title: Comparative levels of excessive daytime sleepiness in common medical disorders.
abstract: BACKGROUND
  Sleep restriction and sleep disorders are common causes of excessive daytime sleepiness (EDS). Medical disorders (MD) can also cause EDS, but previous studies have used non-standardized measures, selected samples, or have examined EDS in singular disorders. This study describes the relative degree of EDS associated with medical disorders to provide comparative data across a range of common medical conditions in a large unselected community-based sample.
  
  
  METHODS
  Responses of 2612 individuals (aged 18-65) were assessed after excluding those with suspected sleep disordered breathing, narcolepsy, and shift workers. Participants across a range of medical disorders were evaluated using the Epworth Sleepiness Scale (ESS) and patient reports of nocturnal sleep.
  
  
  RESULTS
  Sixty-seven percent of the sample reported a MD. The prevalence of EDS (ESS>or=10) was 31.4% in individuals with MD and increased as a function of a number of MD (0 MD=29.4%, 1 MD=28.4%, 2 MD=31.0%, 3 MD=35.3%, 4 MD=38.4%). Disorders which were independent predictors of EDS were ulcers OR=2.21 (95% CI=1.35-3.61), migraines OR=1.36 (95% CI=1.08-1.72), and depression OR=1.46 (95% CI=1.16-1.83) after controlling for other conditions, age, gender, time in bed, caffeine, smoking and alcohol use. Participants with ulcers had the highest prevalence of sleepiness, 50.0%, as well as the highest level of problems falling asleep (40.8%) and awakenings during the night (62.5%).
  
  
  CONCLUSIONS
  Individuals with ulcers, migraines, and depression have independent and clinically significant levels of EDS relative to other common MD.
authors.affiliation: Sleep Disorders and Research Center, Henry Ford Hospital, Detroit, MI, USA.
authors.forename: Alice F
authors.initials: AF
authors.lastname: Stroe
authors.forename: Thomas
authors.initials: T
authors.lastname: Roth
authors.forename: Catherine
authors.initials: C
authors.lastname: Jefferson
authors.forename: David W
authors.initials: DW
authors.lastname: Hudgel
authors.forename: Timothy
authors.initials: T
authors.lastname: Roehrs
authors.forename: Kenneth
authors.initials: K
authors.lastname: Moss
authors.forename: Christopher L
authors.initials: CL
authors.lastname: Drake
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D003866:Depressive Disorder / Q000150:complications; D006970:Disorders of Excessive Somnolence / Q000453:epidemiology / Q000209:etiology*; D006306:Health Surveys; D006801:Humans; D008875:Middle Aged; D008881:Migraine Disorders / Q000150:complications; D010437:Peptic Ulcer / Q000150:complications; D015995:Prevalence; D012737:Sex Factors; D012890:Sleep; D055815:Young Adult
references.citation: Vital Health Stat 10. 2006 Dec;(232):1-153
references.pmid: 17252928
references.citation: Am J Med Sci. 2005 Apr;329(4):163-72
references.pmid: 15832098
references.citation: Int J Equity Health. 2004 May 6;3(1):3
references.pmid: 15128460
references.citation: J Psychosom Res. 1997 Feb;42(2):145-55
references.pmid: 9076642
references.citation: Sleep Med. 2003 Jul;4(4):339-42
references.pmid: 14592307
references.citation: J Neurol. 2000 Sep;247(9):716-7
references.pmid: 11081816
references.citation: J Psychosom Res. 1994;38 Suppl 1:41-7
references.pmid: 7799250
references.citation: Respir Care Clin N Am. 2006 Mar;12(1):55-69, viii
references.pmid: 16530647
references.citation: Drugs. 2003;63(24):2725-37
references.pmid: 14664652
references.citation: J Neurol Neurosurg Psychiatry. 2005 Oct;76(10):1467-8
references.pmid: 16170102
references.citation: Am J Psychiatry. 2003 Jun;160(6):1147-56
references.pmid: 12777274
references.citation: Neurol Clin. 1996 Nov;14(4):791-805
references.pmid: 8923495
references.citation: Int J Geriatr Psychiatry. 2005 Oct;20(10):956-66
references.pmid: 16163747
references.citation: Braz J Psychiatry. 2006 Jun;28(2):126-9
references.pmid: 16810396
references.citation: J Neurol. 2005 Feb;252(2):139-45
references.pmid: 15729517
references.citation: Curr Opin Pulm Med. 2006 Nov;12(6):402-8
references.pmid: 17053488
references.citation: Am J Psychiatry. 1991 Sep;148(9):1177-81
references.pmid: 1882995
references.citation: Arch Gen Psychiatry. 1985 Jul;42(7):657-66
references.pmid: 4015307
references.citation: Sleep. 1988 Feb;11(1):100-9
references.pmid: 3283909
references.citation: Gastroenterology. 1981 Feb;80(2):285-91
references.pmid: 7450419
references.citation: Mov Disord. 2003 Mar;18(3):319-23
references.pmid: 12621636
references.citation: J Psychosom Res. 2004 May;56(5):497-502
references.pmid: 15172205
references.citation: Arch Intern Med. 1997 Dec 8-22;157(22):2645-52
references.pmid: 9531234
references.citation: BMC Psychiatry. 2004 May 26;4:14
references.pmid: 15163350
references.citation: Sleep. 2002 May 1;25(3):315-22
references.pmid: 12003162
references.citation: Psychophysiology. 2001 Nov;38(6):979-87
references.pmid: 12240674
references.citation: Sleep. 2004 Mar 15;27(2):293-8
references.pmid: 15124725
references.citation: Sleep. 1996 Sep;19(7):583-8
references.pmid: 8899938
references.citation: BMC Public Health. 2004 Aug 07;4:35
references.pmid: 15298712
references.citation: Neurophysiol Clin. 1993 Jan;23(1):71-6
references.pmid: 8446074
references.citation: J Intern Med. 1996 May;239(5):417-23
references.pmid: 8642234
references.citation: Sleep. 2004 Dec 15;27(8):1453-62
references.pmid: 15683134
references.citation: J Sleep Res. 2007 Dec;16(4):364-71
references.pmid: 18036081
references.citation: Headache. 2005 Jul-Aug;45(7):904-10
references.pmid: 15985108
references.citation: Semin Neurol. 2005 Mar;25(1):39-51
references.pmid: 15798936
references.citation: Sleep. 2002 May 1;25(3):289-96
references.pmid: 12003159
references.citation: Sleep. 2003 Sep;26(6):678-83
references.pmid: 14572120
references.citation: Dig Dis Sci. 1987 May;32(5):449-53
references.pmid: 3568932
references.citation: Sleep Med. 2006 Jun;7(4):327-32
references.pmid: 16564218
references.citation: Accid Anal Prev. 2001 Jan;33(1):31-41
references.pmid: 11189120
references.citation: Epilepsia. 2006;47 Suppl 5:73-7
references.pmid: 17239111
references.citation: Sleep. 1991 Dec;14(6):540-5
references.pmid: 1798888
references.citation: J Neuropsychiatry Clin Neurosci. 2000 Winter;12(1):86-90
references.pmid: 10678518
references.citation: Am J Public Health. 1997 Oct;87(10):1649-53
references.pmid: 9357347