Lack of Regular Exercise, Depression, and Degree of Apnea are Predictors of Excessive Daytime Sleepiness in Patients with Sleep Apnea: Sex Differences

Abstract

E xcessive daytime sleepiness (EDS) is very common in modern societies. In the general population, the prevalence of EDS is estimated to range between 5% and 20%. [1][2][3][4][5][6][7][8][9] EDS and fatigue are the most common complaints of patients referred to the sleep disorders clinic. 10,11 Moreover, they are potential risk factors for cardiovascular disease and mortality, 12,13 are associated with a negative perception of general health and quality of life, 14,15 and raise major public safety concerns. 16 EDS is commonly assumed to be primarily the result of disturbed or inadequate sleep. Sleep deprivation and sleep apnea are known predictors of EDS. However, in previous studies, the association between EDS and sleep apnea has been found to be significant but rather modest. Two large studies in general population samples demonstrated that, among patients with sleep apnea, approximately 20% to 40% reported EDS. 17,18 On the other hand, it has been found that conditions highly comorbid with sleep apnea, such as obesity, are associated with EDS independent of sleep apnea. [19][20][21] Furthermore, large population-based epidemiologic studies have shown that the presence of EDS is strongly associated with depression, obesity, and diabetes. [7][8][9] More recently, physical activity has been suggested as a novel significant factor for sleepiness in the general population after controlling for body mass index (BMI), apnea, age, and other covariates. 8,9 Studies in sleep apneics have found that sleep fragmentation, nocturnal hypoxemia, depression, and age are independent predictors of daytime sleepiness in this group. [22][23][24][25] However, to our knowledge, no studies have investigated the effect of exercise on daytime sleepiness in patients with sleep apnea.The aim of this study was to determine the association between EDS and lack of regular exercise quantified by a standardized questionnaire, as well as depression and severity of apnea, in a large clinical sample of patients with sleep apnea.

Excessive Daytime Sleepiness Independently Predicts Increased Cardiovascular Risk After Myocardial Infarction

“…First, EDS is closely associated with traditional cardiovascular risk factors, such as obesity, diabetes mellitus, uncontrolled hypertension, and physical inactivity. [22][23][24][25] It is conceivable that mechanisms implicated in CVD risk (eg, inflammation 26 ) may also underlie EDS. Second, aside from SDB, insufficient sleep and other sleep disorders such as insomnia, which may undermine patients' sleep quality and cause EDS, have also been associated with poor cardiovascular outcomes.…”

“…Because EDS is a frequent symptom of several CVD conditions, 12,33 chronic disease management rather than stimulant therapy may reasonably be prioritized to alleviate EDS and to improve cardiac outcomes as well. Meanwhile, because several preventable risk factors for coronary artery disease, such as inactivity, obesity, and a high-carbohydrate diet, 22,24,34 are closely related to EDS, lifestyle adjustment may be recommended. As one of the most important symptoms of moderate to severe SDB, the presence of EDS is an indicator for CPAP therapy.…”

Subjective apnoea symptoms are associated with daytime sleepiness in patients with moderate and severe obstructive sleep apnoea: a retrospective study

“…A correlation between depression and daytime sleepiness has been reported in the general population 7 as well as in patients with OSA. 17,[25][26][27] Ishman et al 26 showed that ESS was significantly associated with depressive symptoms measured by BDI Fast Screen after controlling for race, sex, age and RDI. Kjelsberg et al 27 showed that ESS and low compliance with continuous positive airway pressure therapy were the only predictors of high level of depression measured by the Hospital Anxiety and Depression scale.…”

Evaluation of depression comorbidity in obstructive sleep apnea syndrome

“…Examination of patients with anxiety and depression showed that their sleep patterns were irregular [14]. While it was reported that the incidence of depression in the adult population was between 3% and 10% [15], certain studies demonstrated that the depression incidence was between 20-40% in patients with OSAS [4,16,17]. OSAS may cause depression via sleep loss, sleep disruption, and cognitive changes induced by intermittent hypoxemia, while weight gain and sleep disruption due to depression could cause OSAS [8].…”