Excessive Daytime Sleepiness in Young Adults: A 20-Year Prospective Community Study
J Clin Psychiatry 2005;66(4):521-529
© Copyright 2014 Physicians Postgraduate Press, Inc.
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Objective: Excessive daytime sleepiness (EDS) is
a symptom with high clinical and public health importance because
of its association with increased risk for accidents, decreased
productivity, and impaired quality of life. Little information is
available regarding the longitudinal course or clinical
correlates of EDS. The aim of this study was to explore
associations between self-reported EDS, sleep disorder symptoms,
major depression, and anxiety in a longitudinal community study
of young adults.
Method: A prospective single-age
community study of young adults (Zurich Cohort Study) was
conducted from 1978 through 1999. Information was derived from 6
interviews administered when participants (N = 591) were ages 20,
22, 27, 29, 34, and 40 years. Trained health professionals
administered a semistructured interview for health habits and
psychiatric and medical conditions. The presence of either or
both of 2 symptoms--accidentally falling asleep or excessive need
for sleep during the day--was used to establish the presence of
Results: EDS was a common complaint among
the study participants, with increasing prevalence with age.
Cross-sectionally, EDS was associated with insomnia symptoms,
nocturnal hypersomnia, anxiety disorders, somatization, and
reduced quality of life. Longitudinally, impaired sleep quality,
waking up too early, and anxiety were associated with later EDS.
Conversely, EDS was not significantly associated with later
anxiety or depressive disorders.
Conclusions: Insomnia symptoms and anxiety are
associated with the subsequent occurrence of EDS. Although these
findings do not demonstrate causality, insomnia and anxiety
disorders are prevalent and treatable conditions, and our results
may have important clinical implications for the prevention and
treatment of EDS. Whether the results of this study are limited
to populations with elevated levels of psychopathology remains to