Sleep Disorders Related to Chronic Gastroesophageal Reflux Disease (GERD): Determining Their Prevalence in the European and American General Population

February 10th 2017, Stanford Sleep Epidemiology Research Center (SSERC), Palo Alto.

National Sleep Foundation's sleep quality recommendations: first report

This effort provides evidence-based recommendations and guidance to the public regarding indicators of good sleep quality across the life-span. The National Sleep Foundation assembled a panel of experts from the sleep community and representatives appointed by stakeholder organizations (Sleep Quality Consensus Panel). A systemat- ic literature review identified 277 studies meeting inclusion criteria. Abstracts and full-text articles were provided to the panelists for review and discussion. A modified Delphi RAND/UCLA Appropriate- ness Method with 3 rounds of voting was used to determine agreement. For most of the sleep continuity variables (sleep latency, number of awakenings N5 minutes, wake after sleep onset, and sleep efficiency), the panel members agreed that these measures were appropriate indicators of good sleep quality across the life-span. However, overall, there was less or no consensus regarding sleep architecture or nap-related variables as elements of good sleep quality. This study showed that there is consensus among experts regarding some indicators of sleep quality among otherwise healthy individuals. Education and public health initiatives regarding good sleep quality will require

Ohayon, Maurice et al. "National Sleep Foundation's sleep quality recommendations: first report". Sleep Health: Journal of the National Sleep Foundation , Volume 3 , Issue 1 , 6 - 19

Refining duration and frequency thresholds of restless legs syndrome diagnosis criteria

This study assesses the prevalence of restless legs syndrome (RLS) using DSM-5 criteria and determines what is the most appropriate threshold for the frequency and duration of RLS symptoms. The Sleep-EVAL knowledge base system queried the interviewed subjects on life, sleeping habits, and health. Questions on sleep and mental and organic disorders (DSM-5, ICD- 10) were also asked. A representative sample of 19,136 noninstitutionalized individuals older than 18 years living in the United States was interviewed through a cross-sectional telephone survey. The participation rate was 83.2%. The prevalence of the 4 leg symptoms describing RLS occurring at least 1 d/wk varied between 5.7% and 12.3%. When the frequency was set to at least 3 d/wk, the prevalence dropped and varied between 1.8% and 4.5% for the 4 leg symptoms. Higher frequency of leg symptoms was associated with greater distress and impairment with a marked increase at 3 d/wk. Symptoms were mostly chronic, lasting for more than 3 months in about 97% of the cases. The prevalence of RLS according to DSM-5 was 1.6% (95% confidence interval 1.4%‐1.8%) when frequency was set at 3 d/wk. Stricter criteria for frequency of restless legs symptoms resulted in a reduction of prevalence of the disorder. The prevalence was further reduced when clinical impact was taken into consideration. Conclusions: In order to avoid inflation of case rates and to identify patients in whom treatment is truly warranted, using a more conservative threshold of 3 times or greater per week appears the most appropriate.

Ohayon, Maurice M., et al. "Refining duration and frequency thresholds of restless legs syndrome diagnosis criteria." Neurology 87.24 (2016): 2546-2553.

High Rates of Psychiatric Comorbidity in Narcolepsy: Findings From the Burden of Narcolepsy Disease (BOND) Study of 9,312 Patients in the United States

The objective of this study is to evaluate psychiatric comorbidity patterns in patients with a narcolepsy diagnosis in the United States. Truven Health Analytics MarketScan Research Databases were accessed to identify individuals ≥ 18 years of age with ≥ 1 ICD-9 diagnosis code(s) for narcolepsy continuously insured between 2006 and 2010 and non-narcolepsy controls matched 5:1 (age, gender, region, payer). Extensive subanalyses were conducted to confirm the validity of narcolepsy definitions. Narcolepsy subjects and controls were compared for frequency of psychiatric comorbid conditions (based on ICD-9 codes/Clinical Classification Software [CCS] level 2 categories) and psychiatric medication use. The final population included 9,312 narcolepsy subjects and 46,559 controls (each group, mean age = 46.1 years; 59% female). All categories of mental illness were significantly more prevalent in patients with narcolepsy versus controls, with the highest excess prevalence noted for CCS 5.8 Mood disorders (37.9% vs 13.8%; odds ratio [OR] = 4.0; 95% CI, 3.84.2), CCS 5.8.2 Depressive disorders (35.8% vs 13.0%; OR = 3.9; 95% CI, 3.7‐4.1), and CCS 5.2 Anxiety disorders (25.1% vs 11.9%; OR = 2.5; 95% CI, 2.4‐2.7). Excess prevalence of anxiety and mood disorders (narcolepsy vs controls) was higher in younger age groups versus older age groups. Psychiatric medication usage was higher in the narcolepsy group versus controls in the following categories: selective serotonin reuptake inhibitors (36% vs 17%), anxiolytic benzodiazepines (34% vs 19%), hypnotics (29% vs 13%), serotonin-norepinephrine reuptake inhibitors (21% vs 6%), and tricyclic antidepressants (13% vs 4%) (all P values < .0001). Narcolepsy is associated with significant comorbid psychiatric illness burden and higher psychiatric medication usage compared with the non-narcolepsy population.

Ruoff, Chad, et al. "High Rates of Psychiatric Comorbidity in Narcolepsy: Findings From the Burden of Narcolepsy Disease (BOND) Study of 9,312 Patients in the United States." The Journal of clinical psychiatry (2016).

Artificial Outdoor Nighttime Lights Associate with Altered Sleep Behavior in the American General Population

Our study aims to explore the associations between outdoor nighttime lights (ONL) and sleep patterns in the human population. Cross-sectional telephone study of a representative sample of the general US population age 18 y or older. 19,136 noninstitutionalized individuals (participation rate: 83.2%) were interviewed by telephone. The Sleep-EVAL expert system administered questions on life and sleeping habits; health; sleep, mental and organic disorders (Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision; International Classi cation of Sleep Disorders, Second Edition; International Classi cation of Diseases, 10th Edition). Individuals were geolocated by longitude and latitude. Outdoor nighttime light measurements were obtained from the Defense Meteorological Satellite Program's Operational Linescan System (DMSP/OLS), with nighttime passes taking place between 19:30 and 22:30 local time. Light data were correlated precisely to the geolocation of each participant of the general population sample. Results: Living in areas with greater ONL was associated with delayed bedtime (P < 0.0001) and wakeup time (P < 0.0001), shorter sleep duration (P < 0.01), and increased daytime sleepiness (P < 0.0001). Living in areas with greater ONL also increased the dissatisfaction with sleep quantity and quality (P < 0.0001) and the likelihood of having a diagnostic profile congruent with a circadian rhythm disorder (P < 0.0001). Although they improve the overall safety of people and traffic, nighttime lights in our streets and cities are clearly linked with modifications in human sleep behaviors and also impinge on the daytime functioning of individuals living in areas with greater ONL.

Ohayon, Maurice M., and Cristina Milesi. "Artificial outdoor nighttime lights associate with altered sleep behavior in the american general population." Sleep 39.6 (2016): 1311-1320.

Sleep-deprived motor vehicle operators are unfit to drive: a multidisciplinary expert consensus statement on drowsy driving

This article presents the consensus findings of the National Sleep Foundation Drowsy Driving Consensus Working Group, which was an expert panel assembled to establish a consensus statement regarding sleep-related driving impairment. The National Sleep Foundation assembled a expert panel comprised of experts from the sleep community and experts appointed by stakeholder organizations. A systematic literature review identified 346 studies that were abstracted and provided to the panelists for review. A modified Delphi RAND/UCLA Appropriateness Method with 2 rounds of voting was used to reach consensus. A final consensus was reached that sleep deprivation renders motorists unfit to drive a motor vehicle. After reviewing growing evidence of impairment and increased crash risk among drivers who obtained less than optimal sleep duration in the preceding 24 hours, the panelists recognized the need for public policy guidance as to when it is certainly unsafe to drive. Toward this end, the panelists agreed upon the following expert consensus statement: "Drivers who have slept for two hours or less in the preceding 24 hours are not fit to operate a motor vehicle." Panelists further agreed that most healthy drivers would likely be impaired with only 3 to 5 hours of sleep during the prior 24 hours. There is consensus among experts that healthy individuals who have slept for 2 hours or less in the preceding 24 hours are too impaired to safely operate a motor vehicle. Prevention of drowsy driving will require sustained and collaborative effort from multiple stakeholders. Implications and limitations of the consensus recommendations are discussed.

Czeisler, Charles A., et al. "Sleep-deprived motor vehicle operators are unfit to drive: a multidisciplinary expert consensus statement on drowsy driving." Sleep health 2.2 (2016): 94-99.

National Sleep Foundation's sleep time duration recommendations: methodology and results summary

The objective was to conduct a scientifically rigorous update to the National Sleep Foundation's sleep duration recommendations. The National Sleep Foundation convened an 18-member multidisciplinary expert panel, representing 12 stakeholder organizations, to evaluate scientific literature concerning sleep duration recommendations. We determined expert recommendations for sufficient sleep durations across the lifespan using the RAND/UCLA Appropriateness Method. The panel agreed that, for healthy individuals with normal sleep, the appropriate sleep duration for newborns is between 14 and 17 hours, infants between 12 and 15 hours, toddlers between 11 and 14 hours, preschoolers between 10 and 13 hours, and school-aged children between 9 and 11 hours. For teenagers, 8 to 10 hours was considered appropriate, 7 to 9 hours for young adults and adults, and 7 to 8 hours of sleep for older adults. Sufficient sleep duration requirements vary across the lifespan and from person to person. The recommendations reported here represent guidelines for healthy individuals and those not suffering from a sleep disorder. Sleep durations outside the recommended range may be appropriate, but deviating far from the normal range is rare. Individuals who habitually sleep outside the normal range may be exhibiting signs or symptoms of serious health problems or, if done volitionally, may be compromising their health and well-being.

Hirshkowitz, Max, et al. "National Sleep Foundation's sleep time duration recommendations: methodology and results summary." Sleep Health 1.1 (2015): 40-43.

Challenging the validity of the association between oversleeping and overeating in atypical depression

In this study, we used a strict definition of hypersomnia and tested if the association between overeating-hypersomnia remained positive and significant. Hypersomnia was present if the total sleep time was close to 10 h per day or was at least 2 h longer than in normothymic periods. Cross-sectional study using the adult general population of California and New York. The sample was composed of 6694 individuals aged between 18 and 96 years. Participants were interviewed by telephone using the Sleep-EVAL system. The interviews included various sleep and health topics and the assessment of DSM-IV sleep and psychiatric disorders. The one-month prevalence of major depressive episode was 6.1%, including a one-month prevalence of atypical depression of 1.6%, in this sample. Atypical depression subjects had a greater number of depressive symptoms and a longer duration of the current depressive episode than the other depressive subjects. Depressive subjects with hypersomnia slept longer (8 h, 29 min) than the other depressive subjects (6 h, 36 min) and longer than the subjects "getting too much sleep" (6 h, 48 min). Furthermore, hypersomnia was not associated with overeating while "getting too much sleep" showed a positive association with overeating. Hypersomnia needs to be evaluated using a strict definition. Otherwise, it leads to an overestimation of this symptom in major depressive episode subjects and to a false association with overeating.

Ohayon, Maurice M., and Laura Weiss Roberts. "Challenging the validity of the association between oversleeping and overeating in atypical depression." Journal of psychosomatic research 78.1 (2015): 52-57.

Increased Mortality in Narcolepsy

The objective of this study was to evaluate the mortality rate in patients with narcolepsy. Data were derived from a large database representative of the US population, which contains anonymized patient-linked longitudinal claims for 173 million individuals (Symphony Health Solutions (SHS) Source Lx). All records of patients registered in the SHS database between 2008 and 2010 were used. Identification of patients with narcolepsy was based on ≥ 1 medical claim with the diagnosis of narcolepsy (ICD-9 347.xx) from 2002 to 2012. Dates of death were acquired from the Social Security Administration via a third party; the third party information was encrypted in the same manner as the claims data such that anonymity is ensured prior to receipt by SHS. Annual all-cause mortality rates for 2008, 2009, and 2010 were calculated retrospectively for patients with narcolepsy and patients without narcolepsy in the database, and standardized mortality ratios (SMR) were calculated. Mortality rates were also compared with the general US population (Centers for Disease Control data). SMRs of the narcolepsy population were consistent over the 3-year period and showed an approximate 1.5-fold excess mortality relative to those without narcolepsy. The narcolepsy population had consistently higher mortality rates relative to those without narcolepsy across all age groups, strati ed by age decile, from 25-34 years to 75+ years of age. The SMR for females with narcolepsy was lower than for males with narcolepsy. Narcolepsy was associated with approximately 1.5-fold excess mortality relative to those without narcolepsy. While the cause of this increased mortality is unknown, these findings warrant further investigation.

Ohayon, Maurice M., et al. "Increased mortality in narcolepsy." Sleep 37.3 (2014): 439.

Are confusional arousals pathological?

The objective of this study was to determine the extent that confusional arousals (CAs) are associated with mental disorders and psychotropic medications. This cross-sectional study was conducted with a representative sample of 19,136 noninstitutionalized individuals of the US general population aged 18 years or older. The study was performed using the Sleep-EVAL expert system and investigated sleeping habits; health; and sleep, mental, and medical conditions (DSM-IV-TR, ICSD-II, ICD-10). A total of 15.2% (95% confidence interval 14.6%‐15.8%) (n 5 2,421) of the sample reported episodes of CAs in the previous year; 8.6% had complete or partial amnesia of the episodes and 14.8% had CAs and nocturnal wandering episodes. Eighty-four percent of CAs were associated with sleep/mental disorders or psychotropic drugs. Sleep disorders were present for 70.8% of CAs. Individuals with a circadian rhythm sleep disorder or a long sleep duration ($9 hours) were at higher risk of CAs. Mental disorders were observed in 37.4% of CAs. The highest odds were observed in individuals with bipolar disorders or panic disorder. Use of psy chotropic medication was reported by 31.3% of CAs: mainly antidepressant medications. After eliminating possible causes and associated conditions, only 0.9% of the sample had CA disorder. CAs are highly prevalent in the general population. They are often reported allegedly as a consequence of the treatment of sleep disorders. For the majority of subjects experiencing CAs, no medications were used, but among those who were using medications, antidepressants were most common. Sleep and/or mental disorders were important factors for CAs independent of the use of any medication.

Ohayon, Maurice M., Mark W. Mahowald, and Damien Leger. "Are confusional arousals pathological?." Neurology 83.9 (2014): 834-841.

Insomnia and accidents: cross-sectional study (EQUINOX) on sleep-related home, work and car accidents in 5293 subjects with insomnia from 10 countries

The link between sleepiness and the risk of motor vehicle accidents is well known, but little is understood regarding the risk of home, work and car accidents of subjects with insomnia. An international cross-sectional survey was conducted across 10 countries in a population of subjects with sleep disturbances. Primary care physicians administered a questionnaire that included assessment of sociodemographic characteristics, sleep disturbance and accidents (motor vehicle, work and home) related to sleep problems to each subject. Insomnia was defined using the International Classification of Sleep Disorders (ICSD-10) criteria. A total of 5293 subjects were included in the study, of whom 20.9% reported having had at least one home accident within the past 12 months, 10.1% at least one work accident, 9% reported having fallen asleep while driving at least once and 4.1% reported having had at least one car accident related to their sleepiness. All types of accident were reported more commonly by subjects living in urban compared to other residential areas. Car accidents were reported more commonly by employed subjects, whereas home injuries were reported more frequently by the unemployed. Car accidents were reported more frequently by males than by females, whereas home accidents were reported more commonly by females. Patients with insomnia have high rates of home accidents, car accidents and work accidents related to sleep disturbances indepen- dently of any adverse effects of hypnotic treatments. Reduced total sleep time may be one factor explaining the high risk of accidents in individuals who complain of insomnia.

Leger, Damien, et al. "Insomnia and accidents: cross-sectional study (EQUINOX) on sleep-related home, work and car accidents in 5293 subjects with insomnia from 10 countries." Journal of sleep research 23.2 (2014): 143-152.

Links between occupational activities and depressive mood in young adult populations

The objective of this study was to examine how occupational activities (work, school), separation from parents, environmental conditions, stressors ad social insertion affect on the prevalence of Major Depressive Disorder (MDD) and mental health care-seeking among young adults. This cross-sectional study was conducted in two samples: 1) 19,136 subjective representative of the US non-institutionalized general population including 2082 18e26 y.o. subjects. 2) 2196 subjects representative of the students' population living on an university campus. Telephone interviews were realized using the Sleep-EVAL system to assess sleeping habits, general health, organic, sleep and mental disorders. One-month prevalence of depressed mood was similar between community and campus student groups (21.7% and 23.4%), and less common than for working (23.6%) and non-working (28.2%) young adults in the community. One-month MDD was found in 12.0% of non-working young people, compared with 6.6% of young workers, 3.2% of on-campus students and 4.1% of students in the general population (p < 0.01). Correlates for depressive mood and MDD such as female gender, dissatisfaction with social life, obesity, living with pain and other factors were identified across groups. A minority of on-campus (10.8%) and general population students (10.3%) had sought mental health services in the prior year. Individuals with MDD had higher rates of care-seeking than other young people (p < 0.001), high rates of psychotropic medication use (p < 0.001). Being a student appears to have a protective effect with respect to having depressive symptoms or MDD and seeking needed mental health care. Stress and social isolation were important determinants for depression among young adults.

Ohayon, Maurice M., and Laura Weiss Roberts. "Links between occupational activities and depressive mood in young adult populations." Journal of psychiatric research 49 (2014): 10-17.

Chronic Obstructive Pulmonary Disease and its association with sleep and mental disorders in the general population

The aim of this study was to assess the prevalence of insomnia symptoms in Chronic Obstructive Pulmonary Disease (COPD) participants, their association with psychiatric disorders and their impact on health care utilization and quality of life. A cross-sectional telephone study was carried out using a representative sample consisting of 10,854 non-institutionalized individuals aged 15 or over living in Germany, Spain and the United Kingdom. Interviews were managed by the Sleep-EVAL expert system. The questionnaire included questions on sleeping habits, life habits, health, DSM-IV mental disorders, DSM-IV and ICSD sleep disorders. COPD was defined as chronic bronchitis or emphysema (treated or not) diagnosed by a physician. A total of 2.5% [2.1%e2.8%] of the sample reported having been diagnosed with COPD. As many as 48.1% of COPD had insomnia symptoms, which was twice higher than the rate observed in non-COPD (OR: 2.4). Only 11.8% of COPD addressed their sleep difficulties to their physician. Mental disorders were higher in COPD compared to non-COPD participants: Major Depressive disorder (AOR: 2.8); Generalized Anxiety Disorder (AOR: 11.0); Panic Disorder (AOR: 7.1) and Specific Phobia (AOR: 3.7). As many as 84.4% of COPD with depression and 59.7% of those with an Anxiety Disorder had associated insomnia symptoms. The co-occurrence of both conditions increased by five times the likelihood of hospitalizations in the previous year among COPD. Both conditions were associated with a diminished Quality of Life in COPD. COPD is a debilitating disease accompanied with psychiatric disorders and sleep disturbances in the overwhelming majority of cases. This high comorbidity is associated with greater health care utilization and great deterioration of the quality of life.

Ohayon, Maurice M. "Chronic obstructive pulmonary disease and its association with sleep and mental disorders in the general population." Journal of psychiatric research 54 (2014): 79-84.

The Burden of Narcolepsy Disease (BOND) study: health-care utilization and cost findings

The aim of this study was to characterize health-care utilization, costs, and productivity in a large population of patients diagnosed with narcolepsy in the United States. This retrospective, observational study using data from the Truven Health Analytics Market-Scan Research Databases assessed 5 years of claims data (2006-2010) to compare health-care utilization patterns, productivity, and associated costs among narcolepsy patients (identified by International Classification of Diseases, Ninth Revision (ICD9) narcolepsy diagnosis codes) versus matched controls. A total of 9312 narcolepsy patients (>18 years of age, continuously insured between 2006 and 2010) and 46,559 matched controls were identified. Compared with controls, narcolepsy subjects had approximately twofold higher annual rates of inpatient admissions (0.15 vs. 0.08), emergency department (ED) visits w/o admission (0.34 vs. 0.17), hospital outpatient (OP) visits (2.8 vs. 1.4), other OP services (7.0 vs. 3.2), and physician visits (11.1 vs. 5.6; all p < 0.0001). The rate of total annual drug transactions was doubled in narcolepsy versus controls (26.4 vs. 13.3; p < 0.0001), including a 337% and 72% higher usage rate of narcolepsy drugs and non-narcolepsy drugs, respectively (both p < 0.0001). Mean yearly costs were significantly higher in narcolepsy compared with controls for medical services ($8346 vs. $4147; p<0.0001) and drugs ($3356 vs. $1114; p < 0.0001). Narcolepsy was found to be associated with substantial personal and economic burdens, as indicated by significantly higher rates of health-care utilization and medical costs in this large US group of narcolepsy patients.

Black, Jed, et al. "The Burden of Narcolepsy Disease (BOND) study: health-care utilization and cost findings." Sleep medicine 15.5 (2014): 522-529.

Narcolepsy is complicated by high medical and psychiatric comorbidities: a comparison with the general population

Individuals affected with narcolepsy represent a vulnerable segment of the population. However, we only have a partial understanding of this vulnerability. Our study aims to examine psychiatric disorders and medical conditions associated with narcolepsy. A total of 320 narcoleptic participants were interviewed regarding sleeping habits, health, medication consumption, medical conditions (International Statistical Classification of Diseases and Related Health Problems, 10th edition), sleep disorders (International Classification of Sleep Disorders, second edition [ICSD-2]) and mental disorders (Diagnostic and Statistical Manual of Mental Disorders, fourth edi- tion, text revision [DSM-IV-TR]) using Sleep-EVAL. A general population comparison sample (N = 1464) matched for age, sex, and body mass index (BMI) and interviewed with the same instrument was used to estimate odds ratios (OR). Five diseases were more frequently observed among narcoleptic participants, including hypercholesterolemia (OR, 1.51), diseases of the digestive system (OR, 3.27), heart diseases (OR, 2.07), upper respiratory tract diseases (OR, 2.52), and hypertension (OR, 1.32). Most frequent psychiatric disorders among the narcolepsy group were major depressive disorder (MDD) (OR, 2.67) and social anxiety disorder (OR, 2.43), both affecting nearly 20% of narcoleptic individuals. However, most mood and anxiety disorders were more prevalent among the narcoleptic group. Alcohol abuse or alcohol dependence was comparable between groups. Narcolepsy is associated with a high comorbidity of both medical conditions and psychiatric disorders that need to be addressed when developing a treatment plan.

Ohayon, Maurice M. "Narcolepsy is complicated by high medical and psychiatric comorbidities: a comparison with the general population." Sleep medicine 14.6 (2013): 488-492.

Associations between morningness/eveningness and psychopathology: An epidemiological survey in three in-patient psychiatric clinics

This study aims to examine the association between the chronotype (morningness/eveningness) and specific mental disorders. A cross-sectional epidemiological study was conducted in three in-patient clinical settings. A total of 1468 consecutive in-patients who gave their written consent were enrolled. On the admission day, patients filled sleep questionnaires and a nurse filled a Clinical Global Impressions scale. Hospitalization reports and ICD-10 diagnoses were collected. Sleep/wake schedule was similar between the psychiatric diagnoses. On the other hand, morning type patients had an earlier bedtime, earlier wakeup time and shorter sleep duration than the other chronotype regardless of the diagnosis. In multivariate models, patients with a depressive disorder or a psychosis were more likely to be morning type. Patients with an anxiety disorder, addiction disorder or personality disorder were more likely to be evening type. Age and sleep/wake schedule are contributing factors for the chronotype but mental disorders too appeared to modulate chronotype preferences.

Lemoine, Patrick, Philippe Zawieja, and Maurice M. Ohayon. "Associations between morningness/eveningness and psychopathology: an epidemiological survey in three in-patient psychiatric clinics." Journal of psychiatric research 47.8 (2013): 1095-1098.

Hypersomnia and depressive symptoms: methodological and clinical aspects

The associations between depressive symptoms and hypersomnia are complex and often bidirectional. Of the many disorders associated with excessive sleepiness in the general population, the most frequent are mental health disorders, particularly depression. However, most mood disorder studies addressing hypersomnia have assessed daytime sleepiness using a single response, neglecting critical and clinically relevant information about symptom severity, duration and nighttime sleep quality. Only a few studies have used objective tools such as polysomnography to directly measure both daytime and nighttime sleep propensity in depression with normal mean sleep latency and sleep duration. Hypersomnia in mood disorders, rather than a medical condition per se, is more a subjective sleep complaint than an objective finding. Mood symptoms have also been frequently reported in hypersomnia disorders of central origin, especially in narcolepsy. Hypocretin deficiency could be a contributing factor in this condition. Further interventional studies are needed to explore whether management of sleep complaints improves mood symptoms in hypersomnia disorders and, conversely, whether management of mood complaints improves sleep symptoms in mood disorders.

Dauvilliers, Yves, et al. "Hypersomnia and depressive symptoms: methodological and clinical aspects." BMC medicine 11.1 (2013): 78.

Excessive Sleep Duration and Quality of Life

Using population-based data, we document the comorbidities (medical, neurologic, and psychiatric) and consequences for daily functioning of excessive quantity of sleep (EQS), defined as a main sleep period or 24-hour sleep duration 9 hours accompanied by complaints of impaired functioning or distress due to excessive sleep, and its links to excessive sleepiness. A cross-sectional telephone study was conducted using a representative sample of 19,136 noninstitutionalized individuals living in the United States, aged 18 years (participation rate 1/4 83.2%). The Sleep-EVAL expert system administered questions on life and sleeping habits; health; and sleep, mental, and organic disorders (Diagnostic and Statistical Manual of Mental Disorders, 4th edition, text revision; International Classification of Sleep Disorders: Diagnostic and Coding Manual II, International Classification of Diseases and Related Health Problems, 10th edition). Sleeping at least 9 hours per 24-hour period was reported by 8.4% (95% confidence interval 1/4 8.0-8.8%) of participants; EQS (prolonged sleep episode with distress/impairment) was observed in 1.6% (1.4-1.8%) of the sample. The likelihood of EQS was 3 to 12 higher among individuals with a mood disorder. EQS individuals were 2 to 4 more likely to report poor quality of life than non-EQS individuals as well as interference with socioprofessional activities and relationships. Although between 33 and 66% of individuals with prolonged sleep perceived it as a major problem, only 6.3 to 27.5% of them reported having sought medical attention. EQS is widespread in the general population, co-occurring with a broad spectrum of sleep, medical, neurologic, and psychiatric disorders. Therefore, physicians must recognize EQS as a mixed clinical entity indicating careful assessment and specific treatment planning.

Ohayon, Maurice M., Charles F. Reynolds, and Yves Dauvilliers. "Excessive sleep duration and quality of life." Annals of neurology 73.6 (2013): 785-794.

Hierarchy of insomnia criteria based on daytime consequences

We explored how insomnia symptoms are hierarchically organized in individuals reporting daytime consequences of their sleep disturbances. This is a cross-sectional study conducted in the general population of the states of California, New York, and Texas. The sample included 8937 individuals aged 18 years or older representative of the general population. Telephone interviews on sleep habits and disorders were managed with the Sleep-EVAL expert system and using DSM-IV and ICSD classifications. Insomnia symptoms and global sleep dissatisfaction (GSD) had to occur at least three times per week for at least three months. A total of 26.2% of the sample had a GSD. Individuals with GSD reported at least one insomnia symptom in 73.1% of the cases. The presence of GSD in addition to insomnia symptoms considerably increased the proportion of individuals with daytime consequences related to insomnia. In the classification trees performed, GSD arrived as the first predictor for daytime consequences related to insomnia. The second predictor was nonrestorative sleep followed by difficulty resuming sleep and difficulty initiating sleep. Classification trees are a useful way to hierarchically organize symptoms and to help diagnostic classifications. In this study, GSD was found to be the foremost symptom in identifying individuals with daytime consequences related to insomnia.

Ohayon, Maurice M., et al. "Hierarchy of insomnia criteria based on daytime consequences." Sleep medicine 13.1 (2012): 52-57.

EPIDEMIOLOGY OF RESTLESS LEGS SYNDROME: A SYNTHESIS OF THE LITERATURE

Restless legs syndrome (RLS) has gained considerable attention in the recent years: nearly 50 community-based studies have been published in the last decade around the world. The development of strict diagnostic criteria in 1995 and their revision in 2003 helped to stimulate research interest on this syndrome.

In community-based surveys, RLS has been studied as:

1. a symptom only,
2. a set of symptoms meeting minimal diagnostic criteria of the international restless legs syndrome study group (IRLSSG),
3. meeting minimal criteria accompanied with a specific frequency and/or severity, and
4. a differential diagnosis.

• In the first case, prevalence estimates in the general adult population ranged from 9.4% to 15%.
• In the second case, prevalence ranged from 3.9% to 14.3%.
• When frequency/severity is added, prevalence ranged from 2.2% to 7.9% and when differential diagnosis is applied prevalence estimates are between 1.9% and 4.6%.
• In all instances, RLS prevalence is higher in women than in men.

It also increases with age in European and North American countries but not in Asian countries. Symptoms of anxiety and depression have been consistently associated with RLS. Overall, individuals with RLS have a poorer health than non-RLS but evidence for specific disease associations is mixed.

Future epidemiological studies should focus on systematically adding frequency and severity in the definition of the syndrome in order to minimize the inclusion of cases mimicking RLS.

Ohayon, Maurice M., Ruth O'Hara, and Michael V. Vitiello. "Epidemiology of restless legs syndrome: a synthesis of the literature." Sleep medicine reviews 16.4 (2012): 283-295.

Conference consensus on excessive sleepiness

July 11th 2015, Stanford Sleep Epidemiology Research Center (SSERC), Palo Alto.

Usefulness and limits of clinical and biological tools to evaluate excessive sleepiness

November 14th 2014, Stanford Sleep Epidemiology Research Center (SSERC), Palo Alto.

Excessive Sleepiness is a symptom that affects nearly 25% of the general population. However, this symptom has not been widely studied; instruments to assess it are rare and were developed before 1995. Our understanding of the symptom has since then changed considerably. The goal of this symposium is to inform the attendees on the new research development in the acquisition of knowledge related to excessive sleepiness; the evolution of the concept of excessive sleepiness and to familiarize attendees with the legal, clinical and diagnostic implications of the existing tools used to measure excessive sleepiness. More specifically, usefulness and limits of current tools will be discussed along with the avenues to improve the assessment of excessive sleepiness. Objectives 1. What are the legal implications of excessive sleepiness in terms of legal issues (responsibility in accidents related to excessive sleepiness) and work-related issues (risks for the individuals and for the population) 2. What are the clinical implications in terms of evaluation and treatment. How accurate are the existing biological and clinical tools to determine when sleepiness is excessive and how it evolves over the time. 3. What is the place of excessive sleepiness in current classifications (DSM-5 and ICSD-3): Differences and similarities between DSM-5 and ICSD-3 for Excessive sleepiness

Association between insomnia symptoms and functional status in u.s. Older adults.

Spira AP, Kaufmann CN, Kasper JD, Ohayon MM, Rebok GW, Skidmore E, Parisi JM, Reynolds CF 3rd.
J Gerontol B Psychol Sci Soc Sci. 2014 Nov;69 Suppl 1:S35-41.

Moving Beyond Community Mental Health: Public Mental Health as an Emerging Focus for Psychiatry Residency Training.

Roberts LW, Beresin EV, Coverdale JH, Balon R, Louie AK, Kim JP, Ohayon MM.
Acad Psychiatry. 2014 Oct 23.

Are confusional arousals pathological?

J Psychiatr Res. 2014 Jul;54:79-84.

Increased mortality in narcolepsy.

Ohayon MM, Black J, Lai C, Eller M, Guinta D, Bhattacharyya A.
Sleep. 2014 Mar 1;37(3):439-44.

Links between occupational activities and depressive mood in young adult populations.

J Psychiatr Res. 2014 Jul;54:79-84.

Insomnia and accidents: cross-sectional study (EQUINOX) on sleep-related home, work and car accidents in 5293 subjects with insomnia from 10 countries.

Léger D, Bayon V, Ohayon MM, Philip P, Ement P, Metlaine A, Chennaoui M, Faraut B.
J Sleep Res. 2014 Apr;23(2):143-52.

Strengthening psychiatry's numbers.

Roberts LW, Ohayon M, Coverdale J, Goldsmith M, Beresin EV, Louie AK, Tait GR, Balon R.
Acad Psychiatry. 2013 Sep;37(5):293-6.

Excessive sleep duration and quality of life.

Ohayon MM, Reynolds CF 3rd, Dauvilliers Y.
Ann Neurol. 2013 Jun;73(6):785-94.

Narcolepsy is complicated by high medical and psychiatric comorbidities: a comparison with the general population.

Ohayon MM.
Sleep Med. 2013 Jun;14(6):488-92.

Associations between morningness/eveningness and psychopathology: an epidemiological survey in three in-patient psychiatric clinics.

Lemoine P, Zawieja P, Ohayon MM.
J Psychiatr Res. 2013 Aug;47(8):1095-8.

Hypersomnia and depressive symptoms: methodological and clinical aspects.

Dauvilliers Y, Lopez R, Ohayon M, Bayard S.
BMC Med. 2013 Mar 21;11:78.

Excessive sleepiness is predictive of cognitive decline in the elderly.

Jaussent I, Bouyer J, Ancelin ML, Berr C, Foubert-Samier A, Ritchie K, Ohayon MM, Besset A, Dauvilliers Y.
Sleep. 2012 Sep 1;35(9):1201-7.

Prostatic hyperplasia is highly associated with nocturia and excessive sleepiness: a cross-sectional study.

Chartier-Kastler E, Leger D, Comet D, Haab F, Ohayon MM.
BMJ Open. 2012 May 30;2(3).

Prevalence and comorbidity of nocturnal wandering in the U.S. adult general population.

Ohayon MM, Mahowald MW, Dauvilliers Y, Krystal AD, Léger D.
Neurology. 2012 May 15;78(20):1583-9.

Gate of hell: Excessive somnolence and excessive quantity of sleep prevalence, comorbidity and mortality

A Stanford Sleep Epidemiology Center Symposium
April 27th 2012
At the Stanford Sleep Epidemiology Research Center (SSERC)
3430 West Bayshore Road
Stanford

Why a meeting on Excessive Somnolence (ES) and Excessive Quantity of Sleep (EQS)? Hypersomnolence (DSM-5) is a broad diagnostic term and includes symptoms of Excessive Quantity of Sleep (e.g., extended nocturnal sleep or involuntary daytime sleep) and Excessive Somnolence (e.g. deteriorated quality of wakefulness as a sleep propensity during wakefulness and an inability to remain awake when required). The change from Sleepiness to Somnolence is not only cosmetic for one of the main problems encountered in the study of Excessive Daytime Sleepiness is the lack of uniformity of its definition. Somnolence is more accurate in the fact that its main expression is easily understandable and directly linked with the Hypersomnolence Disorder as recently defined by the DSM-5.

While there is a mounting evidence of the high prevalence of Excessive Somnolence in the community, its meaning in term of medical/psychological consequences remains understudied. There is a growing trend in labeling Excessive Somnolence as a disease or a disorder. So far, there is no data supporting this claim. Excessive Somnolence is not a disease or a disorder: it is a symptom of a sleep disorder or of another disease and for sure part of Hypersomnolence Disorder. There is some scientific evidence linking Excessive Somnolence to cognitive deficits and Excessive Quantity of Sleep to increased mortality risk in the community, but the links with specific sleep disorders remain to be established.

During this meeting, the participants will discuss on several aspects related to comorbidity, mortality and the mechanisms involved in Hypersomnolence Disorders. At the end of this meeting we will have a clearer picture on how we should orient our research efforts to improve our understanding of Hypersomnolence, how it should be measured and what we still have to learn in order to improve the quality of life of people complaining of Excessive Somnolence or Excessive Quantity of Sleep.

More Information: Stanford Sleep Epidemiology Journal