Am. J. Respir. Crit. Care Med., Volume 159, Number 2, February 1999, 502-507

Relation of Sleepiness to Respiratory Disturbance Index
The Sleep Heart Health Study

DANIEL J. GOTTLIEB, CORALYN W. WHITNEY, WILLIAM H. BONEKAT, CONRAD IBER, GARY D. JAMES, MICHAEL LEBOWITZ, F. JAVIER NIETO, and CARL E. ROSENBERG

Department of Medicine, Boston University School of Medicine, Boston, Massachusetts; Department of Biostatistics, University of Washington, Seattle, Washington; Department of Medicine, University of California, Davis, California; Department of Medicine, University of Minnesota, Minneapolis, Minnesota; Cardiovascular Center, Cornell Medical Center, New York, New York; Pulmonary Section, Department of Medicine, University of Arizona College of Medicine, Tucson, Arizona; Department of Epidemiology, Johns Hopkins University School of Hygiene and Public Health, Baltimore, Maryland; and Department of Neurology, Case Western Reserve University, Cleveland, Ohio

Obstructive sleep apnea syndrome is a well recognized cause of excessive sleepiness; however, the relation of sleepiness to mild sleep-disordered breathing (SDB), which affects as much as half the adult population, is uncertain. In order to explore this relation, we conducted a cross-sectional cohort study of community-dwelling adults participating in the Sleep Heart Health Study, a longitudinal study of the cardiovascular consequences of SDB. The study sample comprises 886 men and 938 women, with a mean age of 65 (SD 11) yr. Sleepiness was quantified using the Epworth Sleepiness Scale (ESS). Sleep-disordered breathing was quantified by the respiratory disturbance index (RDI), defined as the number of apneas plus hypopneas per hour of sleep, measured during in-home polysomnography. When RDI was categorized into four groups (< 5, 5 to < 15, 15 to < 30,  30), a significantly progressive increase in mean ESS score was seen across all four levels of SDB, from 7.2 (4.3) in subjects with RDI < 5 to 9.3 (4.9) in subjects with RDI  30 (p < 0.001). There was no significant modification of this effect by age, sex, body mass index, or evidence of chronic restriction of sleep time or periodic limb movement disorder. The percentage of subjects with excessive sleepiness, defined as an ESS score  11, increased from 21% in subjects with RDI < 5 to 35% in those with RDI  30 (p < 0.001). We conclude that SDB is associated with excess sleepiness in community-dwelling, middle-aged and older adults, not limited to those with clinically apparent sleep apnea.

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