Association of daytime sleepiness with obstructive sleep apnoea and comorbidities varies by sleepiness definition in a population cohort of men

作者：Adams Robert J; Appleton Sarah L^*; Vakulin Andrew; Lang Carol; Martin Sean A; Taylor Anne W; McEvoy R Doug; Antic Nick A; Catcheside Peter G; Wittert Gary A

来源：Respirology, 2016, 21(7): 1314-1321.

DOI：10.1111/resp.12829

• depressive disorder
• diabetes mellitus
• excessive somnolence
• nocturia
• obstructive
• sleep apnoea

Background and objectiveTo determine correlates of excessive daytime sleepiness (EDS) identified with the Epworth Sleepiness Scale (ESS) and a more broad definition, while accounting for obstructive sleep apnoea (OSA) in community dwelling men.
MethodsParticipants of the Men Androgens Inflammation Lifestyle Environment and Stress (MAILES) Study (n=837, 40years) without a prior OSA diagnosis, underwent in-home full unattended polysomnography (PSG, Embletta X100), completed the ESS, STOP questionnaire and Pittsburgh Sleep Quality Index in 2010-2011. In 2007-2010, questionnaires and biomedical assessment (in South Australian public hospital-based clinics) identified medical conditions. An alternate EDS definition (EDSAlt) consisted of2 of 3 problems (feeling sleepy sitting quietly; feeling tired/fatigued/sleepy; trouble staying awake).
ResultsEDS(Alt) (30.4%, n=253), but not ESS11 (EDSESS, 12.6%, n=104), increased significantly across OSA severity and body mass index categories. In adjusted analyses, EDSESS was significantly associated with depression: odds ratio (OR), 95%CI: 2.2 (1.3-3.8) and nocturia: 2.0 (1.3-3.2). EDSAlt was associated with depression, financial stress, relationship, work-life balance problems and associations with nocturia and diabetes were borderline. After excluding men with EDSESS, EDSAlt was associated with oxygen desaturation index (3%)16 and the highest arousal index quartile but not with comorbidities.
ConclusionSleepiness not necessarily leading to dozing, but not ESS11, was related to sleep disordered breathing. Clinicians should be alert to (1) differing perspectives of sleepiness for investigation and treatment of OSA, and (2) the presence of depression and nocturia in men presenting with significant Epworth sleepiness regardless of the presence of OSA.
Correlates of sleepiness defined by the ESS and an alternate broader definition were determined while accounting for OSA. Nocturia and depression were associated with ESS-determined sleepiness. OSA was associated with the alternate definition among men without ESS-determined sleepiness. Differing perspectives of sleepiness for OSA investigation and treatment need consideration.

• 出版日期2016-10
• 单位河北医科大学