1. Excessive day time sleepiness as assessed by Modified Epworth Sleepiness Scale among urban elderly population: Results from the preliminary data of AIIMS Cohort Study
Ashok Kumar Patel, Arun Kumar Yadav, Bhaskar Thakur, Renu Bhasin, Suprabha Srivastava, Deepti Vibha, Manjari Tripathi, S.N. Dwivedi, Shashi Kant, Kameshwar Prasad for AIIMS Cohort Study Group*
All India Institute of Medical Sciences, New Delhi, India
Table: Frequency and Percentage of Chance of Dozing in various situations
INTRODUCTION s
Would Never Doze
Frequency (%)
Slight Chance of Dozing
Moderate chance of Dozing
High Chance of Dozing
Sitting & Reading
369 (54.75)
182 (27.00)
94 (13.95)
29(4.30) 
Watching TV
338 (50.00)
192 (28.40)
121 (17.90)
25(3.70)
Sitting inactive in a public place
546 (81.01)
93 (13.80)
29 (4.30)
6(0.89)
As a passenger in a car/bus/train
426 (63.02)
159 (23.52)
60 (8.88)
31(4.58)
Laying down to rest in the afternoon when circumstances permit
343(50.66)
206 (30.43)
97(14.33)
31 (4.58)
Sitting and Talking to someone
638(94.38)
33 (4.88)
5(0.74)
0.00
Sitting quietly after lunch
236(34.86)
239 (35.30)
150(22.16)
52 (7.66)
In a car (while driving), while stopped for few minutes
629(96.18)
17 (2.60)
 5(0.76)
 3 (0.46)
AIIMS Cohort Study has been launched in AIIMS, New Delhi India in collaboration with Erasmus University Rotterdam, the Netherlands.
This study aimed to recruit 7,500 elderly populations in each of rural & urban settings in India with the goal to study the known as well as novel determinants of stroke and cognitive function among elderly population.
Within this study, day time sleepiness was assessed with the help of modified Epworth sleep questionnaire.
Excessive daytime sleepiness (EDS) is commonly a secondary symptom of sleep disorders and it is characterized by the difficult in maintaining awake in the wake period1.
In addition, it is also related to poor health status.
Excessive daytime sleepiness is a public health concern.
It can be caused by disorders such as Obstructive Sleep Apnea (OSA), which is a known risk factor for stroke.
Hence this present study has been undertaken to estimate the prevalence of the excessive daytime sleepiness in urban Indian population.
DISCUSSION
OBJECTIVE
An average score of modified Epworth sleepiness scale was found 4.05 in our participants.
Male participants has reported more excessive day time sleepiness than female. But there is no significant difference was found in our population similar result has been reported by Lee H.J et al
Age groups, group (60-69) has reported more day time sleepiness in comparison of other group (50-59, 70-79, 80 & above). Few studies has reported excessive day time sleepiness more likely in increasing age but we could not found in our participants.
This difference may occurred due to cultural variation and not enough sample size.
There is no significant difference between diabetic and non diabetic in our participants.
There is no significant difference between obese and normal weight in our participants.
Moderate and high chances of dozing while sitting and reading, watching TV, sitting inactive in public places, as a passenger in a car/bus/train, rest in afternoon, sitting and talking, sitting quietly after lunch and travelling in car was noted in our participants.
To estimate the prevalence of the excessive daytime sleepiness in urban Indian population.
To see the association between Epworth sleepiness score and diabetics.
To see the association between Epworth score and obesity.
 MATERIALS
AIIMS cohort study has been started in India with the scientific goal to study known as well as novel determinants of stroke and cognitive function among elderly (>50 years) Indian population with the aim to recruit population.
Within this study, data on day time sleepiness is collected with the help of the Modified Epworth Sleepiness Scale by trained social worker from urban site (Vasant Kunj).
The data on modified Epworth Sleepiness Scale is available for 709 participant.
 STATISTICAL ANALYSIS 
Descriptive statistics:
Mean and Standard Deviation were calculated for continuous variables
Frequency measures were used for categorical variables.
A P value of < 0.05 was considered as statistically significant.
Data was analyzed using the STATA, version 13.0 (StataCorp  Stata Statistical Software: Release 13. College Station, TX: StataCorp LP).
LIMITATION
Sample size may not be enough to detect the significant association.
The baseline data could not capture any event of stroke as well as cognitive decline.
Therefore additionally we could not quantify the association of excessive daytime sleepiness with these events.
RESULTS
A total of 50.07% female & 49.93% male were participated in this study. Mean age (SD) 64.2 (±8.2) female & 66.9 (±9.1) Male, P value =
Mean value of Epworth score in population was 4.05 (±3.57).
Table. Association Between Excessive Day Time Sleepiness and Demographic Characteristics
CONCLUSION
We found that highest chance of dozing in our participants is in situation “sitting quietly after lunch”. This study suggests for further research to establish association between day time sleepiness, diabetes and obesity.
Variables
Epworth N
Mean
P Value
Gender
Female
355
3.84±3.37
0.230
Male
354
4.27±3.74
Age Group
50-59
171
4.09±3.89
0.820
60-69
278
4.16±3.58
70-79
159
3.97±3.28
80 & above 41
3.58±3.22
Diabetes status
Non- Diabetic
443
4.02 ±3.5
0.743
Diabetic
189
4.12 ±3.6
Obese
Non-obese
458
4.1±3.6
0.827
165
4.0±3.6
COMPETING INTEREST
Authors are the investigators of AIIMS Cohort Study.
FUNDING SOURSE
Department of Biotechnology, Government of India, New Delhi, India.
ACKNOWLEDGEMENT
We acknowledge the technical assistance of staff members of the Neurology Department of All India Institute of Medical Sciences, New Delhi. We also thank all participants for their participation in the present study.
We would also like to thank the Department of Biotechnology, Government of India for providing resources through the Programme support in in AIIMS Cohort Study.