No abstract

Many different subjective tools are being used to measure excessive daytime sleepiness (EDS) but the most widely used is the Epworth Sleepiness Scale (ESS). However, it is unclear if using the ESS is adequate on its own when assessing EDS. The aim of this study was to estimate the characteristics and prevalence of EDS using the ESS and the Basic Nordic Sleep Questionnaire (BNSQ) in general population samples. Participants aged 40 years and older answered questions about sleepiness, health, sleep‐related symptoms and quality of life. Two groups were defined as suffering from EDS: those who scored >10 on the ESS (with increased risk of dozing off) and those reporting feeling sleepy during the day ≥3 times per week on the BNSQ. In total, 1,338 subjects (53% male, 74.1% response rate) participated, 13.1% reported an increased risk of dozing off, 23.2% reported feeling sleepy and 6.4% reported both. The prevalence of restless leg syndrome, nocturnal gastroesophageal reflux, difficulties initiating and maintaining sleep and nocturnal sweating was higher among subjects reporting feeling sleepy compared to non‐sleepy subjects. Also, subjects reporting feeling sleepy had poorer quality of life and reported more often feeling unrested during the day than non‐sleepy subjects. However, subjects reporting increased risk of dozing off (ESS > 10) without feeling sleepy had a similar symptom profile as the non‐sleepy subjects. Therefore, reporting only risk of dozing off without feeling sleepy may not reflect problematic sleepiness and more instruments in addition to ESS are needed when evaluating daytime sleepiness.

Excessivedaytimesleepinessincludesbothaninabilitytostayawakeduringtheday and a general feeling of sleepiness. We describe different dimensions of daytime sleepinessinadultswithmoderate-severeobstructivesleepapnea(OSA)beforeandafter 2 years of positive airway pressure (PAP) treatment. Using the Epworth Sleepiness Scale (score >10 defined as "risk of dozing") and Basic Nordic Sleep Questionnaire (feeling sleepy ≥3 times/week defined as "feeling sleepy"), participants were categorised into sleepiness phenotypes labelled non-sleepy, risk of dozing only, feeling sleepyonly,orbothsymptoms.ParticipantsrepeatedbaselineassessmentsandPAP adherencewasevaluatedafter2years.PAP-adherentsubjectswithsleepinesssymptoms at both baseline and follow-up were considered persistently sleepy. Of the 810 participants,722(89%)returnedforfollow-up.Atbaseline,17.7%werenon-sleepy, 7.7%wereatriskofdozingonly,24.7%werefeelingsleepyonly,and49.9%hadboth symptoms.PAPadherencedidnotdifferbybaselinesleepinessphenotype.Patients withriskofdozingdemonstratedgreaterPAPbenefitsforsleepinesssymptomsthan non-sleepy and feeling sleepy only phenotypes. Using these phenotypes, 42.3% of PAPusershadpersistentsleepiness;theyhadlesssevereOSA(p <0.001),morepersistent OSA symptoms and more often had symptoms of insomnia than patients in whomsleepinessresolved.Ourpresentresults,therefore,suggestthatmeasuringthe riskofdozingandthefeelingofsleepinessreflectdifferentsleepinesscomponents