title: Prevalence and determinants of subjective sleepiness in healthy elderly with unrecognized obstructive sleep apnea.
abstract: OBJECTIVE
  Obstructive sleep apnea (OSA) is associated with behavioral consequences such as excessive daytime sleepiness (EDS). The aim of this study was to establish the presence of sleepiness in elderly with unrecognized OSA and the factors explaining its occurrence.
  
  
  METHODS
  A total of 825 healthy elderly (aged ≥65 years) undergoing clinical, respiratory polygraphy, and heart-rate variability analysis were studied. According to the apnea-hypopnea index (AHI), the subjects were stratified in four categories: no-OSA (AHI <5), mild (5 > AHI <15), moderate (15 ≥ AHI <30), and severe OSA (AHI ≥30). Participants with EDS were defined on the basis of the Epworth Sleepiness Scale (ESS) score ≥10.
  
  
  RESULTS
  Overall, the mean ESS score was 5.7 ± 5.6, 14.9% showing EDS with an increasing trend according to OSA severity (p <0.001). Sleepy subjects were more frequently men, having a greater body mass index (BMI), alcohol intake, depression score, and indices of OSA severity (23% of severe OSA cases being sleepy). No differences were present between sleepy and non-sleepy subjects in regard to other clinical, metabolic, and autonomic nervous system measurements. Regression analyses adjusted for age, gender, BMI, hypertension, depression score, autonomic sleep fragmentation, and AHI and/or oxygen desaturation index revealed that gender (p <0.0001), depression score (p <0.0001), and BMI (p = 0.01) were the only significant factors affecting the presence of sleepiness in this population.
  
  
  CONCLUSIONS
  In healthy elderly with OSA, the prevalence of EDS was low, and it affected only severe cases. Despite a weak association between the ESS score and the AHI index, male gender and depression score were the most significant predictors for the occurrence of sleepiness.
authors.affiliation: Faculté de Médecine Jacques Lisfranc, Service de Physiologie Clinique et de l'Exercice (Pole Hospitalier NOL), CHU Nord, Université Jean Monnet, Saint-Etienne, SNA EPIS EA 4607, PRES de Lyon, France. Electronic address: emilia.sforza@gmail.com.
authors.forename: Emilia
authors.initials: E
authors.lastname: Sforza
authors.affiliation: Faculté de Médecine Jacques Lisfranc, Service de Physiologie Clinique et de l'Exercice (Pole Hospitalier NOL), CHU Nord, Université Jean Monnet, Saint-Etienne, SNA EPIS EA 4607, PRES de Lyon, France.
authors.forename: Vincent
authors.initials: V
authors.lastname: Pichot
authors.affiliation: Faculté de Médecine Jacques Lisfranc, Service de Physiologie Clinique et de l'Exercice (Pole Hospitalier NOL), CHU Nord, Université Jean Monnet, Saint-Etienne, SNA EPIS EA 4607, PRES de Lyon, France.
authors.forename: Magali Saint
authors.initials: MS
authors.lastname: Martin
authors.affiliation: Faculté de Médecine Jacques Lisfranc, Service de Physiologie Clinique et de l'Exercice (Pole Hospitalier NOL), CHU Nord, Université Jean Monnet, Saint-Etienne, SNA EPIS EA 4607, PRES de Lyon, France.
authors.forename: Jean Claude
authors.initials: JC
authors.lastname: Barthélémy
authors.affiliation: Faculté de Médecine Jacques Lisfranc, Service de Physiologie Clinique et de l'Exercice (Pole Hospitalier NOL), CHU Nord, Université Jean Monnet, Saint-Etienne, SNA EPIS EA 4607, PRES de Lyon, France.
authors.forename: Frédéric
authors.initials: F
authors.lastname: Roche
mesh_terms: D000367:Age Factors; D000368:Aged; D000428:Alcohol Drinking / Q000009:adverse effects; D015992:Body Mass Index; D003863:Depression / Q000150:complications; D006970:Disorders of Excessive Somnolence / Q000453:epidemiology* / Q000209:etiology; D005260:Female; D006801:Humans; D008297:Male; D015995:Prevalence; D012307:Risk Factors; D012737:Sex Factors; D020181:Sleep Apnea, Obstructive / Q000150:complications*; D012892:Sleep Deprivation / Q000150:complications; D011795:Surveys and Questionnaires
keywords: Autonomic nervous system activity; Elderly; Obstructive sleep apnea; Sleepiness