title: The impact of ageing and sex on the association between sleepiness and sleep disordered breathing.
abstract: The aim of our study was to investigate age-related changes in sleepiness symptoms associated with sleep disordered breathing (SDB). Wisconsin Sleep Cohort participants were assessed using polysomnography, the Epworth Sleepiness Scale (ESS) and the multiple sleep latency test (MSLT). SDB was defined as an apnoea/hypopnoea index ≥15 events·h(-1), and sleepiness as ESS ≥10 and MSLT ≤5 min. Odds ratios were calculated using generalised estimating equations associating sleepiness with SDB, and conditional logistic regression examining changes in longitudinal sleepiness status (ESS only). Models were a priori stratified by sex. ESS was measured in 1,281 participants and MSLT in 998 at multiple time-points (ESS n=3,695; MSLT n=1,846). Significant interactions were found between SDB and age in males, but not females. The odds ratios modelled for sleepiness in a 40-yr-old male with SDB were significant compared to a male without SDB (ESS 2.1 and MSLT 2.9); however, these associations were not significant at 60 yrs of age. The within-subject odds ratio for sleepiness was also significant at 40 yrs of age (OR 3.4), but not at 60 yrs of age. The age-related reductions in the association between sleepiness and SDB may have clinical implications for the diagnosis and treatment of SDB in older people as sleepiness is often used as a therapeutic target.
authors.affiliation: Academic Unit of Sleep and Ventilation, Royal Brompton Hospital, Sydney Street, London, SW3 6NP, UK. m.morrell@imperial.ac.uk
authors.forename: Mary J
authors.initials: MJ
authors.lastname: Morrell
authors.forename: Laurel
authors.initials: L
authors.lastname: Finn
authors.forename: Alison
authors.initials: A
authors.lastname: McMillan
authors.forename: Paul E
authors.initials: PE
authors.lastname: Peppard
mesh_terms: D000328:Adult; D000367:Age Factors; D000375:Aging; D015331:Cohort Studies; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D017286:Polysomnography / Q000379:methods; D012044:Regression Analysis; D012737:Sex Factors; D012890:Sleep; D012891:Sleep Apnea Syndromes / Q000150:complications*; D012894:Sleep Stages; D011795:Surveys and Questionnaires