Association of daytime sleepiness with obstructive sleep apnoea and comorbidities varies by sleepiness definition in a population cohort of men.
To determine correlates of excessive daytime sleepiness (EDS) identified with the Epworth Sleepiness Scale (ESS) and a more broad definition, while accounting for obstructive sleep apnoea (OSA) in community dwelling men.



Participants of the Men Androgens Inflammation Lifestyle Environment and Stress (MAILES) Study (n = 837, ≥ 40 years) without a prior OSA diagnosis, underwent in-home full unattended polysomnography (PSG, Embletta X100), completed the ESS, STOP questionnaire and Pittsburgh Sleep Quality Index in 2010-2011. In 2007-2010, questionnaires and biomedical assessment (in South Australian public hospital-based clinics) identified medical conditions. An alternate EDS definition (EDSAlt ) consisted of ≥ 2 of 3 problems (feeling sleepy sitting quietly; feeling tired/fatigued/sleepy; trouble staying awake).



EDSAlt (30.4%, n = 253), but not ESS ≥ 11 (EDSESS , 12.6%, n = 104), increased significantly across OSA severity and body mass index categories. In adjusted analyses, EDSESS was significantly associated with depression: odds ratio (OR), 95%CI: 2.2 (1.3-3.8) and nocturia: 2.0 (1.3-3.2). EDSAlt was associated with depression, financial stress, relationship, work-life balance problems and associations with nocturia and diabetes were borderline. After excluding men with EDSESS , EDSAlt was associated with oxygen desaturation index (3%) ≥ 16 and the highest arousal index quartile but not with comorbidities.



Sleepiness not necessarily leading to dozing, but not ESS ≥ 11, was related to sleep disordered breathing. Clinicians should be alert to (1) differing perspectives of sleepiness for investigation and treatment of OSA, and (2) the presence of depression and nocturia in men presenting with significant Epworth sleepiness regardless of the presence of OSA.
The Health Observatory, Discipline of Medicine, University of Adelaide, Woodville, South Australia, Australia.
Robert J
RJ
Adams
The Health Observatory, Discipline of Medicine, University of Adelaide, Woodville, South Australia, Australia. sarah.appleton@adelaide.edu.au.|Freemasons Centre for Men's Health, Discipline of Medicine, University of Adelaide, Adelaide, South Australia, Australia. sarah.appleton@adelaide.edu.au.
Sarah L
SL
Appleton
Adelaide Institute for Sleep Health, a Flinders Centre of Research Excellence, School of Medicine, Faculty of Medicine, Nursing and Health Sciences, Flinders University, Bedford Park, South Australia, Australia.|NHMRC Centre for Integrated Research and Understanding of Sleep (CIRUS), Woolcock Institute of Medical Research, Central Clinical School, University of Sydney, Sydney, New South Wales, Australia.
Andrew
A
Vakulin
The Health Observatory, Discipline of Medicine, University of Adelaide, Woodville, South Australia, Australia.
Carol
C
Lang
Freemasons Centre for Men's Health, Discipline of Medicine, University of Adelaide, Adelaide, South Australia, Australia.
Sean A
SA
Martin
Population Research & Outcomes Studies, Discipline of Medicine, University of Adelaide, Adelaide, South Australia, Australia.
Anne W
AW
Taylor
Adelaide Institute for Sleep Health, a Flinders Centre of Research Excellence, School of Medicine, Faculty of Medicine, Nursing and Health Sciences, Flinders University, Bedford Park, South Australia, Australia.|Department of Medicine, Flinders University, Bedford Park, Adelaide, South Australia, Australia.
R Doug
RD
McEvoy
Adelaide Institute for Sleep Health, a Flinders Centre of Research Excellence, School of Medicine, Faculty of Medicine, Nursing and Health Sciences, Flinders University, Bedford Park, South Australia, Australia.|Department of Medicine, Flinders University, Bedford Park, Adelaide, South Australia, Australia.
Nick A
NA
Antic
Adelaide Institute for Sleep Health, a Flinders Centre of Research Excellence, School of Medicine, Faculty of Medicine, Nursing and Health Sciences, Flinders University, Bedford Park, South Australia, Australia.|Department of Medicine, Flinders University, Bedford Park, Adelaide, South Australia, Australia.
Peter G
PG
Catcheside
The Health Observatory, Discipline of Medicine, University of Adelaide, Woodville, South Australia, Australia.|Freemasons Centre for Men's Health, Discipline of Medicine, University of Adelaide, Adelaide, South Australia, Australia.
Gary A
GA
Wittert
D000328:Adult; D001315:Australia; D015331:Cohort Studies; D015897:Comorbidity; D003866:Depressive Disorder / Q000453:epidemiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D017286:Polysomnography; D012307:Risk Factors; D020181:Sleep Apnea, Obstructive / Q000150:complications* / Q000503:physiopathology / Q000523:psychology; D011795:Surveys and Questionnaires; D014851:Wakefulness
depressive disorder; diabetes mellitus; excessive somnolence; nocturia; obstructive; sleep apnoea