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Hypersomnolence and Sleep Related Complaints in Metropolitan, Urban, and Rural Georgia.

Decker MJ, Lin JS, Tabassum H, Reeves WC.
Hypersomnolence and Sleep Related Complaints in Metropolitan, Urban, and Rural Georgia
American Journal of Epidemiology DOI: 10.1093/aje/kwn365
The complete electronic version of this article is available at http://aje.oxfordjournals.org/cgi/content/full/kwn365

Summary

CFS presents a diagnostic and management challenge because there are no characteristic clinical signs or diagnostic laboratory abnormalities.  The typical clinical picture of CFS resembles that of sleep disorders; it is important for physicians to be aware of this and include evaluation for sleep disorders (many of which can be treated) when working up patients with suspected CFS.  Attempts to elucidate the pathophysiology of CFS must also consider sleep disorders. Most of the postulated etiologies of CFS (e.g., infection, immune and hormone perturbations) affect sleep; and, conversely, primary sleep disorders, sleep deprivation and experimental disruption of sleep produce many of the features of CFS (e.g., fatigue, impaired cognition, joint pain and stiffness). Indeed, untreated primary sleep disorders, such as sleep apnea and narcolepsy, preclude diagnosis of CFS.  In addition to the importance of evaluating the possible contribution of sleep pathology to CFS, insufficient sleep and primary sleep disorders themselves are associated with a variety of chronic conditions including diabetes, hypertension, cardiovascular disease, stroke, and obesity. Besides sleep disorders representing a harbinger of significant chronic morbidity and mortality, hypersomnolence poses hazards to both the affected individuals and others when commuting on public roadways or while operating public transport or commercial carrier systems.  By failing to maintain the necessary state of wakefulness to safely conduct critical processes under their jurisdiction, hypersomnolent individuals have contributed to catastrophic and potentially avoidable accidents, such as Three Mile Island, Chernobyl, and Bhopal.


Despite its importance, the prevalence of persistent hypersomnolence and accompanying sleep disorders within the general population remains unclear. Therefore, we took advantage of our CFS surveillance system to ascertain the prevalence of persistent hypersomnolence in metropolitan, urban, and rural Georgia.  We found that 16% of adults in Georgia reported problems staying awake during the day, about 30% reported insomnia (problems falling asleep, sleeping through the night, or unrefreshing sleep) and 33% reported snoring (a marker of sleep apnea.

Abstract

Persistent daytime hypersomnolence is associated with significant morbidity and mortality, but its prevalence in the population has been poorly documented. This study sought to characterize the prevalence of persistent daytime hypersomnolence, difficulties initiating and maintaining sleep, unrefreshing sleep, snoring, and the presence of physician-diagnosed sleep disorders in metropolitan, urban, and rural US Georgia populations. Between September 2004 and July 2005, a total of 6,530 randomly selected well and unwell adults, identified by screening interviews of 10,837 households (contacted by random digit dialing), completed a detailed phone interview. Sixteen percent reported persistent problems staying awake during the day; 26% reported persistent problems falling asleep at night; 31% experienced problems sleeping through the night; 34% were bothered by unrefreshing sleep; and 33% reported that they snored. In spite of the high occurrence of reported persistent sleep problems, only 10% of the survey participants reported having been diagnosed with a sleep disorder. These study findings highlight the need for increased public and clinician awareness with respect to proactively indentifying signs and symptoms of sleep disorders, a better understanding of their adverse impact upon morbidity and mortality, and their negative impact upon socioeconomic and academic potential.

Page last modified: January 15, 2009

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