{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,1]],"date-time":"2026-10-01T18:25:08Z","timestamp":1790879108117,"version":"4.1.0"},"reference-count":35,"publisher":"Oxford University Press (OUP)","issue":"2","license":[{"start":{"date-parts":[[1999,2,1]],"date-time":"1999-02-01T00:00:00Z","timestamp":917827200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/pages\/standard-publication-reuse-rights"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[1999,2,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>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 ( &amp;lt; 5, 5 to &amp;lt; 15, 15 to &amp;lt; 30, \u2265 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 &amp;lt; 5 to 9.3 (4.9) in subjects with RDI \u2265 30 (p &amp;lt; 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 \u2265 11, increased from 21% in subjects with RDI &amp;lt; 5 to 35% in those with RDI \u2265 30 (p &amp;lt; 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.<\/jats:p>","DOI":"10.1164\/ajrccm.159.2.9804051","type":"journal-article","created":{"date-parts":[[2013,4,4]],"date-time":"2013-04-04T13:53:04Z","timestamp":1365083584000},"page":"502-507","source":"Crossref","is-referenced-by-count":450,"title":["Relation of Sleepiness to Respiratory Disturbance Index: The Sleep Heart Health Study"],"prefix":"10.1093","volume":"159","author":[{"given":"DANIEL J.","family":"GOTTLIEB","sequence":"first","affiliation":[{"name":"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"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"CORALYN W.","family":"WHITNEY","sequence":"additional","affiliation":[{"name":"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"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"WILLIAM H.","family":"BONEKAT","sequence":"additional","affiliation":[{"name":"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"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"CONRAD","family":"IBER","sequence":"additional","affiliation":[{"name":"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"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"GARY D.","family":"JAMES","sequence":"additional","affiliation":[{"name":"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"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"MICHAEL","family":"LEBOWITZ","sequence":"additional","affiliation":[{"name":"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"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"F. JAVIER","family":"NIETO","sequence":"additional","affiliation":[{"name":"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"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"CARL E.","family":"ROSENBERG","sequence":"additional","affiliation":[{"name":"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"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[1999,2,1]]},"reference":[{"key":"2026032708564510400_B1","doi-asserted-by":"crossref","first-page":"540","DOI":"10.1378\/chest.91.4.540","article-title":"Prevalence of reported sleep disturbances in a general adult population and their relationship to obstructive airways diseases.","volume":"91","author":"Klink","year":"1987","journal-title":"Chest"},{"key":"2026032708564510400_B2","doi-asserted-by":"crossref","first-page":"100","DOI":"10.1093\/sleep\/11.1.100","article-title":"Catastrophes, sleep, and public policy: consensus report.","volume":"11","author":"Mitler","year":"1988","journal-title":"Sleep"},{"key":"2026032708564510400_B3","doi-asserted-by":"crossref","first-page":"562","DOI":"10.1016\/S0149-2918(96)80207-4","article-title":"Etiologies and sequelae of excessive daytime sleepiness.","volume":"18","author":"Roth","year":"1996","journal-title":"Clin. 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Engl. J. Med."},{"key":"2026032708564510400_B14","doi-asserted-by":"crossref","first-page":"65","DOI":"10.1093\/sleep\/20.1.65","article-title":"Prevalence of sleep-disordered breathing in ages 40\u201364 years: a population-based survey.","volume":"20","author":"Kripke","year":"1997","journal-title":"Sleep"},{"key":"2026032708564510400_B15","doi-asserted-by":"crossref","first-page":"478","DOI":"10.1093\/sleep\/9.4.478","article-title":"Sleep-disordered breathing and its concomitants in a subclinical population.","volume":"9","author":"Berry","year":"1986","journal-title":"Sleep"},{"key":"2026032708564510400_B16","doi-asserted-by":"crossref","first-page":"845","DOI":"10.1164\/ajrccm\/136.4.845","article-title":"Clinical significance of sleep apnea in the elderly.","volume":"136","author":"Knight","year":"1987","journal-title":"Am. Rev. Respir. Dis."},{"key":"2026032708564510400_B17","first-page":"345","article-title":"Sleep-disordered breathing in the healthy elderly.","volume":"101","author":"Phillips","year":"1992","journal-title":"Sleep"},{"key":"2026032708564510400_B18","first-page":"1077","article-title":"The Sleep Heart Health Study: design, rationale and methods.","volume":"20","author":"Quan","year":"1997","journal-title":"Sleep"},{"key":"2026032708564510400_B19","doi-asserted-by":"crossref","first-page":"540","DOI":"10.1093\/sleep\/14.6.540","article-title":"A new method for measuring daytime sleepiness: the Epworth Sleepiness Scale.","volume":"14","author":"Johns","year":"1991","journal-title":"Sleep"},{"key":"2026032708564510400_B20","doi-asserted-by":"crossref","first-page":"376","DOI":"10.1093\/sleep\/15.4.376","article-title":"Reliability and factor analysis of the Epworth Sleepiness Scale.","volume":"15","author":"Johns","year":"1992","journal-title":"Sleep"},{"key":"2026032708564510400_B21","doi-asserted-by":"crossref","first-page":"703","DOI":"10.1093\/sleep\/17.8.703","article-title":"Sleepiness in different situations measured by the Epworth Sleepiness Scale.","volume":"17","author":"Johns","year":"1994","journal-title":"Sleep"},{"key":"2026032708564510400_B22","doi-asserted-by":"crossref","first-page":"1257","DOI":"10.1176\/ajp.136.10.1257","article-title":"Prevalence of sleep disorders in the Los Angeles metropolitan area.","volume":"136","author":"Bixler","year":"1979","journal-title":"Am. 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Psychosom. Res."},{"key":"2026032708564510400_B35","doi-asserted-by":"crossref","first-page":"608","DOI":"10.1093\/sleep\/20.8.608","article-title":"Sleep-disordered breathing and motor vehicle accidents in a population-based sample of employed adults.","volume":"20","author":"Young","year":"1997","journal-title":"Sleep"}],"container-title":["American Journal of Respiratory and Critical Care Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/ajrccm\/article-pdf\/159\/2\/502\/67429911\/ajrccm_159_2_502.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/ajrccm\/article-pdf\/159\/2\/502\/67429911\/ajrccm_159_2_502.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,3,27]],"date-time":"2026-03-27T12:57:01Z","timestamp":1774616221000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/ajrccm\/article\/159\/2\/502\/8530079"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[1999,2,1]]},"references-count":35,"journal-issue":{"issue":"2","published-online":{"date-parts":[[1999,2,1]]},"published-print":{"date-parts":[[1999,2,1]]}},"URL":"https:\/\/doi.org\/10.1164\/ajrccm.159.2.9804051","relation":{},"ISSN":["1073-449X","1535-4970"],"issn-type":[{"value":"1073-449X","type":"print"},{"value":"1535-4970","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[1999,2]]},"published":{"date-parts":[[1999,2,1]]}}}