title: Excessive daytime sleepiness and metabolic syndrome: a cross-sectional study.
abstract: OBJECTIVE
  Excessive daytime sleepiness (EDS) has been associated with singular independent symptoms of metabolic syndrome, such as insulin resistance and diabetes. The aim of this study was to assess whether this relationship is sustained among individuals who meet criteria for the whole syndrome.
  
  
  METHODS
  994 Women aged 21-94 years (median 50.2 years, IQR 34-65) and 840 men aged 24-92 years (median 60.4 years, IQR 47-73) who resided in the Barwon Statistical Division, South-Eastern Australia, and participated in the Geelong Osteoporosis Study (GOS) between the years of 2001 and 2008. Anthropometric measurements, lifestyle, mood, demographic and health-related factors were obtained. Sleep duration was categorized as short (<6 h), average (6-9 h) and long (>9 h). Sleepiness was assessed using the Epworth Sleepiness Scale (ESS), and scores of ≥ 10 indicated EDS. The presence of metabolic syndrome was assessed using a modified version of criteria as outlined by the International Diabetics Federations recommendations (2005).
  
  
  RESULTS
  Women: 138 (14.0%) of the women reported EDS; those with EDS were heavier, had a greater body mass index (BMI) and were more likely to have metabolic syndrome. The association between EDS and metabolic syndrome was sustained following adjustment for age and hours sleep (adjusted OR=1.90, 95% CI 1.16-3.09), however BMI attenuated the relationship (adjusted OR=1.64, 95% CI =1.05-2.57). These findings were independent of smoking status, alcohol intake, medication use, socioeconomic status, physical activity and current diagnosis of a depressive illness. Men: 111 (13.2%) of the men reported EDS; those with EDS had a greater waist circumference and were more likely to have metabolic syndrome. Analysis of age-stratified data (<60 years vs. ≥60 years) revealed that the older men with EDS were more likely to have metabolic syndrome (OR=1.71, 95% CI 1.01-2.92), however, age explained this association (age adjusted OR=1.51, 95% CI 0.88-2.60). In the younger age group, no association was detected between EDS and metabolic syndrome. For both men and women, the prevalence of combined EDS and metabolic syndrome increased progressively with age.
  
  
  CONCLUSIONS
  For women, the association between EDS and metabolic syndrome appears to be driven by adiposity measures; while for men, the association is somewhat attributed to older age. Additional research is required to assess temporal associations with underlying sleep pathology.
authors.affiliation: IMPACT SRC, School of Medicine, Deakin University, Geelong, Australia; Institute for Breathing and Sleep, Austin Health, Melbourne, Australia. Electronic address: achayley@deakin.edu.au.
authors.forename: Amie C
authors.initials: AC
authors.lastname: Hayley
authors.affiliation: IMPACT SRC, School of Medicine, Deakin University, Geelong, Australia.
authors.forename: Lana J
authors.initials: LJ
authors.lastname: Williams
authors.affiliation: Institute for Breathing and Sleep, Austin Health, Melbourne, Australia; School of Psychology, Counselling & Psychotherapy, Cairnmillar Institute, Camberwell, Australia.
authors.forename: Gerard A
authors.initials: GA
authors.lastname: Kennedy
authors.affiliation: IMPACT SRC, School of Medicine, Deakin University, Geelong, Australia; Department of Psychiatry, The University of Melbourne, Parkville, Australia; Orygen Research Centre, Parkville, Australia; Florey Institute for Neuroscience and Mental Health Parkville Australia.
authors.forename: Michael
authors.initials: M
authors.lastname: Berk
authors.affiliation: IMPACT SRC, School of Medicine, Deakin University, Geelong, Australia; NorthWest Academic Centre, Department of Medicine, The University of Melbourne, St Albans, Australia.
authors.forename: Sharon L
authors.initials: SL
authors.lastname: Brennan
authors.affiliation: IMPACT SRC, School of Medicine, Deakin University, Geelong, Australia; NorthWest Academic Centre, Department of Medicine, The University of Melbourne, St Albans, Australia.
authors.forename: Julie A
authors.initials: JA
authors.lastname: Pasco
mesh_terms: D050154:Adiposity; D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D015992:Body Mass Index; D015331:Cohort Studies; D003430:Cross-Sectional Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D024821:Metabolic Syndrome / Q000453:epidemiology / Q000503:physiopathology*; D008875:Middle Aged; D015995:Prevalence; D057566:Self Report; D012720:Severity of Illness Index; D012737:Sex Factors; D012893:Sleep Wake Disorders / Q000453:epidemiology / Q000209:etiology* / Q000503:physiopathology; D014739:Victoria / Q000453:epidemiology; D055105:Waist Circumference; D055815:Young Adult
keywords: Epidemiology; Excessive daytime sleepiness; Metabolic syndrome; Metabolism; Population