Excessive Daytime Sleepiness and Cardiovascular Mortality in US Adults: A NHANES 2005–2008 Follow-Up Study

Objective Involvement of the hypothalamus is rare in patients with systemic lupus erythematosus (SLE). In this study, we measured cerebrospinal fluid (CSF) orexin-A levels in SLE patients with hypothalamic lesions to investigate whether the orexin system plays a role in SLE patients with hypothalamic lesions who present with excessive daytime sleepiness (EDS). Methods Orexin-A levels were measured in CSF from four patients with SLE who presented with hypothalamic lesions detected by MRI. Three patients underwent repeated CSF testing. All patients met the updated American College of Rheumatology revised criteria for SLE. Results Tests for serum anti-aquaporin-4 antibodies, CSF myelin basic protein and CSF oligoclonal bands were negative in all patients. All patients presented with EDS. Low to intermediate CSF orexin-A levels (92–180 pg/ml) were observed in three patients in the acute stage, two of whom (patients 1 and 2) underwent repeated testing and showed increased CSF orexin-A levels, reduced abnormal hypothalamic lesion intensities detected by MRI and EDS dissipation at follow-up. In contrast, CSF orexin-A levels were normal in one patient (patient 4) while in the acute stage and at follow-up, despite improvements in EDS and MRI findings. Patient 4 showed markedly increased CSF interleukin-6 levels (1130 pg/ml) and a slightly involved hypothalamus than the other patients. Conclusions Our findings suggest that the orexinergic system has a role in EDS in SLE patients with hypothalamic lesions. Furthermore, cytokine-mediated tissue damage might cause EDS without orexinergic involvement.

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Natural history of excessive daytime sleepiness: a population-based 5-year longitudinal study

SLEEP ◽

10.1093/sleep/zsz249 ◽

2019 ◽

Vol 43 (3) ◽

Cited By ~ 1

Author(s):

I Jaussent ◽

C M Morin ◽

H Ivers ◽

Y Dauvilliers

Keyword(s):

Sleep Duration ◽

Excessive Daytime Sleepiness ◽

Daytime Sleepiness ◽

Adult Population ◽

Population Based ◽

Normal Weight ◽

Point Reduction ◽

Nighttime Sleep ◽

Over Time

Abstract Study Objectives To document the rates of persistent, remitted, and intermittent excessive daytime sleepiness (EDS) in a longitudinal 5-year community study of adults and to assess how changes in risk factors over time can predict improvement of daytime sleepiness (DS). Methods Participants were recruited in 2007–2008 as part of a population-based epidemiological study implemented in Canada. They completed postal assessments at baseline and at each yearly follow-up. An Epworth Sleepiness Scale total score >10 indicated clinically significant EDS; a 4-point reduction between two consecutive evaluations defined DS improvement. Socio-demographic, lifestyle, health characteristics, and sleep-related measures (e.g. insomnia symptoms, sleep duration, sleep medication) were self-reported at each time point. Cox proportional-hazard models were used to predict EDS and DS remissions over 5 years. Results Among the 2167 participants, 33% (n = 714) met criteria for EDS at baseline, of whom 33% had persistent EDS, 44% intermittent EDS, and 23% remitted EDS over the follow-up. Furthermore, 61.4% of 2167 initial participants had stable DS, 27.1% sustained DS improvement and 8.5% transient improvement over the follow-up. The main predictors of EDS remission or DS improvement were normal weight, taking less hypnotics, having hypertension, increased nighttime sleep duration, and decreased insomnia, and depressive symptoms. Conclusions EDS waxes and wanes over time with frequent periods of remission and is influenced by behavioral characteristics and changes in psychological, metabolic, and nighttime sleep patterns. Targeting these predictors in future interventions is crucial to reduce DS in the general adult population.

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Systolic Hypertension in Pregnancy and Cardiovascular Mortality: A 44-Year Follow-up Study

Hypertension in Pregnancy ◽

10.1080/10641950701826810 ◽

2008 ◽

Vol 27 (1) ◽

pp. 87-94 ◽

Cited By ~ 5

Author(s):

Riitta Luoto ◽

Elham Kharazmi ◽

Elise Whitley ◽

Jani Raitanen ◽

Mika Gissler ◽

...

Keyword(s):

Cardiovascular Mortality ◽

Systolic Hypertension ◽

Follow Up Study ◽

Hypertension In Pregnancy ◽

In Pregnancy

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Mononucleosis and chronic daytime sleepiness. A long-term follow-up study

Archives of Internal Medicine ◽

10.1001/archinte.146.7.1333 ◽

1986 ◽

Vol 146 (7) ◽

pp. 1333-1335 ◽

Cited By ~ 19

Author(s):

C. Guilleminault

Keyword(s):

Daytime Sleepiness ◽

Follow Up Study ◽

Long Term Follow Up

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Association between Co-Morbidities and the Prevalence of Excessive Daytime Sleepiness over a Four-Year Period

Clocks & Sleep ◽

10.3390/clockssleep1040035 ◽

2019 ◽

Vol 1 (4) ◽

pp. 459-470

Author(s):

Karunanayake ◽

Dosman ◽

Fenton ◽

Rennie ◽

Kirychuk ◽

...

Keyword(s):

Regression Model ◽

First Nations ◽

Excessive Daytime Sleepiness ◽

Daytime Sleepiness ◽

First Nation ◽

Longitudinal Change ◽

Canadian Population ◽

Health Project ◽

Multilevel Logistic Regression Model

Excessive daytime sleepiness (EDS) is a common problem in general the Canadian population. It can effect day-to-day activities and is also associated with several health issues. This study aimed to investigate the association between co-morbidities and the prevalence of EDS over a four-year period in adults living in two First Nation communities. Data collected during the First Nations Lung Health Project (FNLHP) conducted in two Cree First Nation communities in Saskatchewan in 2012–2013 (Cycle 1) and 2016 (Cycle 2) were used for this analysis. There were 859 participants aged 18 years and older at baseline (Cycle 1) and 821 participants aged 18 years and older at follow-up (Cycle 2) who completed the interviewer-administered questionnaire. An Epworth Sleepiness Scale (ESS) score > 10 was considered to be abnormal and identified as a case of EDS at both time points. A multilevel logistic regression model using a generalized estimating equations approach was used to analyze the data. The prevalence of EDS at baseline (Cycle 1) was 11.2% (91/815) and 10.0% (80/803) at follow-up (Cycle 2). Based on the predicted model, longitudinal change in the prevalence of EDS was −0.11% for 358 individuals who participated in both cycles. There were 49% males at baseline and 48% males at follow-up. Multivariate regression model results revealed that crowding, shortness of breath, loud snoring, chronic lung disease, depression and gastric reflux were the main significant predictors of EDS. In addition, the interaction between sex and age was significant. Some of the co-morbid conditions were associated with EDS. Therefore, managing such conditions requires considerations in strategies to decrease the prevalence of daytime sleepiness.

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