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Excessive Daytime Sleepiness in Patients with Depressive Symptoms in a

Nigerian Family Practice setting

Article · June 2014

DOI: 10.4172/2167-0277.1000167

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 Shittu et al., J Sleep Disorders Ther 2014, 3:4
Sleep Disorders & Therapy http://dx.doi.org/10.4172/2167-0277.1000167

Research Article Open Access

Excessive Daytime Sleepiness in Patients with Depressive Symptoms in a

Nigerian Family Practice Setting
Shittu RO1*, Issa BA2, Olanrewaju GT2, Odeigah LO1, Sule AG1, Sanni MA3 and Aderibigbe SA4
1
Department of Family Medicine, Kwara State Specialist Hospital, Nigeria
2
Department of Behavioral Sciences, University of Ilorin Teaching Hospital, Nigeria
3
Department of Hematology, Kwara State Specialist Hospital, Nigeria
4
Department of Epidemiology and Community Health, University of Ilorin Teaching Hospital, Nigeria

Abstract
Objectives: Clinically significant Excessive Daytime Sleepiness (EDS) is frequently encountered among patients
with depressive symptoms, and a significant association was observed between depression, body mass index and
EDS. Incidentally this sleep disorder is often overlooked. The aim of this study was to examine the association
between excessive daytime sleepiness, depressive symptoms, body mass index and blood pressure in a Nigerian
family practice setting.
Methods: This was a hospital based cross sectional study. Systematic sampling method was used in recruiting
the patients. The PHQ-9 was administered to the respondents to screen for depressive symptoms. EDS was
evaluated using the Epworth Sleepiness Scale (ESS). The international classification of BMI was used. Classification
of hypertension was made according to (JNC 7).
Results: One hundred and seventy eight (44.5%) were found to have one form of depression or the other. There
was female preponderance. Depression was prominent in the age group 51-60 years, more among the married
than the single, as well as those with low socio economic status. There was strong statistical association between
age, sex, marital status, level of education, occupation and monthly income (p-values 0.008, 0.000, 0.000, 0.003,
0.000 and 0.001 respectively). Forty five (25.3%) were hypertensive. Fifty nine (33.1%) scored 10 or more on the
ESS which was clinically significant sleepiness. Forty seven (26.4%) were obese constituting (23.7%) of the poor
sleepers. Ninety three (52.2%) were poor sleepers, sleeping less than the normal 7 hours.
Conclusion: In this study, significant EDS was found with patients with depressive disorders and higher body
mass index. Therefore patients with a complaint of EDS should be thoroughly assessed for depression and obesity.

Keywords: Excessive daytime sleepiness; Depressive symptoms; remain awake [6]. Individuals who have EDS also have increased risk
Nigerian; Family practice setting of motor vehicle crashes, industrial disasters and occupational errors
[7-10]. EDS occurs among depressed individuals and is a predictor of
Introduction and a risk factor for depression [11-14].
The impact of sleep on psychomotor performance varies with the EDS is one of the main symptoms of depressive disorder [13].
degree of sleepiness. Epidemiological studies have indicated a strong association between
Mild sleepiness produces only minor disruptions of daily functions. EDS and depression [11-13]. This sleep disturbance and others play a
Moderate sleepiness is associated with sleepy episodes occurring during significant role as predictors of depression. They are indeed important
activities. Severe sleepiness may impair function, causing a broad range when screening for depression onset. EDS frequently leads depressed
of neuropsychological deficits like depression [1]. patients to seek medical assistance, yet it is commonly under evaluated
[15]. Therefore, the understanding and proper management of this
One major cause of sleepiness is insufficient sleep. Sleep deprivation
sleep disturbance is required for proper clinical evaluation and eventual
and the resultant daytime sleepiness can result in depression, anger and
management of the patients.
confusion. Acute sleep deprivation also affects daytime alertness and
mood [2]. There is paucity of data on EDS among depressed patients in
Nigeria in particular and West Africa in general. The aim of this study
Poor sleepers experience more problems with daytime functioning
than good sleepers and highly depressed poor sleepers report greater
impairment in function during the day. Examination of level of
sleepiness among people with insomnia complaints and found that *Corresponding author: Shittu RO, Department of Family Medicine, Kwara
different levels of sleepiness were related to nocturnal sleep latencies. State Specialist Hospital, Sobi, Ilorin, Kwara State, Nigeria, Tel: 23-48035062687;
E-mail: [email protected]
Sleep debt secondary to sleep deprivation is one of the cardinal Received April 11, 2014; Accepted June 11, 2014; Published June 17, 2014
causes of EDS [3]. Other common causes include narcolepsy, idiopathic
Citation: Shittu RO, Issa BA, Olanrewaju GT, Odeigah LO, Sule AG, et al. (2014)
hypersomnia and obstructive sleep apnea and drugs that have sedative/ Excessive Daytime Sleepiness in Patients with Depressive Symptoms in a
hypnotic properties [4]. Medical aetiology of EDS includes head Nigerian Family Practice Setting. J Sleep Disorders Ther 3: 167 doi:10.4172/2167-
trauma, cerebrovascular disease and brain tumors [5]. EDS and 0277.1000167
depressive symptoms may also be familial or hereditary. Copyright: © 2014 Shittu RO, et al. This is an open-access article distributed under
the terms of the Creative Commons Attribution License, which permits unrestricted
The symptoms of EDS range from drowsiness and reduced use, distribution, and reproduction in any medium, provided the original author and
performance to episodes of involuntary sleep in spite of efforts to source are credited.

J Sleep Disorders Ther

ISSN: 2167-0277 JSDT, an open access journal Volume 3 • Issue 4 • 1000167
Citation: Shittu RO, Issa BA, Olanrewaju GT, Odeigah LO, Sule AG, et al. (2014) Excessive Daytime Sleepiness in Patients with Depressive
Symptoms in a Nigerian Family Practice Setting. J Sleep Disorders Ther 3: 167 doi:10.4172/2167-0277.1000167

Page 2 of 5

was therefore to evaluate EDS in outpatients with depressive symptoms using a standard mercury sphygmomanometer. The onsets of the
and to study its relationship with Body Mass Index (BMI). This will also first-phase (systolic) and fifth-phase (diastolic) Korotkoff sounds were
create the awareness that is required by physicians in the family practice recorded. The mean of the second and third measurements were used
setting show that number of people with EDS who are mismanaged will in the analyses. Classification of hypertension was made according to
be reduced. the seventh report of the Joint National Committee on Prevention,
Detection, Evaluation and Treatment of high blood pressure (JNC 7).
Methodology The following classification of blood pressure for adults aged ≥18 years
This study was carried out at the Family Medicine Department was used.
of the Kwara State Specialist Hospital, Sobi, Ilorin, Nigeria, from 30th Normal Systolic: <120 mm Hg Diastolic: <80 mm Hg
October to 30th November, 2013. The Patients Health Questionnaire Pre-hypertension Systolic: 120-139 mm Hg Diastolic: 80-89 mm Hg
(PHQ-9) [16] (Appendix A) which is a brief, 9 item, patients self-report Stage 1 hypertension 140-159 mm Hg Diastolic: 90-99 mm Hg
depression assessment tool that was derived from the interview-based Stage 2 hypertension ≥ 160 mm Hg Diastolic: ≥ 100 mm Hg
PRIME-MD [17] was used. It was specifically developed for use, in
primary care general medical settings. Many depression screening Completed questionnaire and measurements were entered into a
and severity tools have been used in primary care, with good results. computer data base. The data were analyzed using the epidemiological
The PHQ-9, however, offers several advantages, because it is easily information (Epi-info) 2005 software package of Center for Disease
understood and it has very high face validity for patients and clinicians Control and Prevention (CDC). The 2 by 2 contingency tables were
in primary care. Many other instruments use a 1-week time frame, used to carry out Chi-square test and to find out the level of significance
but the PHQ-9 uses a 2 week time frame, which conforms to DSM-4 and values less than 0.05 were regarded as statistically significant.
criteria. It is the only tool that was specifically developed for use as a
Results
patient self-administered depression diagnostic tool, rather than as a
severity or screening tool. It is the only short self-report tool that can Table 1 shows the association between socio-demographic
reasonably be used both for diagnosis of DSM-4 major depression variables and depression. Majority were females, depression was
as well as for tracking of severity of major depression over time [18]. prominent in the age group 51-60 years, more among the married than
Psychometric evaluation of the PHQ-9 revealed a sensitivity ranging the single as well as those with low socio economic status. There was
from 62%-92% and a specificity between 74%-88% [16-18]. All subjects strong statistical association between age, sex, marital status, level of
were screened for depression using PHQ-9. Scoring and level of education and occupation, (p-values 0.008, 0.000, 0.000, 0.003, and
depression was assessed viz: (1-4) Minimal depression, (5-9) Mild 0.000 respectively).
depression, (10-14) Moderate depression, (15-19) moderately severe
Table 2 displays the Epworth Sleeping Scale used to determine the
depression, and (20-27) severe depression. Some direct depression care,
level of Daytime Sleepiness and Depression. Fifty nine (33.1%) scored
such as care support, coordination, case management, and treatment
10 and more which was considered clinically significant sleepiness.
was embarked on. Using the systematic random sampling, the PHQ-9
was administered to all the respondents, to screen for depression, until Table 3 shows the association between Excessive Daytime
the estimated sample size of 178 was obtained. Respondents who scored Sleepiness and Duration of Sleep. Ninety three (52.2%) were poor
one and more were assessed clinically for depression. The severity of sleepers with less than the normal 7 hours of sleep.
the depression was further classified as minimal, mild, moderate and
severe [15-17]. Table 4 displays the association between Excessive Daytime
Sleepiness and Body Mass Index (BMI). Forty seven (26.4%) were
EDS was evaluated in the patients using the English Language obese. While 14 (23.7%) were poor sleepers.
version of the Epworth Sleepiness Scale (ESS) (Appendix B). This
is a self-administered, eight-item, well-validated [18] and widely Table 5 shows the association between Excessive Daytime
used subjective sleepiness scale. The patients were asked to score the Sleepiness and Blood Pressure. Forty five (25.3%) were hypertensive,
likelihood of falling asleep in eight different situations. Scores on the out of which 16 (5.5%) were poor sleepers.
ESS range from 0 to 24, with higher scores indicating greater likelihood Discussion
of sleepiness. This questionnaire measures the propensity of patients
to sleep or doze during active and passive situations commonly Most of the patients were low-income middle-aged women.
encountered during the wake period. The metrics of the ESS ranges These results compare favorably with a previous work carried out in a
from 0 to 24. ESS scores <10 were considered as indicative of less severe major public hospital [21]. Women were reported to have depressive
sleepiness and scores > 10 were deemed clinically significant sleepiness symptoms more frequently than men [22], as well as elderly and
[19]. middle-aged adults in relation to youngsters [23]. This result differs
considerably from the study of Eldevik where it was reported that men
Height and weight were measured according to standardized
were affected to a greater extent than women [24].
procedures. Body Mass Index (BMI) was calculated as weight in Kg
divided by height in m2 (kg/m2). The international classification of The results showed that almost half of the patients with depressive
BMI was used. The principal cut-off points were as follows: moderate symptoms in this study experienced clinically significant EDS. These
thinness (16.00-16.99), mild thinness (17.00-18.49), normal (18.50- findings are consistent with previous reports of a strong association
24.99), pre-obese (25.00-29.99), obese class I (30.00-34.99), obese class between daytime sleepiness and depression [11,25].
II (35.00-39.99), obese class III (>40.00) [20].
Many of the patients (33.1%) had EDS defined as ESS score of ≥ 10.
An Accosson Mercury sphygmomanometer was used to measure This was comparable to the work of Chellappa and colleagues [26] who
the resting blood pressure of the subjects. Blood pressure was measured reported 42.8% and to the (44.8%) reported by Mume et al. [27] but
3 times in the sitting position by trained and certified technicians lower than 57.2% reported by Chellappa [26]. This result was higher

J Sleep Disorders Ther

ISSN: 2167-0277 JSDT, an open access journal Volume 3 • Issue 4 • 1000167
Citation: Shittu RO, Issa BA, Olanrewaju GT, Odeigah LO, Sule AG, et al. (2014) Excessive Daytime Sleepiness in Patients with Depressive
Symptoms in a Nigerian Family Practice Setting. J Sleep Disorders Ther 3: 167 doi:10.4172/2167-0277.1000167

Page 3 of 5

DEPRESSION
Variables
Minimal Depression Mild Depression Moderate Depression Severe Depression Total P-value
Age
21-30 15 6 2 1 24 0.008
31-40 13 8 0 2 23
41-50 36 11 0 0 47
51-60 31 20 0 0 51
≥ 61 24 9 0 0 33
Total 119 54 2 3 178
Sex
Male 33 3 0 3 39 0.000
Female 86 51 2 0 139
Total 119 54 2 3 178
Ethnicity
Hausa 116 51 2 3 172 0.567
Yoruba 3 1 0 0 4
Igbo 0 2 0 0 2
Others 0 2 0 0 2
Total 119 54 2 3 178
Religion
Christianity 21 6 0 0 27 0.541
Islam 98 48 2 3 151
Total 119 54 2 3 178
Marital Status
Married 73 27 2 0 102 0.000
Single 7 2 0 3 12
Divorced 5 1 0 0 6
Separated 6 6 0 0 12
Widow 28 18 0 0 46
Total 119 54 2 3 178
Level of Education
Non-formal 71 37 0 0 108 0.003
Primary 16 6 0 0 22
Secondary 16 7 0 2 25
Tertiary 16 4 2 1 23
Total 119 54 2 3 178
Occupation
Trader 38 18 0 0 56 0.000
Civil servant 19 4 2 2 27
Self employed 45 28 0 0 73
Unemployed 15 4 0 0 19
Student 2 0 0 1 3
Total 119 54 2 3 178
Table 1: Association between Socio-Demographic Variables and Depression.

Level of Depression
EDS Total p-value
Minimal Depression Mild Depression Moderate Depression Severe Depression
≤ 10 88 29 2 0 119 0.003
≥ 10 31 25 0 3 59
Total 119 54 2 3 178
Table 2: Association between Excessive Daytime Sleepiness and Depression.

than that obtained from analysis of the Geolong Osteoporosis Study, EDS and depression have some genes in common and may be familial
where 13% of the 844 women surveyed were found to have EDS, as [5]. EDS has also been found to be strongly associated with suicidal
measured by the Epworth Sleepiness Scale. Some other studies also ideation in depressed patients [30]. It is therefore clear that for
found a significant association between EDS and depression [11]. complete clinical evaluation of depressive symptoms, evaluation of
Hayley et al. [28] reported that EDS patients had an increased likelihood EDS is paramount. The clinician must therefore have a high index of
of experiencing current and/or a lifetime history of depressive disorders suspicion of depressive disorder in patients who present with features
compared to those without EDS. Overall, sleepiness may be attributed of EDS. Incidentally, there are no facilities for objective and subjective
to depressive disorder [29]. evaluation of sleep complaints in Nigeria, making it difficult to make
There is thus ample evidence that EDS is a red flag of depression. a cast iron diagnosis. It is therefore imperative for the authorities to

J Sleep Disorders Ther

ISSN: 2167-0277 JSDT, an open access journal Volume 3 • Issue 4 • 1000167
Citation: Shittu RO, Issa BA, Olanrewaju GT, Odeigah LO, Sule AG, et al. (2014) Excessive Daytime Sleepiness in Patients with Depressive
Symptoms in a Nigerian Family Practice Setting. J Sleep Disorders Ther 3: 167 doi:10.4172/2167-0277.1000167

Page 4 of 5

DURATION OF SLEEP
EDS Total p-value
≥7 6.1-7hours 5-6hours <5hours
≤ 10 65 13 26 16 119 0.023
≥ 10 20 5 25 9 59
Total 85 17 51 25 178
Table 3: Association between Excessive Daytime Sleepiness and Duration of Sleep.

Body Mass Index

EDS Total p-value
≤ 10 ≥ 10
Moderate thinness 0 3 3 0.029
Mild thinness 4 3 7
Normal 46 21 67
Pre-Obese 36 18 54
Obese Class 1 23 4 27
Obese Class 2 7 5 12
Obese Class 3 3 5 8
Total 119 59 178
Table 4: Association between Excessive Daytime Sleepiness and Body Mass Index (BmI).

BLOOD PRESSURE
EDS Total p-value
Normal Pre-HTN Stage 1 Stage 2
≤ 10 66 24 14 15 119 0.776
≥ 10 28 15 8 8 59
Total 94 39 22 23 178
Table 5: Association between Excessive Daytime Sleepiness and Blood Pressure.

provide enough facilities and personnel in the field of sleep medicine of sleep complaints. Concerted effort should be made by appropriate
to assist in this regard. Clinicians should be aware of the magnitude of authorities to establish facilities for dealing with sleep complaints.
the problem of EDS, especially among depressed patients, and should Besides, enough personnel in the field of sleep medicine in the country
adopt holistic approach to assist them. should be encouraged. It is expected that with adequate and proper
facilities in place, the number of personnel in this field will gradually
The current study demonstrated a significant association between
increase. In the meantime, clinicians should be aware of the magnitude
EDS and Body Mass Index. Previous researches have established that
of the problem of EDS, particularly, among depressed patients and be
EDS in non-pathological populations is not necessarily attributable
proactive in its management so as to reduce the burden of depressive
to BMI and/or obesity [31]. Hayley et al. [28] reported that EDS and
disorder in the developing countries.
depression were independent of BMI. Thus, despite the established
link between EDS and depression [32] and BMI and depression, future Declaration of Interest
research assessing the prevalence of EDS while controlling for BMI to
assess the mechanisms of this relationship will deepen and broaden our No conflict of interest.
knowledge in this field. It has further been suggested that EDS may be References
related to the weight gain which is from the use of both antidepressant
1. Rosenthal L, Roehrs TA, Rosen A, Roth T (1993) Level of sleepiness and total
medication and neuroleptic medications, or a combination of these sleep time following various time in bed conditions. Sleep 16: 226-232.
[33]. There is new evidence that a preceding maladaptive lifestyle and
2. Bonnet MH, Arand DL (1995) We are chronically sleep deprived. Sleep 18:
health factors often associated with the development of depression, 908-911.
such as obesity [34] contribute to maintain negative lifestyle and health
outcomes which are recognized to share pathology with EDS, such as 3. Pagel JF (2009) Excessive daytime sleepiness. Am Fam Physician 79: 391-
396.
sleep disturbances.
4. Edd EM, Flores S (2009) Sleepiness or excessive daytime somnolence. Geriatr
Forty five (25.3%) were hypertensive, out of which 16 (5.5%) were Nurs 30: 53-60.
poor sleepers. No significant association was found between EDS and 5. Lessov-Schlaggar CN, Bliwise DL, Krasnow RE, Swan GE, Reed T (2008)
blood pressure, contrary to Cui et al. [35] where the prevalence of self- Genetic association of daytime sleepiness and depressive symptoms in elderly
reported EDS and mean values of systolic and diastolic blood pressure men. Sleep 31: 1111-1117.
levels were significant. 6. Bittencourt LR, Silva RS, Santos RF, Pires ML, Mello MT (2005) Excessive
daytime sleepiness. Rev Bras Psiquiatr 27 Suppl 1: 16-21.
Conclusion
7. Ulfberg J, Carter N, Talbäck M, Edling C (1996) Excessive daytime sleepiness
In the present study, clinically significant EDS was frequently at work and subjective work performance in the general population and among
heavy snorers and patients with obstructive sleep apnea. Chest 110: 659-663.
encountered among patients with depressive symptoms, and a
significant association was observed between depression and EDS. 8. Lindberg E, Carter N, Gislason T, Janson C (2001) Role of snoring and daytime
Thus, careful investigation of daytime sleepiness in depressed patients sleepiness in occupational accidents. Am J Respir Crit Care Med 164: 2031-
2035.
is advised during clinical evaluation.
9. Melamed S, Oksenberg A (2002) Excessive daytime sleepiness and risk of
Incidentally, there are no facilities in Nigeria for proper evaluation occupational injuries in non-shift daytime workers. Sleep 25: 315-322.

J Sleep Disorders Ther

ISSN: 2167-0277 JSDT, an open access journal Volume 3 • Issue 4 • 1000167
Citation: Shittu RO, Issa BA, Olanrewaju GT, Odeigah LO, Sule AG, et al. (2014) Excessive Daytime Sleepiness in Patients with Depressive
Symptoms in a Nigerian Family Practice Setting. J Sleep Disorders Ther 3: 167 doi:10.4172/2167-0277.1000167

Page 5 of 5

10. Garbarino S (2008) Sleep disorders and road accidents in truck drivers. G Ital 23. Blazer DG (2000) Mood disorders: epidemiology. Comprehensive textbook of
Med Lav Ergon 30: 291-296. psychiatry, 7th ed, Philadelphia, Lippincott Williams & Wilkins, 1298-1308.

11. Hublin C, Kaprio J, Partinen M, Heikkilä K, Koskenvuo M (1996) Daytime 24. Eldevik MF, Flo E, Moen BE, Pallesen S, Bjorvatn B (2013) Insomnia, excessive
sleepiness in an adult, Finnish population. J Intern Med 239: 417-423. sleepiness, excessive fatigue, anxiety, depression and shift work disorder in
nurses having less than 11 hours in-between shifts. PLoS One 8: e70882.
12. Breslau N, Roth T, Rosenthal L, Andreski P (1996) Sleep disturbance and
psychiatric disorders: a longitudinal epidemiological study of young adults. Biol 25. Young TB (2004) Epidemiology of daytime sleepiness: definitions,
Psychiatry 39: 411-418. symptomatology, and prevalence. J Clin Psychiatry 65 Suppl 16: 12-16.

13. Silber MH (2001) Sleep disorders. Neurol Clin 19: 173-186. 26. Chellappa SL, Araújo JF (2006) Excessive daytime sleepiness in patients with
depressive disorder. Rev Bras Psiquiatr 28: 126-129.
14. Fava M (2004) Daytime sleepiness and insomnia as correlates of depression.
J Clin Psychiatry 65 Suppl 16: 27-32. 27. Mume CO (2010) Excessive daytime Sleepiness among depressed patients.
Libyan J Med 5.
15. Tylee A, Gastpar M, Lépine JP, Mendlewicz J (1999) DEPRES II (Depression
Research in European Society II): a patient survey of the symptoms, disability 28. Hayley AC, Williams LJ, Berk M, Kennedy GA, Jacka FN, et al. (2013) The
and current management of depression in the community. DEPRES Steering relationship between excessive daytime sleepiness and depressive and anxiety
Committee. Int Clin Psychopharmacol 14: 139-151. disorders in women. Aust N Z J Psychiatry. 47: 772-778.

16. Kroenke K, Spitzer RL, Williams JB (2003) The Patient Health Questionnaire-2: 29. Cano-Lozano MC, Espinosa-Fernández L, Miró E, Buela-Casas G (2003) A
validity of a two-item depression screener. Med Care 41: 1284-1292. review of sleep disorders in depression. Rev Neurol 36: 366-375.

17. Spitzer RL, Williams JB, Kroenke K, Linzer M, DeGruy FV 3rd, et al. (1997) 30. Johns M, Hocking B (1997) Daytime sleepiness and sleep habits of Australian
Utility of a new procedure for diagnosing mental disorders in primary care. The workers. Sleep 20: 844-849.
PRIME-MD 1000 study. JAMA 272: 1749-1756.
31. Scott KM, McGee MA, Wells JE, Oakley Browne MA (2008) Obesity and mental
18. Johns MW (1991) A new method for measuring daytime sleepiness: the disorders in the adult general population. J Psychosom Res 64: 97-105.
Epworth sleepiness scale. Sleep 14: 540-545.
32. Guilleminault C, Brooks SN (2001) Excessive daytime sleepiness: a challenge
19. Kroenke K, Spitzer RL, Williams JB (2001) The PHQ-9: validity of a brief for the practising neurologist. Brain 124: 1482-1491.
depression severity measure. J Gen Intern Med 16: 606-613.
33. Stanton JM (1995) Weight gain associated with neuroleptic medication: a
20. Johns MW (1993) Daytime sleepiness, snoring, and obstructive sleep apnea. review. Schizophr Bull 21: 463-472.
The Epworth Sleepiness Scale. Chest 103: 30-36.
34. Gallicchio L, Kalesan B (2009) Sleep duration and mortality: a systematic
21. Berry JM, Storandt M, Coyne A (1984) Age and sex differences in somatic review and meta-analysis. J Sleep Res 18: 148-158.
complaints associated with depression. J Gerontol 39: 465-467.
35. Cui R, Tanigawa T, Sakurai S, Yamagishi K, Imano H, et al. (2008) Associations
22. Hara C, Lopes Rocha F, Lima-Costa MF (2004) Prevalence of excessive of sleep-disordered breathing with excessive daytime sleepiness and blood
daytime sleepiness and associated factors in a Brazilian community: the pressure in Japanese women. Hypertens Res 31: 501-506.
Bambuí study. Sleep Med 5: 31-36.

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