ethnic Study of Atherosclerosis (MESA). The sample included 5,173 older adults (mean age = 66.4 years) recruited from 6 field centers in the United States. Excessive daytime sleepiness (EDS) was evaluated using two measures: self-report of feeling excessively sleepy ≤ 5 days per month and the Epworth Sleepiness Scale (ESS) > 12. White participants were more likely than other groups to report EDS ≤ 5 days per month. After controlling for covariates, African American and Hispanic participants remained less likely to report EDS ≤ 5 days per month. African Americans were more likely to score > 12 on the ESS than White participants. Odds ESS > 12 in African American participants were attenuated but remained significant after controlling for covariates. Results indicate measurement of race/ethnic differences in EDS may result in conflicting estimates of race/ethnic variation. Furthermore, attenuation of differences in ESS < 12 suggests this measure has a stronger association with current health.

Prevalence of excessive daytime sleepiness and associated factors in the adult population of Korea.

OBJECTIVE: Information on the prevalence and correlates of excessive daytime sleepiness (EDS) is limited for Asians. We determined the prevalence of EDS and its associated factors in the adult population of Korea. SUBJECTS AND METHODS: The subjects consisted of 4405 Koreans aged 40-69 years from the Korean Genome Epidemiology Study, which is an ongoing prospective population-based study. Data were collected from a comprehensive health examination and a questionnaire at baseline. RESULTS: The prevalence of EDS was 12.2% (10.7% for men and 13.7% for women). In multivariate models including sociodemographic, biochemical, clinical and sleep-related factors, age, physical activity, education, habitual snoring, waking up feeling unrefreshed, perceived insufficient sleep, and crawly feelings in the legs were significantly associated with EDS. Subjects aged 50-59 years had an excess risk of EDS by 1.42-fold (95% confidence interval [CI]=1.13-1.77) compared to those aged 40-49 years. In addition, the subjects with top quartile group of physical activity had a 1.80-fold (95% CI=1.18-2.73) higher risk of EDS than those with the lowest quartile group. A higher level of education was inversely associated with the risk of EDS. Furthermore, the subjects with habitual snoring had a 1.92-fold (95% CI=1.47-2.50) greater risk of EDS than non-snorers. Perceived insufficient sleep also increased the risk of EDS by 1.58-fold (95% CI=1.29-1.93) compared to perceived sufficient sleep. Subjects with crawly feelings in the legs had a 1.51-fold (95% CI=1.13-2.00) higher risk of EDS than those without crawly feelings in the legs. In addition, waking up feeling unrefreshed elevated a 1.24-fold (95% CI=1.01-1.53) risk of EDS compared to waking up feeling refreshed. CONCLUSIONS: Our findings show that EDS is associated with a variety of factors in Korean adults, and habitual snoring or sleep-related problems increase the risk of EDS. Whether interventions to modify associated correlates can alter EDS warrants further study.

Sleep quality and daytime sleepiness among Polish anaesthesiologists and intensivists.

PURPOSE: We aimed to investigate sleep quality (SQ), daytime sleepiness (DS), and their relation with subject- and work-related factors among Polish anaesthesiologists. METHODS: The study group comprised 786 anaesthesiologists. The Sleep Quality Scale (SQS) was applied in order to assess SQ, while excessive DS was evaluated using the Epworth Sleepiness Scale (ESS). RESULTS: The median score on the SQS was 31 (IQR 27-35) points. The median score on the ESS was 17 (IQR 13-20) points, with mild-to-moderate excessive DS found in 260 (33.1%) and severe excessive DS among 478 (60.8%) of those surveyed. Worse SQ was found in females; smokers; those who suffered from any chronic diseases; those who were receiving medication interfering with sleeping habits; those who were unsatisfied with their sleep; those who had a greater number of night shifts; and those who had a lower number of non-working days. A detrimental sleepiness pattern was determined by one's advanced age, the presence of any chronic diseases and lower satisfaction with one's sleep quantity. CONCLUSION: Poor SQ and excessive DS are frequently occurring phenomena. Since sleep disturbances are also related to the nature of their profession, the problem could be reduced by introducing organisational changes at work.

Periodic limb movements during sleep: population prevalence, clinical correlates, and racial differences.

STUDY OBJECTIVE: There is growing interest in the study of periodic limb movements during sleep and their potential clinical correlates. The aim of the present analysis is to address the lack of population-based studies using polysomnographic (PSG) measures to determine the prevalence of period limb movements during sleep in specific racial groups as well as the general population. SETTINGS AND PARTICIPANTS: A community-based sample of 592 participants drawn from the general population of tricounty Detroit (mean age = 41.9 +/- 12.6 years; 52.9% F; 31.5% African American). All individuals were assessed using objective and subjective measures in the sleep laboratory. MEASUREMENTS: Participants were evaluated during a 24-h laboratory assessment, including a polysomnogram and multiple sleep latency test. Periodic leg movements were scored using standard criteria. Reports of sleep disturbance and daytime sleepiness were also assessed using standardized measures including the Global Sleep Assessment Questionnaire (GSAQ) and the Epworth Sleepiness Scale (ESS). RESULTS: The overall prevalence of periodic limb movements during sleep (PLMSI >15) was 7.6%. African Americans had a lower prevalence of PLMSI >15 than Caucasians (4.3% vs. 9.3%; chi2= 4.5, P < 0.05). Regardless of race, symptoms of insomnia were significantly higher in individuals with PLMSI >15 than in those with PLMSI < or =15 (45% vs. 25%; chi2= 6.84, P < 0.01). CONCLUSION: This is the first study to determine the prevalence of PLMS in a population-based sample using standardized objective criteria. A key finding of the present study is that racial differences in this PSG parameter do exist, with African Americans being less likely to have elevated PLMS.

Sleep-wake patterns and sleep disturbance among Hong Kong Chinese adolescents.

STUDY OBJECTIVES: To determine sleep-wake patterns and evaluate sleep disturbance in Hong Kong adolescents; to identify factors that are associated with sleep disturbance; and to examine the relationship of sleep-wake variables and academic performance. DESIGN AND SETTING: A school-based cross-sectional survey. PARTICIPANTS: Sample included 1629 adolescents aged 12 to 19 years. MEASUREMENTS AND RESULTS: Self-report questionnaires, including sleep-wake habit questionnaire, Sleep Quality Index, Morningness/ Eveningness scale, Epworth Sleepiness Scale, Perceived Stress Scale, academic performance, and personal data were administered. The average school-night bedtime was 23:24, and total sleep time was 7.3 hr. During weekends, the average bedtime and rise time was delayed by 64 min and 195 min, respectively. The prevalence of sleep disturbances occurring > or = 3 days per week in the preceding 3 months were: difficulty falling asleep (5.6%), waking up during the night (7.2%), and waking up too early in the morning (10.4%). The prevalence of > or = 1 of these three symptoms was 19.1%. Stepwise regression analyses revealed that circadian phase preference was the most significant predictor for school night bedtime, weekend oversleep, and daytime sleepiness. Perceived stress was the most significant risk factor for sleep disturbance. Students with marginal academic performance reported later bedtimes and shorter sleep during school nights, greater weekend delays in bedtime, and more daytime sleepiness than those with better grades. CONCLUSION: The prevalence of sleep deprivation and sleep disturbance among Hong Kong adolescents is comparable to those found in other countries. An intervention program for sleep problems in adolescents should be considered.

Influence of race and socioeconomic status on sleep: Pittsburgh SleepSCORE project.

OBJECTIVE: To examine the independent and interactive effects of race and socioeconomic status (SES) on objective indices and self-reports of sleep. METHODS: The sleep of 187 adults (41% black; mean age = 59.5 +/- 7.2 years) was examined. Nine nights of actigraphy and two nights of inhome polysomnography (PSG) were used to assess average sleep duration, continuity, and architecture; self-report was used to assess sleep quality. Psychosocial factors, health behaviors, and environmental factors were also measured. RESULTS: Blacks had shorter sleep duration and lower sleep efficiency, as measured by actigraphy and PSG, and they spent less time proportionately in Stage 3-4 sleep, compared with others (p < .01). Lower SES was associated with longer actigraphy-measured latency, more wake after sleep onset as measured by PSG, and poorer sleep quality on the Pittsburgh Sleep Quality Index (p < .05). CONCLUSIONS: Blacks and perhaps individuals in lower SES groups may be at risk for sleep disturbances and associated health consequences.

Associations of sleep-disordered breathing with excessive daytime sleepiness and blood pressure in Japanese women.

Sleep-disordered breathing (SDB) is a recognized risk factor for excessive daytime sleepiness (EDS) and hypertension, but evidence of this association in Asian women is limited. We conducted a cross-sectional study of 3,568 women aged 30-69 years living in three Japanese communities. The 3% oxygen desaturation index (ODI) was selected as the indicator of SDB, and blood oxygen fall was estimated by overnight pulse oximetry. The prevalence of SDB was 20.2% for 3% ODI>or=5, 6.4% for 3% ODI>or=10, and 2.8% for 3% ODI>or=15 among Japanese women aged 30-69 years. The 3% ODI was positively associated with the prevalence of self-reported EDS and mean values of systolic and diastolic blood pressure levels. The multivariate odds ratios for 3% ODI of 5-9, 10-14, and >or=15 in reference to 3% ODI<5 were 1.9 (1.2-3.0), 2.2 (1.0-4.6), and 1.8 (0.7-4.4) (p for trend=0.01), respectively, for EDS and 1.1 (0.9-1.4), 1.2 (0.8-1.8), and 2.2 (1.4-3.4) (p for trend<0.001), respectively, for hypertension. The severity of SDB was significantly associated with EDS and hypertension among Japanese women.

Depression symptomatology and diagnosis: discordance between patients and physicians in primary care settings.

BACKGROUND: To examine the agreement between depression symptoms using an assessment tool (PHQ-9), and physician documentation of the same symptoms during a clinic visit, and then to examine how the presence of these symptoms affects depression diagnosis in primary care settings. METHODS: Interviewer administered surveys and medical record reviews. A total of 304 participants were recruited from 2321 participants screened for depression at two large urban primary care community settings. RESULTS: Of the 2321 participants screened for depression 304 were positive for depression and of these 75.3% (n = 229) were significantly depressed (PHQ-9 score > or = 10). Of these, 31.0% were diagnosed by a physician with a depressive disorder. A total of 57.6% (n = 175) of study participants had both significant depression symptoms and functional impairment. Of these 37.7% were diagnosed by physicians as depressed. Cohen's Kappa analysis, used to determine the agreement between depression symptoms elicited using the PHQ-9 and physician documentation of these symptoms showed only slight agreement (0.001-0.101) for all depression symptoms using standard agreement rating scales. Further analysis showed that only suicidal ideation and hypersomnia or insomnia were associated with an increased likelihood of physician depression diagnosis (OR 5.41 P sig < .01 and (OR 2.02 P sig < .05 respectively). Other depression symptoms and chronic medical conditions had no affect on physician depression diagnosis. CONCLUSION: Two-thirds of individuals with depression are undiagnosed in primary care settings. While functional impairment increases the rate of physician diagnosis of depression, the agreement between a structured assessment and physician elicited and or documented symptoms during a clinical encounter is very low. Suicidality, hypersomnia and insomnia are associated with an increase in the rate of depression diagnosis even when physician and self report of the symptom differ. Interventions that emphasize the use of routine structured screening of primary care patients might also improve the rate of diagnosis of depression in these settings. Further studies are needed to explore depression symptom assessment during physician patient encounter in primary care settings.

Stability of the Pittsburgh Sleep Quality Index and the Epworth Sleepiness Questionnaires over 1 year in early middle-aged adults: the CARDIA study.

STUDY OBJECTIVES: To describe the stability of the Pittsburgh Sleep Quality Index (PSQI) and the Epworth Sleepiness Scale (ESS) scores over 1 year among a population-based sample of black and white early middle-aged adults. PARTICIPANTS: More than 600 participants, aged 38 to 50 years, from the Chicago site of the Coronary Artery Risk Development in Young Adults (CARDIA) Study. METHODS: The PSQI and ESS were completed twice, approximately 1 year apart, between 2003 and 2005. Seven PSQI 4-level component scores, a global PSQI score, and the ESS scores were calculated. A PSQI global score greater than 5 was classified as poor quality sleep, and an ESS score greater than 10 was classified as high daytime sleepiness. RESULTS: The mean+/-SD PSQI score was 5.7+/-3.1 in Year 1 and 5.9+/-3.1 in Year 2. The mean ESS score was 7.4+/-4.3 in Year 1 and 7.2+/-4.2 in Year 2. The Pearson correlation coefficient for the PSQI score in both years in the full sample was .68 and ranged from .54 among black men to .72 among black women. The Pearson correlation coefficient for the ESS score in both years in the full sample was .76 and ranged from .70 among black men to .80 among white men. In the full sample, 76% had the same PSQI dichotomous classification, and 85% had the same ESS dichotomous classification in both years. CONCLUSIONS: These results suggest that the PSQI and ESS are stable measures of sleep quality and sleepiness over the past year in early middle-aged adults.

The Epworth Sleepiness Scale: influence of age, ethnicity, and socioeconomic deprivation. Epworth Sleepiness scores of adults in New Zealand.

STUDY OBJECTIVES: To examine possible relationships between excessive sleepiness (Epworth Sleepiness Scale score >10), and age, sex, ethnicity, socioeconomic deprivation, usual sleep, and self-reported symptoms of obstructive sleep apnea. DESIGN: Mail-out survey to a stratified random sample of 10,000 people aged 30 to 60 years, selected from the electoral roll. SETTING: Nationwide survey of adults in New Zealand (71% response rate). PARTICIPANTS: The sample design aimed for equal numbers of Maori and non-Maori participants, men and women, and participants in each age decade. INTERVENTIONS: N/A. MEASUREMENTS AND RESULTS: Two-page questionnaire. Maori participants had higher mean Epworth Sleepiness Scale scores than non-Maori (7.5 versus 6.0) and were more likely to have an Epworth Sleepiness Scale score of more than 10. Logistic multiple regression modeling identified the following significant independent risk factors for having an Epworth Sleepiness Scale score >10: being Maori, male, older, reporting more or less than 7.5 to 8.0 hours usual sleep, never or rarely getting enough sleep, never or rarely waking refreshed, larger neck circumference, observed apneas, and not drinking alcohol (compared with moderate alcohol consumption). CONCLUSIONS: The relationships between an Epworth Sleepiness Scale score >10 and sleep habits and risk factors for obstructive sleep apnea are as expected. The relationships between an ESS score > 10 and being Maori, a man, older, or more socioeconomically deprived could be related to a higher prevalence of sleep disorders in these groups. However, more research is needed to understand possible differences not only in pathophysiologic processes, but also in the wider societal trends and pressures that may impact differentially on sleep and sleepiness.

Prevalence and determinants of excessive daytime sleepiness in an Asian multi-ethnic population.

BACKGROUND AND PURPOSE: To investigate the prevalence and determinants of daytime sleepiness in an Asian multi-ethnic population. Cross-sectional survey based on a questionnaire in multi-ethnic Asian adult population of Singapore (2.4 million). PATIENTS AND METHODS: Measured frequency of excessive daytime sleepiness (EDS), socio-demographic status, sleep duration, perceived sleep insufficiency, frequent awakenings, difficulty falling asleep, snoring, breathing pauses, GHQ-12, shift work, solvent exposure at work, substance use, medications, and chronic diseases in random sample of 2,298 adults, aged 20-74 years, representing Chinese, Malays and Indians. RESULTS: Among the respondents, 10.8% reported usually feeling sleepy in the daytime, and 9.0% were classified as having EDS. Marked ethnic difference was observed, with higher rates of EDS in Malays and Chinese, compared to Indians. Increased risk of EDS was associated with perceived sleep insufficiency; snoring and breathing pauses; shift work and solvent exposure at work; psychiatric morbidity and chronic diseases, particularly chronic rhinitis; and medications with sedating effects. CONCLUSIONS: Daytime sleepiness is associated with a multiplicity of highly prevalent risk factors in the community, including sleep behavior, breathing-, work- and medically related factors. Significant ethnic differences, which were not explained by these factors, were observed between Chinese, Malays and Indians.

Ethnic-specific associations of sleep duration and daytime napping with prevalent type 2 diabetes in postmenopausal women.

OBJECTIVE: The objective of this study was to evaluate ethnic differences in the associations of nighttime sleep and daytime napping durations with prevalent type 2 diabetes. METHODS: Samples of White (n = 908), Filipina (n = 330), and Black (n = 371) community-dwelling, postmenopausal women aged 50-86 years were evaluated with cross-sectional data obtained during 1992-1999 including self-reported duration of nighttime sleep and daytime napping, behaviors, medical history, and medication use. The prevalence of type 2 diabetes was evaluated with a 2-h 75-g oral glucose tolerance test. RESULTS: Overall, 10.9% of White, 37.8% of Filipina, and 17.8% of Black women had type 2 diabetes. Average sleep durations were 7.3, 6.3, and 6.6 h and napping durations were 16.8, 31.7, and 25.9 min for White, Filipina, and Black women, respectively. Sleep duration showed a significant (p < 0.01) nonlinear association with type 2 diabetes in Filipina women, with increased odds of diabetes at both low and high sleep durations independent of age, body mass index (BMI), triglyceride to high-density lipoprotein (HDL) ratio, hypertension, and daytime napping duration. Daytime napping duration was associated with type 2 diabetes only among White women; those napping ≥ 30 min/day had 74% (95% confidence interval (CI) = 10%, 175%) higher odds of diabetes compared to non-nappers independent of covariates including nighttime sleep duration. CONCLUSIONS: Results suggest ethnic-specific associations of nighttime sleep and daytime napping durations with type 2 diabetes.

The Prevalence and Characteristics of Primary Headache and Dream-Enacting Behaviour in Japanese Patients with Narcolepsy or Idiopathic Hypersomnia: A Multi-Centre Cross-Sectional Study.

BACKGROUND: Because the prevalence and characteristics of primary headache have yet to be thoroughly studied in patients with hypersomnia disorders, including narcolepsy and idiopathic hypersomnia, we examined these parameters in the Japanese population. METHODS: In a multicentre cross-sectional survey, among 576 consecutive outpatients with sleep disorders, 68 narcolepsy patients and 35 idiopathic hypersomnia patients were included. Additionally, 61 healthy control subjects participated. Semi-structured headache questionnaires were administered to all participants. RESULTS: The patients with narcolepsy (52.9%) and idiopathic hypersomnia (77.1%) more frequently experienced headache than the healthy controls (24.6%; p<0.0001). The prevalence rates were 23.5%, 41.2% and 4.9% for migraine (p<0.0001) and 16.2%, 23.5% and 14.8% (p = 0.58) for tension-type headache among the narcolepsy patients, the idiopathic hypersomnia patients and the control subjects, respectively. Those who experienced migraine more frequently experienced excessive daytime sleepiness, defined as an Epworth Sleepiness Scale score of ≥10, than those who did not experience headache among the patients with narcolepsy (93.8% vs. 65.6%, p = 0.040) and idiopathic hypersomnia (86.7% vs. 37.5%, p = 0.026). Dream-enacting behaviour (DEB), as evaluated by the rapid eye movement sleep disorders questionnaire, was more frequently observed in the narcolepsy patients than in the idiopathic hypersomnia patients and the control subjects. An increased DEB frequency was observed in the narcolepsy patients with migraines compared to those without headache. CONCLUSIONS: Migraines were frequently observed in patients with narcolepsy and idiopathic hypersomnia. DEB is a characteristic of narcolepsy patients. Further studies are required to assess the factors that contribute to migraines in narcolepsy and idiopathic hypersomnia patients.