{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,25]],"date-time":"2026-09-25T05:59:26Z","timestamp":1790315966953,"version":"4.1.0"},"reference-count":44,"publisher":"Wiley","issue":"2","license":[{"start":{"date-parts":[[2025,8,19]],"date-time":"2025-08-19T00:00:00Z","timestamp":1755561600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2025,8,19]],"date-time":"2025-08-19T00:00:00Z","timestamp":1755561600000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"funder":[{"DOI":"10.13039\/100000050","name":"National Heart, Lung, and Blood Institute","doi-asserted-by":"publisher","award":["K25HL152006"],"award-info":[{"award-number":["K25HL152006"]}],"id":[{"id":"10.13039\/100000050","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100015620","name":"Center for Innovations in Quality, Effectiveness and Safety","doi-asserted-by":"publisher","award":["CIN 13\u2010413"],"award-info":[{"award-number":["CIN 13\u2010413"]}],"id":[{"id":"10.13039\/100015620","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100007915","name":"Baylor College of Medicine","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100007915","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Journal of Sleep Research"],"published-print":{"date-parts":[[2026,4]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:p>Excessive daytime sleepiness (EDS) is linked to adverse clinical outcomes. This study evaluated changes in a validated tool to assess EDS, the Epworth Sleepiness Scale (ESS) and mortality risk. This retrospective cohort study included Veterans receiving sleep\u2010related services in the Department of Veterans Affairs (VA) from October 4, 1999 to August 18, 2018, with two qualifying ESS measures. ESS values were extracted from patient notes using a validated natural language processing (NLP) pipeline (96% accuracy). ESS scores were categorised as Normal (0\u201310) or Abnormal (11\u201324). Patients were grouped based on ESS changes: Normal\u2010Normal, Normal\u2010Abnormal, Abnormal\u2010Abnormal and Abnormal\u2010Normal. Cox proportional hazards models adjusted for time, age, sex, race and comorbid conditions assessed the risk of 5\u2010year all\u2010cause mortality. Among 17,967 qualifying Veterans (mean age: 56.3 (SD 13.5) years), 11.75% died within 5\u2009years of the second ESS measure. At baseline, 9342 (52.0%) had EDS, for whom 2232 (12.4%) improved to normal by the second exam (Abnormal\u2010Normal). The Normal\u2010Abnormal group had a 25% higher adjusted all\u2010cause mortality risk within 5\u2009years (aHR: 1.25, 95% CI: 1.09, 1.44) compared to the Normal\u2010Normal group, with progressively increasing risk after age 55. In contrast, neither persistent abnormal sleepiness (Abnormal\u2010Abnormal) nor improvement from abnormal to normal (Abnormal\u2010Normal) was associated with significantly different mortality risk compared to the Normal\u2010Normal group. ESS can efficiently identify EDS, which may serve as a clinical marker for 5\u2010year all\u2010cause mortality risk, particularly among Veterans seeking VHA sleep services aged 55 and older.<\/jats:p>","DOI":"10.1111\/jsr.70168","type":"journal-article","created":{"date-parts":[[2025,8,19]],"date-time":"2025-08-19T10:21:23Z","timestamp":1755598883000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Changes in Self\u2010Reported Excessive Daytime Sleepiness Are Associated With 5\u2010Year All\u2010Cause Mortality Risk Among Veterans"],"prefix":"10.1111","volume":"35","author":[{"ORCID":"https:\/\/orcid.org\/0009-0008-8489-3227","authenticated-orcid":false,"given":"Katherine G.","family":"Bay","sequence":"first","affiliation":[{"name":"Center for Innovations in Quality, Effectiveness and Safety (IQuESt)  Houston Texas USA"},{"name":"Department of Medicine Baylor College of Medicine  Houston Texas USA"},{"name":"Big Data Scientist Training Enhancement Program (BD\u2010STEP), VA Office of Research and Development  Washington DC USA"},{"name":"Michael E. DeBakey VA Medical Center  Houston Texas USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Arash","family":"Maghsoudi","sequence":"additional","affiliation":[{"name":"Center for Innovations in Quality, Effectiveness and Safety (IQuESt)  Houston Texas USA"},{"name":"Department of Medicine Baylor College of Medicine  Houston Texas USA"},{"name":"Michael E. DeBakey VA Medical Center  Houston Texas USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0002-7952-3009","authenticated-orcid":false,"given":"Amin","family":"Ramezani","sequence":"additional","affiliation":[{"name":"Brigham and Women's Hospital, Harvard Medical School  Boston Massachusetts USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Drew A.","family":"Helmer","sequence":"additional","affiliation":[{"name":"Center for Innovations in Quality, Effectiveness and Safety (IQuESt)  Houston Texas USA"},{"name":"Department of Medicine Baylor College of Medicine  Houston Texas USA"},{"name":"Big Data Scientist Training Enhancement Program (BD\u2010STEP), VA Office of Research and Development  Washington DC USA"},{"name":"Michael E. DeBakey VA Medical Center  Houston Texas USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Amir","family":"Sharafkhaneh","sequence":"additional","affiliation":[{"name":"Department of Medicine Baylor College of Medicine  Houston Texas USA"},{"name":"Michael E. DeBakey VA Medical Center  Houston Texas USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Javad","family":"Razjouyan","sequence":"additional","affiliation":[{"name":"Center for Innovations in Quality, Effectiveness and Safety (IQuESt)  Houston Texas USA"},{"name":"Department of Medicine Baylor College of Medicine  Houston Texas USA"},{"name":"Big Data Scientist Training Enhancement Program (BD\u2010STEP), VA Office of Research and Development  Washington DC USA"},{"name":"Michael E. DeBakey VA Medical Center  Houston Texas USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2025,8,19]]},"reference":[{"key":"e_1_2_10_2_1","doi-asserted-by":"publisher","DOI":"10.1001\/archinte.160.21.3252"},{"issue":"4","key":"e_1_2_10_3_1","first-page":"287","article-title":"Performance of Epworth Sleepiness Scale and Tiredness Symptom Used With Simplified Diagnostic Tests for the Identification of Sleep Apnea","volume":"12","author":"Borsini E.","year":"2019","journal-title":"Sleep Science"},{"key":"e_1_2_10_4_1","doi-asserted-by":"publisher","DOI":"10.5664\/jcsm.7108"},{"key":"e_1_2_10_5_1","doi-asserted-by":"publisher","DOI":"10.1016\/0021-9681(87)90171-8"},{"key":"e_1_2_10_6_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.sleh.2023.10.009"},{"key":"e_1_2_10_7_1","doi-asserted-by":"publisher","DOI":"10.1016\/0895-4356(92)90133-8"},{"key":"e_1_2_10_8_1","doi-asserted-by":"publisher","DOI":"10.3390\/jcm11010067"},{"key":"e_1_2_10_9_1","doi-asserted-by":"publisher","DOI":"10.5664\/jcsm.2754"},{"key":"e_1_2_10_10_1","doi-asserted-by":"publisher","DOI":"10.1038\/sj.ijo.0802126"},{"key":"e_1_2_10_11_1","doi-asserted-by":"publisher","DOI":"10.5665\/sleep.4488"},{"key":"e_1_2_10_12_1","doi-asserted-by":"publisher","DOI":"10.1002\/sim.3378"},{"key":"e_1_2_10_13_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.mayocp.2020.08.033"},{"key":"e_1_2_10_14_1","doi-asserted-by":"publisher","DOI":"10.1038\/s42003-021-02825-4"},{"key":"e_1_2_10_15_1","article-title":"Prevalence of Obstructive Sleep Apnea Among Veterans and Nonveterans","volume":"39","author":"Goldstein L. A.","year":"2024","journal-title":"American Journal of Health Promotion"},{"key":"e_1_2_10_16_1","doi-asserted-by":"publisher","DOI":"10.1080\/07853890.2024.2352028"},{"key":"e_1_2_10_17_1","doi-asserted-by":"publisher","DOI":"10.1631\/jzus.B1300109"},{"key":"e_1_2_10_18_1","doi-asserted-by":"publisher","DOI":"10.1093\/sleep\/30.10.1245"},{"key":"e_1_2_10_19_1","doi-asserted-by":"publisher","DOI":"10.1093\/sleep\/14.6.540"},{"key":"e_1_2_10_20_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.smrv.2007.01.002"},{"key":"e_1_2_10_21_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.sleh.2019.09.004"},{"key":"e_1_2_10_22_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.sleep.2015.01.007"},{"key":"e_1_2_10_23_1","doi-asserted-by":"publisher","DOI":"10.1111\/jsr.13019"},{"key":"e_1_2_10_24_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.sleep.2020.07.048"},{"key":"e_1_2_10_25_1","doi-asserted-by":"publisher","DOI":"10.3390\/nu14245196"},{"key":"e_1_2_10_26_1","doi-asserted-by":"publisher","DOI":"10.5664\/jcsm.11254"},{"key":"e_1_2_10_27_1","doi-asserted-by":"publisher","DOI":"10.5664\/jcsm.8486"},{"key":"e_1_2_10_28_1","doi-asserted-by":"publisher","DOI":"10.3390\/diseases9040088"},{"key":"e_1_2_10_29_1","doi-asserted-by":"publisher","DOI":"10.3138\/jmvfh-2020-0038"},{"key":"e_1_2_10_30_1","unstructured":"National Center for Health Statistics.2024.\u201cPublic\u2010Use Linked Mortality Files.\u201d"},{"key":"e_1_2_10_31_1","unstructured":"National Heart Lung and Blood Institute.2019.\u201cAdvancing the Science of Sleep and Circadian Biology Research in SLEEP RESEARCH PLAN.\u201dNational Institutes of Health."},{"key":"e_1_2_10_32_1","doi-asserted-by":"publisher","DOI":"10.5664\/jcsm.26512"},{"key":"e_1_2_10_33_1","doi-asserted-by":"publisher","DOI":"10.1007\/s11695-010-0335-4"},{"key":"e_1_2_10_34_1","doi-asserted-by":"publisher","DOI":"10.1097\/NT.0000000000000092"},{"key":"e_1_2_10_35_1","doi-asserted-by":"publisher","DOI":"10.1007\/s11325-005-0043-9"},{"key":"e_1_2_10_36_1","doi-asserted-by":"publisher","DOI":"10.1007\/s11325-012-0700-8"},{"key":"e_1_2_10_37_1","doi-asserted-by":"publisher","DOI":"10.1378\/chest.08-0934"},{"key":"e_1_2_10_38_1","doi-asserted-by":"publisher","DOI":"10.1111\/jsr.13476"},{"key":"e_1_2_10_39_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.sleep.2021.03.015"},{"key":"e_1_2_10_40_1","doi-asserted-by":"publisher","DOI":"10.1111\/jsr.12687"},{"key":"e_1_2_10_41_1","unstructured":"The Management of Chronic Insomnia Disorder and Obstructive Sleep Apnea Work Group.2019.\u201cVA\/DoD Clinical Practice Guideline for the Management of Chronic Insomnia Disorder and Obstructive Sleep Apnea. U.S. Department of Veterans Affairs.\u201d"},{"key":"e_1_2_10_42_1","unstructured":"Veterans Affairs.2024.\u201cEligibility for VA Health Care.\u201dhttps:\/\/www.va.gov\/health\u2010care\/eligibility\/."},{"key":"e_1_2_10_43_1","doi-asserted-by":"publisher","DOI":"10.1038\/ijo.2013.172"},{"key":"e_1_2_10_44_1","doi-asserted-by":"publisher","DOI":"10.1007\/s11325-020-02015-2"},{"key":"e_1_2_10_45_1","doi-asserted-by":"publisher","DOI":"10.3945\/ajcn.113.068122"}],"container-title":["Journal of Sleep Research"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/jsr.70168","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1111\/jsr.70168","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/jsr.70168","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,25]],"date-time":"2026-09-25T05:18:31Z","timestamp":1790313511000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/jsr.70168"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,8,19]]},"references-count":44,"journal-issue":{"issue":"2","published-print":{"date-parts":[[2026,4]]}},"alternative-id":["10.1111\/jsr.70168"],"URL":"https:\/\/doi.org\/10.1111\/jsr.70168","archive":["Portico"],"relation":{},"ISSN":["0962-1105","1365-2869"],"issn-type":[{"value":"0962-1105","type":"print"},{"value":"1365-2869","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,8,19]]},"assertion":[{"value":"2025-02-04","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-07-27","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-08-19","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"e70168"}}