Tiredness and sleepiness in bus drivers and road accidents in Peru: a quantitative study]

OBJECTIVE: To evaluate the relationship that tiredness and sleepiness in bus drivers have to road accidents in Peru. Information from various countries indicates that driver sleepiness plays an important role in road accidents. However, there is only limited information on this subject in Peru. METHODS: Using a supervised, pretested survey, a cross-sectional observational and comparative study was carried out with 238 bus drivers who drive on the Northern Pan American Highway of Peru. To determine the relationship between variables the chi-square test was used, along with the Pearson correlation coefficient. The level of significance was set at P < 0.05. The variables analyzed were: tiredness, sleepiness, hours of driving per day, daily hours of sleep, body mass index, snoring, sleep apnea, and either having had or almost having had an accident while driving. RESULTS: Of the 238 drivers, all of them were men, 45% said they had had or nearly had had an accident while driving, 55% slept less than 6 hours per day, 31% had slept less than 6 hours in the 24 hours before answering the survey, and 80% were in the habit of driving more than 5 hours without stopping. Of the drivers, 56% of them reported being tired at least some of the time while driving; of this group, 65% of them reported being tired during the early morning. Seventy-six drivers (32%) said that while they were driving their eyes had fallen shut. In terms of where they slept, 194 of the drivers (81%) said they always slept in the lower luggage compartment of the bus while another driver was driving the bus or when the bus was parked in the bus terminal. The steps that drivers took to avoid falling asleep while driving included: wetting the face with water, eating fruit, opening the window of the driver's compartment, drinking coffee, listening to music, smoking, chewing coca leaves, and drinking alcohol mixed with coca leaves. In the opinion of 55% of the drivers, the leading cause of road accidents is tiredness. Accidents and near-accidents while driving occurred mainly between midnight and 6 a. m. Having an accident or a near-accident was strongly associated with tiredness and with having the eyes drop shut while driving (P < 0.0005). CONCLUSIONS: Tiredness and sleepiness while driving were common among the bus drivers, with various possible causes: acute and chronic sleep deprivation, irregular schedule changes, and sleep disorders due to the drivers' working conditions. Our results support the hypothesis that fatigue and sleepiness among bus drivers are related to road accidents.     

Vehicle accidents related to sleep: a review

Falling asleep while driving accounts for a considerable proportion of vehicle accidents under monotonous driving conditions. Many of these accidents are related to work--for example, drivers of lorries, goods vehicles, and company cars. Time of day (circadian) effects are profound, with sleepiness being particularly evident during night shift work, and driving home afterwards. Circadian factors are as important in determining driver sleepiness as is the duration of the drive, but only duration of the drive is built into legislation protecting professional drivers. Older drivers are also vulnerable to sleepiness in the mid-afternoon. Possible pathological causes of driver sleepiness are discussed, but there is little evidence that this factor contributes greatly to the accident statistics. Sleep does not occur spontaneously without warning. Drivers falling asleep are unlikely to recollect having done so, but will be aware of the precursory state of increasing sleepiness; probably reaching a state of fighting off sleep before an accident. Self awareness of sleepiness is a better method for alerting the driver than automatic sleepiness detectors in the vehicle. None of these have been proved to be reliable and most have shortcomings. Putative counter measures to sleepiness, adopted during continued driving (cold air, use of car radio) are only effective for a short time. The only safe counter measure to driver sleepiness, particularly when the driver reaches the stage of fighting sleep, is to stop driving, and--for example, take a 30 minute break encompassing a short (< 15 minute) nap or coffee (about 150 mg caffeine), which are very effective particularly if taken together. Exercise is of little use. CONCLUSIONS: More education of employers and employees is needed about planning journeys, the dangers of driving while sleepy, and driving at vulnerable times of the day.     

Sleep, sleepiness and motor vehicle accidents: a national survey

OBJECTIVE: To assess the role of sleep-related factors, ethnicity and socioeconomic deprivation in self-reported motor vehicle accidents while driving, after controlling for gender, age and driving exposure. METHODS: Mail survey to a random electoral roll sample of 10,000 people aged 30-60 years, stratified by age decades and ethnicity (71% response rate). The analytical sample included 5,534 current drivers (21.6% Maori men, 21.2% Maori women, 30% non-Maori men, 27.2% non-Maori women). RESULTS: Multiple logistic regression analyses revealed the following independent risk factors for accident involvement while driving (last three years): being younger; higher average weekly driving hours; never/rarely getting enough sleep (OR=1.26, 95% CI 1.06-1.49); reporting any chance of dozing in a car while stopped in traffic (Epworth Sleepiness Scale question 8, OR=1.52, 95% CI 1.15-2.02); and among women, being non-Maori. Total Epworth score was not significantly related to reported accident involvement. CONCLUSIONS: Chronic sleep restriction, and any likelihood of dozing off at the wheel of a motor vehicle, were significant independent predictors of self-reported involvement in all types of motor vehicle accidents, not only those identified as fatigue-related. The Epworth Sleepiness Scale alone is not a reliable clinical tool for identifying individuals at higher risk of crashes. IMPLICATIONS: Factors relating to chronic sleepiness were as important as established demographic risk factors for self-reported motor vehicle accident involvement among 30-60 year-old drivers. The findings reinforce the need for multi-faceted campaigns to reduce sleepy driving.     

Sleepiness of occupational drivers

Drowsiness and sleeping at the wheel are now identified as the reasons behind fatal crashes and highway accidents caused by occupational drivers. For many years, fatigue has been associated to risk of accidents but the causes of this symptom were unclear. Extensive or nocturnal driving was associated to accidents but few reports differentiated fatigue from sleepiness. In the early nineties, epidemiological data started investigating sleepiness and sleep deprivation as cause of accidents. Sleepiness at the wheel, sleep restriction and nocturnal driving have been incriminated in 20% of traffic accidents. Drugs affecting the central nervous system (i.e., narcotic analgesics, antihistamine drugs), nocturnal breathing disorders and narcolepsy have been also associated with an increasing risk of accidents. Treatments improving daytime vigilance (i.e., nasal Continuous Positive Airway Pressure) reduce significantly the risk of traffic accidents for a reasonable economical cost. Sleep disorders among occupational drivers need to be systematically investigated. Chronic daytime sleepiness is still under diagnosed and sleep disorders (i.e. obstructive sleep apnea syndrome) are not enough explored and treated in this exposed population of sedentary males. Drivers education and work schedules integrating notions of sleep hygiene as well as promotion of sleep medicine could significantly improve road safety.     

Excessive daytime sleepiness among the Japanese general population

BACKGROUND: Excessive daytime sleepiness is one of the principal symptoms of sleep disturbances, and is often associated with serious consequences including traffic and industrial accidents, decreased productivity, and interpersonal problems. However, there are few epidemiologic studies on excessive daytime sleepiness in a large scale sample targeting Japanese general population. METHODS: The survey was performed using a self-administered questionnaire in June 2000, targeting a population randomly selected from among 300 communities throughout Japan. This questionnaire included information about sleep habits and sleep problems. Excessive daytime sleepiness measured according to a question "Do you fall asleep when you must not sleep (for example when you are driving a car)?" RESULTS: A total of 28,714 subjects completed the questionnaire. The prevalence of excessive daytime sleepiness was 2.5% (male=2.8% and female=2.2%). Backward elimination analysis showed that the following were associated with excessive daytime sleepiness: male sex, young age, short sleep duration, subjective insufficient sleep, loss of deep sleep, disagreeable sensations in the legs, interruption of sleep by snoring or dyspnea, and feeling psychological stress. Interruption of sleep by snoring or dyspnea was the strongest associated factor (adjusted odds ratio=2.46, 95% confidence interval=1.76-3.43) of excessive daytime sleepiness. CONCLUSIONS: These results suggest that excessive daytime sleepiness in Japanese is associated with several sleep problems. These findings may be useful in attempts to prevent excessive daytime sleepiness in the general population of Japan.     

驾驶员睡眠打鼾及日间嗜睡与交通事故关系

目的调查睡眠打鼾与日间嗜睡对机动车驾驶员交通事故的影响。方法对2006年9月11-15日在北京市朝阳区亚运村验车场5个工作日内前来验车驾驶员进行现场问卷调查。结果共发放问卷1 002份,回收合格问卷988份。报告睡眠打鼾者133人,占13.50%;爱泼沃斯思嗜睡量表(Epworth Sleepiness Scale,ESS)评分≥9分者529人,占53.9%;报告曾发生追尾事故者346人,占35.02%;睡眠打鼾者与睡眠不打鼾者发生追尾事故分别为1.11次/人和0.62次/人,差异有统计学意义(P<0.01);且随着睡眠打鼾年数的增加,ESS评分的增高,发生追尾事故人均次数也随之增加。结论睡眠打鼾且日间嗜睡者驾驶员发生交通事故风险较高,需进一步进行调查与干预。     

交通事故与驾驶员因素的关系

目的　探讨驾驶员的生活事件、驾驶紧张、寻衅性驾驶等因素对交通事故的影响。方法　采用生活事件量表、驾驶紧张问卷、寻衅性驾驶行为问卷等测试了 90 5名汽车驾驶员 ,并调查了交通事故经历和影响事故的因素。结果　事故驾驶员的生活事件、驾驶紧张和寻衅驾驶得分分别为 2 1.79± 14 .10、2 3.81± 11.86、9.4 2± 8.2 5 ,明显高于无事故组 (分别为 16 .82± 8.4 5、2 0 .0 9± 10 .6 3、5 .6 6± 7.5 4 ) ,差异有显著性 (P <0 .0 1) ;且交通事故次数与生活事件、驾驶紧张、寻衅性驾驶、疲劳驾驶、每周驾车时间、饮酒指数有明显的相关 (P <0 .0 5 )。Logistic回归 (Forward :LR法 )分析表明 ,交通事故与每周驾驶时间、疲劳驾驶、寻衅性驾驶、饮酒指数的关系密切。结论　驾驶员的生活事件、驾驶紧张、寻衅性驾驶是影响交通事故的重要因素。     

Daytime sleepiness: an epidemiological study of young adults.

OBJECTIVES: Although excessive daytime sleepiness is associated with increased risks for accidents, decreased productivity, and interpersonal difficulties, information on its epidemiology is scarce. This paper examines correlates of and suspected risk factors for daytime sleepiness from a longitudinal epidemiological study of young adults. METHODS: The sample consisted of 1007 randomly selected young adults from a large health maintenance organization in southeast Michigan. Data were gathered in personal interviews conducted with 97% of the sample 5.5 years after baseline. Information on sleep characteristics in the last 2 weeks, including daytime sleepiness, nocturnal sleep onset, snoring, and hours of sleep, was collected on a self-administered instrument. Psychiatric disorders were measured by the National Institute of Mental Health's Diagnostic Interview Schedule. RESULTS: The average length of nocturnal sleep on weekdays was 6.7 hours. Daytime sleepiness was inversely related to hours of sleep and positively related to the ease of falling asleep at night; it varied significantly by employment and marital status. Snoring was associated with increased daytime sleepiness, as was recent major depression. CONCLUSIONS: Factors that might increase daytime sleepiness among young adults include social factors (being single and being employed full time) and pathological conditions (frequent snoring and major depression).     

An estimation of the prevalence of excessive daytime sleepiness based on age and sex distribution of epworth sleepiness scale scores: a population based survey

OBJECTIVES: To describe the distribution of subjective daytime sleepiness among local residents using the Epworth Sleepiness Scale (ESS) and estimate the prevalence of excessive daytime sleepiness (EDS) in a general Japanese adult population. METHODS: Subjects consisted of all residents aged 20 years and over from a self-governing body of approximately 10,000 people located in the Hokkaido region. Questionnaires, which included a Japanese version of the ESS, were distributed and later collected by a health promoter who visited subjects' residences between October and December 2000. Subjects of the analysis were restricted to those who answered five items or more out of a total of eight items. Means and standard deviations of the ESS global score were calculated for each age group by gender. And differences with reference to sex and age were examined by ANOVA. The prevalence of EDS in the Japanese general population was estimated from this study's results by direct age adjustment using the Japanese census figures for 2000. Factors related to EDS were also examined. RESULTS: A total of 5,327 residents responded to the survey (86.0%). Of these, 4,412 (71.2%) were entered for analysis. The average (+/- standard deviation) ESS global score were with 5.18 +/- 3.75 (males 5.25 +/- 3.89, females 5.12 +/- 3.75). Differing significantly age, regardless of sex (P<0001). From the overall prevalence of EDS of 9.2% (males 9.6%, females 8.8%), the estimated prevalence in the Japanese general population was to be 8.9% (males 9.3%, females 8.4%). EDS was found to be related to age, sleep duration under six hours and to snoring (P=0.002, P=0.008 and P<0.001). CONCLUSION: This study provided baseline data for the distribution by sex and age group of subjective daytime sleepiness in a community using the ESS and was used to generate the first ever estimated prevalence of EDS in the general Japanese adult population. The finding should prove useful for clinicians and researchers interested in (1) screening for daytime sleepiness, (2) evaluating changes between pre and post-interventions, (3) comparing epidemiological findings across studies, and lastly, (4) making of health policy. Daytime sleepiness estimated by ESS differs with the sex and age, possibly related to bio-medical and socio-medical factors. Further research is need to detail this problem.     

Work organisation and unintentional sleep: results from the WOLF study

Background: Falling asleep at work is receiving increasing attention as a cause of work accidents.

Aims: To investigate which variables (related to work, lifestyle, or background) are related to the tendency to fall asleep unintentionally, either during work hours, or during leisure time.

Methods: 5589 individuals (76% response rate) responded to a questionnaire. A multiple logistic regression analysis of the cross sectional data was used to estimate the risk of falling asleep.

Results: The prevalence for falling asleep unintentionally at least once a month was 7.0% during work hours and 23.1% during leisure time. The risk of unintentional sleep at work was related to disturbed sleep, having shift work, and higher socioeconomic group. Being older, being a woman, and being a smoker were associated with a reduced risk of unintentionally falling asleep at work. Work demands, decision latitude at work, physical load, sedentary work, solitary work, extra work, and overtime work were not related to falling asleep at work. Removing "disturbed sleep" as a predictor did not change the odds ratios of the other predictors in any significant way. With respect to falling asleep during leisure time, disturbed sleep, snoring, high work demands, being a smoker, not exercising, and higher age (>45 years) became risk indicators.

Conclusion: The risk of involuntary sleep at work is increased in connection with disturbed sleep but also with night work, socioeconomic group, low age, being a male, and being a non-smoker.

     

Association between pupillometric sleepiness measures and sleep latency derived by MSLT in clinically sleepy patients

Objectives

The multiple sleep latency test (MSLT) has been employed extensively in clinical and research settings as a gold standard for objectively measuring sleepiness. In a general population or in a variety of work settings, however, a more convenient, rapidly administered measuring method is preferable. We examined the potential utility of pupillometry by comparing its objective measures, pupillary unrest index (PUI) and relative pupillary unrest index (RPUI), with MSLT-derived sleep latency (SL).

Methods

The study cohort comprised 45 patients (39 males, 6 females, mean age 38.9 ± 11.3 years) referred to the Sleep Disorders Center for the two-nap SL test. SL was measured twice before noon, and pupillometric measurement was performed immediately before each SL test. Subjective sleepiness was measured by using the Epworth Sleepiness Scale (ESS).

Results

The association between PUI and SL was significant and far closer than that between RPUI and SL. A significant difference was observed between the two groups, based on each subject’s experience of drowsy driving accidents over the past 3 years in the PUI and RPUI, as well as in SL. The subjective sleepiness measure, ESS, did not relate to any other physiological sleepiness measures.

Conclusions

In our study cohort, the pupillometric sleepiness measure, PUI, was significantly correlated with, and behaved in a manner equivalent to, MSLT-derived SL in clinically sleepy patients. However, several points remain to be carefully examined before applying pupillometry for screening sleepiness in a general population, or in occupational settings.     

Spatial clusters of daytime sleepiness and association with nighttime noise levels in a Swiss general population (GeoHypnoLaus)

Introduction

Daytime sleepiness is highly prevalent in the general adult population and has been linked to an increased risk of workplace and vehicle accidents, lower professional performance and poorer health. Despite the established relationship between noise and daytime sleepiness, little research has explored the individual-level spatial distribution of noise-related sleep disturbances. We assessed the spatial dependence of daytime sleepiness and tested whether clusters of individuals exhibiting higher daytime sleepiness were characterized by higher nocturnal noise levels than other clusters.

Rumble strips in centre of the lane and the effect on sleepy drivers

The aim of this study was to describe the effects of sleep loss on behavioural and subjective indicators of sleepiness on a road containing a milled rumble strip in the centre of the lane. Particular attention was paid to behavioural and subjective indicators of sleepiness when using the centre lane rumble strip, and to possible erratic driving behaviour when hitting a rumble strip. In total 9 regular shift workers drove during the morning hours after a full night shift and after a full night sleep. The order was balanced. The experiment was conducted in a moving base driving simulator on rural roads with a road width of 6.5 and 9 meters. Out of the 1,636 rumble strip hits that occurred during the study, no indications of erratic driving behaviour associated with the jolt caused by making contact with the centre lane rumble strip could be found. Comparing the alert condition with the sleep deprived condition, both the standard deviation of lateral position (SDLP) and the Karolinska Sleepiness Scale (KSS) increased for sleepy drivers. For the two road widths, the drivers drove closer to the centre line on the 6.5-meter road. The KSS and the SDLP increased with time on task. This simulator study indicates that rumble strips in the centre of the lane may be an alternative to centreline and edgeline rumble strips on narrow roads.     

Sleepiness and road accidents among policemen on shif-work on Italian highways: study of the national highway network in the period of 1993-1997

Sleep disorders and daytime sleepiness are the most frequent disturbances reported by shift-workers. Sleepiness and fatigue can increase the risk of human errors and accidents especially during night work. In order to evaluate the time distribution and the possible role of sleepiness on road accidents in policemen on shift-work on highway patrols over 24 hours, we analyzed 1218 car accidents that occurred on the Italian highway network in the period 1993-1997. Accidents occurring during day shifts were significantly correlated with traffic density while accidents occurring during night shifts were not. During the 19:00-01:00 h shift the number of accidents showed a progressively increasing trend with two significant peaks around 23:00 and 01:00 h. Accidents occurring during the 01:00-07:00 h shift did not show significant trends. Information about sleep habits before starting night shifts were obtained by means of telephone interviews. While 85% of the subjects usually took a nap (30-90 min) before the 01:00-07:00 h shift only 15% took a short nap (< 30 minutes) before the 19:00-01:00 h shift. The data can be interpreted as a balance between circadian factors, homeostasis and fatigue related influences and spontaneously adopted counteracting strategies to increase the level of vigilance during night work hours. While a long nap seems to reduce the risk of accidents during the 01:00-07:00 h shift, policemen seem to underestimate the risk of sleepiness during the shift 19:00-01:00 h shift.     

机动车驾驶员道路交通伤害危险因素的病例对照研究

目的：探讨道路伤害中机动车驾驶员的危险因素，为进一步开展交通道路伤害预防提供科学依据。方法：采用病例对照研究方法，通过面询方法收集事故驾驶员和非事故驾驶员的一般情况、睡眠状况、急性困倦、吸烟、饮酒、违章驾驶行为等情况。以SPSS11．5软件进行统计分析。结果：调查了150名事故驾驶员和174名非事故驾驶员。在控制了其他影响因素情况下，驾驶时因感觉/判断错误、疏忽大意、遇紧急情况措施不当和违章操作的OR值（95％CI）分别是137．51（15．773-1198．876）、72．82（18．980-279．344）、25．16（3．097-204．398）和13．27（1．976-89．146）；初中及以下教育程度的驾驶员发生事故的危险性是高中及以上教育程度驾驶员的2．76倍（95％CI：1．082-7．021）；实际驾龄〈5年的驾驶员发生事故的危险性是实际驾龄≥5年的驾驶员的3．04倍（95％CI：1．235-7．457）；驾驶时感觉/判断失误与每周驾驶时间存在交互作用，每周驾驶时间≥40h的驾驶员，因感觉秽4断错误而发生交通事故的危险性低于每周驾驶时间〈40h的驾驶员（OR=0．022，95％CI：0．001-0．371）。结论：驾驶时疏忽大意、感觉/判断错误、遇紧急事故措施不当、违章操作、初中及以下教育程度、实际驾龄短是道路交通伤害中机动车驾驶员的危险因素。     

Impact of overnight traffic noise on sleep quality,sleepiness, and vigilant attention in long-haul truck drivers: Results of a pilot study

This study aimed to evaluate the impact of traffic noise along the motorway on sleep quality, sleepiness, and vigilant attention in long-haul truck drivers. This was a randomized, crossover, within-subject controlled study. Healthy long-haul truck drivers spent 6 consecutive nights in a real truck berth with full sleep laboratory equipment. During 3 nights, subjects were exposed to replayed traffic noise alongside motorways, whereas the other 3 nights were without traffic noise. Polysomnography was recorded during the nights and numerous sleepiness tests and vigilance examinations were performed during the following standardized working day. Outcome measures were compared between noisy and silent nights using the paired Wilcoxon test. Ten healthy long-haul truck drivers with a mean age of 36.3 ± 7.3 years completed the study as planned. On noisy nights, subjects had greater latencies to the rapid eye movement (REM) phase (90 ± 32 min vs 69 ± 16 min, P = 0.074) and higher percentages of sleep stage 1 (13.7 ± 5.5% vs 11.2 ± 4.4%; P = 0.059). Subjects also rated their sleep quality as having been better during nights without noise (28.1 ± 3.7 vs 30.3 ± 6.2, P = 0.092). The impact of these differences on daytime sleepiness and vigilance was rather low; however, mean Karolinska Sleepiness Scale (KSS) scores measured during the course of the following day were higher on six out of eight occasions after noisy nights. The effects of overnight traffic noise on sleep quality are detectable but unlikely to have any major impact on the vigilant attention and driving performance of long haul-truck drivers with low nocturnal noise sensitivity. This might not be true for subgroups prone to sleeping disorders.     

Obstructive sleep apnea-hypopnea syndrome patients with overweight and hypertension in a Japanese workplace

The objective of this study was to determine the relationship between obstructive sleep apnea-hypopnea syndrome (OSAHS) and overweight combined with hypertension and to examine whether OSAHS in conjunction with overweight and hypertension is associated with daytime sleepiness. In a Japanese workplace of 28,636 employees, 368 men (19-62 yr old), who were anxious regarding their OSAHS symptoms, underwent home pulse oximetry. Of these, 153 men subsequently underwent all-night polysomnography (PSG), and OSAHS was diagnosed in 149. We next classified these 149 men into the following groups: A [Overweight (-)/Hypertension (-), n=41], B [Overweight (-)/Hypertension (+), n=15], C [Overweight (+)/Hypertension (-), n=46], and D [Overweight (+)/Hypertension (+), n=47]. The Epworth Sleepiness Scale (ESS) was used to evaluate daytime sleepiness and the apnea-hypopnea index (AHI) was used to evaluate the severity of OSAHS. The averages of the ESS score and the AHI were compared in each group. Both the average ESS scores and the percentage of ESS scores > or =11 were not significantly different among the groups. The average AHI of group D was the highest among all of the groups and that of group C was significantly higher than those of groups A and B. In all the groups, the OSAHS patients with overweight and hypertension in this study had the highest AHI. The level of daytime sleepiness evaluated by the ESS in this study was almost the same in the OSAHS patients regardless of the degree of overweight or hypertension. These observations suggest that it is necessary to positively recommend PSG to men who are suspected of having OSAHS with overweight and hypertension, even if they do not have daytime sleepiness.     

Sleepiness in various shift combinations of irregular shift systems

The present study examined the occurrence of sleepiness in various shift combinations ending with a night or morning shift. Three weeks' sleep/work shift diary data, collected from 126 randomly selected train drivers and 104 traffic controllers, were used in statistical analyses. The occurrence of sleepiness at work (i.e., Karolinska Sleepiness Scale 7 or higher) was tested with a generalised linear model with repeated measurements including explanatory factors related to shifts, sleep, and individual characteristics. The prevalence of severe sleepiness varied between 25% and 62% in the combinations ending with a night shift and between 12% and 27% in the combinations ending with a morning shift. The occurrence of sleepiness did not, however, systematically vary between the shift combinations in either case. An increased risk for sleepiness was associated with high sleep need and long shift duration in the night shift and with high sleep need, short main sleep period, long shift duration and an early shift starting time in the morning shift. Also having a child was associated with an increased risk for sleepiness in the night shift. The results suggest that the shift history of 24-36 h prior to the night and the morning shift is not strongly associated with the occurrence of sleepiness at work, but there are other factors, such as shift length and starting time and sleep need, that affect a risk for sleepiness at work.     

Somnolence diurne excessive. Étude épidémiologique basée sur un questionnaire « sommeil/respiration »

BackgroundA field survey used a “sleep-breathing” questionnaire to estimate the prevalence of the excessive daytime sleepiness in a sample of middle-aged males.MethodsEight hundred and fifty men aged 22 to 66 years agreed to answer a questionnaire and have anthropometric measurements. To the question on excessive daytime sleepiness, 90 subjects (10.8%) responded “often” or “almost always”; 740 gave a negative answer.ResultsThe sleepy subjects were older and had a higher “central” weight. All the sleep-disturbed breathing symptoms and those suggesting sleep disturbances were more frequent in sleepy subjects. Sleepiness was significantly associated with sleep apnea and chronic bronchitis. Logistic regression identified six items independently associated with daytime sleepiness; there were three indirect indicators of sleepiness, age, a history of chronic bronchitis and disruptive movements during sleep.ConclusionsThis epidemiologic study in a sample of active middle-aged males confirms the association of daytime sleepiness with a series of respiratory and non-respiratory sleep disturbances. The original findings are the role of a “central” obesity, the association with nightmares, and the role of chronic bronchitis as a determinant of daytime sleepiness.