title: Excessive daytime sleepiness among rural residents in Saskatchewan.
abstract: BACKGROUND
  Obstructive sleep apnea (OSA) is a common diagnosis in clinical practice. Excessive daytime sleepiness may be a warning for possible OSA.
  
  
  OBJECTIVE
  To assess the prevalence of excessive daytime sleepiness as measured by the Epworth Sleepiness Scale (ESS) in a rural community population; potential risk factors for OSA were also assessed.
  
  
  METHODS
  In 2010, a baseline respiratory health questionnaire within the Saskatchewan Rural Health Study was mailed to 11,982 households in Saskatchewan. A total of 7597 adults within the 4624 (42%) respondent households completed the ESS questionnaire. Participants were categorized according to normal or high (>10) ESS scores. Data obtained included respiratory symptoms, doctor-diagnosed sleep apnea, snoring, hypertension, smoking and demographics. Body mass index was calculated. Multivariable logistic regression analysis examined associations between high ESS scores and possible risk factors. Generalized estimating equations accounted for the two-tiered sampling procedure of the study design.
  
  
  RESULTS
  The mean age of respondents was 55.0 years and 49.2% were male. The prevalence of ESS>10 and 'doctor diagnosed' OSA were 15.9% and 6.0%, respectively. Approximately 23% of respondents reported loud snoring and 30% had a body mass index >30 kg⁄m2. Of those with 'doctor-diagnosed' OSA, 37.7% reported ESS>10 (P<0.0001) and 47.7% reported loud snoring (P<0.0001). Risk of having an ESS>10 score increased with age, male sex, obesity, lower socioeconomic status, marriage, loud snoring and doctor-diagnosed sinus trouble.
  
  
  CONCLUSIONS
  High levels of excessive daytime sleepiness in this particular rural population are common and men >55 years of age are at highest risk. Examination of reasons for residual sleepiness and snoring in persons with and without sleep apnea is warranted.
authors.forename: John A
authors.initials: JA
authors.lastname: Gjevre
authors.forename: Punam
authors.initials: P
authors.lastname: Pahwa
authors.forename: Chandima
authors.initials: C
authors.lastname: Karunanayake
authors.forename: Louise
authors.initials: L
authors.lastname: Hagel
authors.forename: Donna
authors.initials: D
authors.lastname: Rennie
authors.forename: Joshua
authors.initials: J
authors.lastname: Lawson
authors.forename: Roland
authors.initials: R
authors.lastname: Dyck
authors.forename: James
authors.initials: J
authors.lastname: Dosman
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012424:Rural Population; D012525:Saskatchewan / Q000453:epidemiology; D012890:Sleep; D012893:Sleep Wake Disorders / Q000453:epidemiology*; D055815:Young Adult