Original articleExcessive daytime sleepiness in obstructive sleep apnea: prevalence, severity, and predictors☆
Introduction
Excessive daytime sleepiness (EDS) is a well recognized consequence of obstructive sleep apnea (OSA), increasingly considered an important health problem leading to accidents, psychosocial morbidity and poor quality of life [1], [2], [3], [4]. However, the subjective evaluation of EDS is complicated by the fact that patients may complain of fatigue, tiredness, and lack of energy rather than sleepiness itself [5]. Therefore, objective assessment of prevalence, severity, and predictors of EDS in OSA would be useful in understanding the magnitude of the problem and identifying high risk groups.
Several studies have looked into the predictive factors of EDS in OSA patients from predominantly Caucasian populations [6], [7], [8], [9], [10]. A study from Singapore has indicated prevalence of snoring and OSA syndrome to be around 77 and 15%, respectively, in that country [11]. In this context, we were interested in determining prevalence, severity, and predictors of EDS in the local OSA population of Singapore.
Section snippets
Sample and acquisition of data
A total of 195 consecutive patients diagnosed with OSA at the Sleep Disorders Unit of Singapore General Hospital between January 2000 and December 2002, having gone through both overnight polysomnography (PSG) and multiple sleep latency test (MSLT) were included in the study. All patients were seen by a single clinician (KP), who routinely performed MSLT and PSG in every case. The vast majority of cases were referred because of snoring, and a few for the complaint of daytime sleepiness.
Demographic characteristics
The study population consisted of 89.4% males and 10.6% females, with a mean age distribution of 45.5±11.1 years, median of 45 years and range of 20–74 years.
Polysomnographic characteristics
Mild OSA was determined in 35.9% of cases, with 27.2 and 36.9% falling into the moderate and severe OSA groups, respectively. Descriptive statistics for both the EDS and no-EDS groups are presented in Table 1. The majority of snorers (86.8%) belonged to the EDS groups (Table 2).
MSLT characteristics
EDS proved to be highly prevalent (87.2%) among OSA patients,
Discussion
The number of studies published on possible predictors of EDS in OSA underscores the clinical importance of this subject [6], [7], [8], [9], [10]. However, the studies are not absolutely homogeneous. There are some differences evident in the study design, statistical methodology, and tools used to evaluate EDS among different studies. Yet they provide a useful insight into this phenomenon.
Various tools such as Epworth Sleepiness Scale (ESS) and MSLT have been used to evaluate and quantify
References (22)
- et al.
Etiologies and sequelae of excessive daytime sleepiness
Clin Ther
(1996) Sleepiness, fatigue, tiredness, and lack of energy in obstructive sleep apnea
Chest
(2000)- et al.
Determinants of daytime sleepiness in obstructive sleep apnea
Chest
(1988) - et al.
Slow-wave activity in sleep apnea patients before and after continuous positive airway pressure treatment. Contribution to daytime sleepiness
Chest
(2001) - et al.
Catastrophes, sleep, and public policy: consensus report
Sleep
(1998) The cost of sleep-related accidents: a report for the National Commission on Sleep Disorders Research
Sleep
(1994)- et al.
Relationship between sleepiness and general health status
Sleep
(1996) - et al.
The association between daytime sleepiness and sleep-disordered breathing in NREM and REM sleep
Sleep
(2002) - et al.
Modeling hypersomnolence in sleep-disordered breathing. A novel approach using survival analysis
Am J Respir Crit Care Med
(1999) - et al.
Sleep fragmentation indices as predictors of daytime sleepiness and nCPAP response in obstructive sleep apnea
Am J Respir Crit Care Med
(1998)
From snoring to sleep apnea in a Singapore population
Sleep Res Online
Cited by (136)
Causal relationship between Gut Microbiota and Obstructive sleep apnea
2023, Archives of Gerontology and GeriatricsDual ultra-wideband (UWB) radar-based sleep posture recognition system: Towards ubiquitous sleep monitoring
2023, Engineered RegenerationElevated body mass index increases the risk of cardiovascular events in hypertensive patients accompanied with obstructive sleep apnea: A cohort study
2022, Obesity Research and Clinical PracticeCitation Excerpt :Fourth, it is reported that excessive daytime sleepiness (EDS) is the predictor of cardiovascular events [56], whereas we failed to assess EDS in the present study, possibly bringing unknown bias to the current observation. However, EDS, as a major symptom, is reported to be 15–87% in OSA and increases with OSA severity [57–59]. We have adjusted for OSA severity, which may have, in part, attenuated the potential bias from unmeasured EDS to the results.
- ☆
This data was presented and published in abstract form at the 7th World Congress on Sleep Apnea, Helsinki, Finland in July 2003.