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    • Daytime somnolence was assessed by

    2018-11-05

    Daytime somnolence was assessed by the use of the Epworth sleepiness scale, which consists of eight questions rated on a four point Likert scale ranging from 0 (no chance of falling asleep) to 3 (high chance of falling asleep) with a maximum total score of 24; a score ≥10 is considered positive [11].
    Results The door-to-door survey disclosed 688 Atahualpa residents aged ≥40 years. Of these, 26 refused to participate and 27 were excluded because of a stroke. Therefore, daytime somnolence and CVH status were evaluated in 635 persons (mean age 59±12.5 years; 58% women). Overall, 140 persons (22%) had EDS, defined as a score ≥10 in the Epworth sleepiness scale. Mean age and the percentage of women were similar across persons with and without EDS. A poor CVH was noticed in 436 persons (68.7%). Persons with a poor CVH were older than those with intermediate/ideal CVH (mean±SD age: 60.4±12.7 versus 55.9±11.4 years, p<0.001), but there were no difference in the percentage of women across both groups (56% versus 61%, p=0.286). In a generalized linear model, after adjusting for age and sex, EDS was not associated with a poor CVH status (OR: 1.03; 95% C.I.: 0.68–1.56). The percentage of some individual metrics in the poor range – mainly physical activity and blood MDV 3100 levels – were slightly higher among persons with than in those without EDS; however, such differences did not reach statistical significance (Table 1).
    Discussion This study shows no association between EDS and a poor CVH status in Natives/Mestizos living in rural Ecuador. This could be partly related to the high number of persons with EDS, a problem that has also been reported from other rural populations [12], and that may not be necessary related to an increased prevalence of OSA, but to the peaceful lifestyle at the rural level, providing a scenario for daytime dozing. In addition, there are limitations with the use of Epworth sleepiness scale as it does not consider circadian variations and induces people to imagine themselves in situations that may not be habitual to them. Furthermore, motivation can supersede EDS at least temporarily and variations in the Epworth sleepiness scale score over time can occur. As we assessed EDS and CVH status in a cross-sectional survey, we could not evaluate whether incident vascular events are increased among persons with EDS. Longitudinal studies in these underserved populations are warranted to settle the risk of vascular events or vascular death according to the presence of EDS (irrespective of the CVH status). In addition, sodium-potassium pump is difficult to determine the actual prevalence and severity of OSA on the basis of self-reported EDS, since the latter may be related to a number of different conditions such as metabolic or toxic diseases, or the use of certain drugs [13]. Future studies should include direct measures of sleep architecture that only polysomnography may provide [5].
    Conflicts of interest
    Funding
    Introduction The National Sleep Foundation (NSF), in its 2005 “Sleep in America” poll, noted that 40% of Americans reported getting fewer than seven hours of sleep per night on weekdays, with an average sleep length for adults on weekdays of 6.9h per night. Additionally, when measuring sleep habits, results indicated that only 49% of participants reported having “a good night׳s sleep” almost every night [27]. Furthermore, there are some variations in sleep quality demographically; women reported needing more sleep than men (6.8h vs. 6.2h) and older adults were more likely to report often having a good night׳s sleep (38% of 18–29 year olds vs. 60% of those 65 and older) [27]. In subsequent press releases, the NSF concluded that inadequate sleep contributes to vehicular accidents, work tardiness, absenteeism, and relationship problems [28]. However, a mere 22% percent reported getting less sleep than they needed to “function their best” [27]. Overall, this suggests that many Americans are not aware of their sleep needs, sleep deficiency, or daytime deficits in functioning due to inadequate sleep.