Both Sleep and Psychological Health Affect EDS Risk

In addition to sleep-related factors, the risk for excessive daytime sleepiness is significantly higher among individuals experiencing depression, psychological stress, and feelings of low control over life, according to study results recently published in the Journal of Sleep Research.

Previous research has demonstrated that chronic excessive daytime sleepiness is associated with increased odds of heart disease, higher mortality, and motor-vehicle or work-related accidents. Despite these risks, there is a paucity of data evaluating modifiable risk factors of excessive daytime sleepiness.

To address this knowledge gap, researchers analyzed data from the Swedish CArdioPulmonary bioImage Study (SCAPIS) cohort to identify risk factors for excessive daytime sleepiness in a large population-based cohort. The SCAPIS cohort included 27,976 randomly selected adults from 6 regions in Sweden. Each participant completed a questionnaire that included demographic information as well as other factors like lifestyle, socioeconomic status, chronic illness, mental health, and other sleep-related variables. The researchers used the Epworth Sleepiness Scale (ESS) to measure sleepiness, and defined excessive daytime sleepiness as a total score above 10.

Of the 27,976 adults included in the study, 14,436 were women, 13,540 were men, and the participants had a mean age of 57.5 years (SD=4.3). The majority of participants slept 7 hours per night (44%) and ranked their sleep quality as “good” (49%). However, 47.4% of participants had insomnia and 16% of participants had excessive daytime sleepiness.

The researchers found that short sleep duration was associated with increased daytime sleepiness. In logistic regression models that adjusted for demographic, sleep, and psychological factors, the odds of excessive daytime sleepiness were significantly higher among individuals who slept 7 hours (odds ratio [OR], 1.16; 95% CI, 1.02-1.31), 6 hours (OR, 1.58; 95% CI, 1.39-1.81), 5 hours (OR, 1.83; 95% CI, 1.53-2.18), and 4 (OR, 1.84; 95% CI, 1.36-2.49) hours or less per night, relative to a sleep duration of 8 hours per night. Further, sleeping 10 hours per night also increased excessive daytime sleepiness risk (OR, 2.67; 95% CI, 1.50-4.74).

Excessive daytime sleepiness was also significantly more likely among individuals with poor sleep quality (OR, 1.26; 95% CI, 1.10-1.44), insomnia (OR, 1.26; 95% CI, 1.14-1.38), gastro-esophageal reflux (OR, 1.47; 95% CI, 1.21-1.79), and snoring (OR, 1.46; 95% CI, 1.34-1.59) compared with those who did not experience these sleep problems.

Beyond sleep-related factors, the researchers found that all psychological distress variables were linked to excessive daytime sleepiness. The factors most strongly associated with increased excessive daytime sleepiness risk were sadness and depression (OR, 1.20; 95% CI, 1.10-1.32), constant stress over the past 5 years (OR, 1.72; 95% CI, 1.35-2.19), and low perceived control in life (OR, 1.75; 95% CI, 1.55-1.97).

The study authors concluded, “The identification of not only sleep-related factors but also psychological factors, as strong independent contributors to daytime sleepiness, underscores the need for a holistic approach in addressing and potentially reducing daytime sleepiness in patients and on a societal level.”

Study limitations include the reliance on self-reported data, the inability to take factors like shift work and medications into account, and the limited age range of included participants.

Still, these results indicate further research could inform interventions that target sleep and mental health together for less daytime sleepiness. They may also offer cause to reassess the American Academy of Sleep Medicine (AASM) current sleep duration recommendations of 7 hours a night minimum for optimal health.

This article originally appeared on Sleep Wake Advisor