Sleepiness, fatigue, tiredness, and lack of energy in obstructive sleep apnea

Chervin, Ronald D.

doi:10.1378/chest.118.2.372

Cited by 571Obstructive Sleep Apnea ResearchSleep and related disordersSleep and Work-Related Fatigue

Sleepiness, fatigue, tiredness, and lack of energy in obstructive sleep apnea

Chervin, Ronald D.·2000·Chest

DOI 10.1378/chest.118.2.372

Open this paper in CoChat — free account

Abstract

Study objectives Sleepiness is a key symptom in obstructive sleep apnea syndrome (OSAS) and can be objectively assessed with a multiple sleep latency test (MSLT). We studied the terms that patients prefer to describe their symptoms-sleepiness, fatigue, tiredness, or lack of energy-and how these terms relate to objective findings.Design Observational.Setting University-based sleep laboratory.Patients Consecutive OSAS patients referred for diagnostic polysomnography and an MSLT.Methods Data were obtained from sleep studies and questionnaires.Results Subjects included 117 men and 73 women, with a mean (+/- SD) age of 49 +/- 13 years, an apnea and hypopnea rate of 32 +/- 28/h of sleep, and an MSLT mean sleep latency of 7 +/- 5 min. Subjects more frequently reported problems with fatigue, tiredness, and lack of energy than sleepiness (57%, 61%, and 62% vs 47%). When required to select the one most significant symptom, more patients chose lack of energy (about 40%) than any other problem, including sleepiness (about 22%). Objective measures of sleepiness and apnea severity showed little or no association with any symptom, but female gender showed significant associations with each.Conclusions Complaints of fatigue, tiredness, or lack of energy may be as important as that of sleepiness to OSAS patients, among whom women appear to have all such complaints more frequently than men. The diagnosis of OSAS should not be excluded based only on a person's tendency to emphasize fatigue, tiredness, or lack of energy more than sleepiness.

Integrity signals

Registry

Crossref · 10.1378/chest.118.2.372

Cites

37 of 37 references verified0 citation errors · 0 not checkable

Statistics

Recomputing p-values needs the paper’s full text.

Claims the paper makes

This paper’s full text isn’t openly available, so its claims and self-check weren’t run. The registry and citation checks still apply.

Claims other papers make about this one

Each is checked against this paper’s own text: does it say what the citing paper says it does?

OSA commonly results in symptoms similar to insomnia, including frequent post-apneic nocturnal awakenings, perceptions of nonrestorative sleep, daytime sleepiness and fatigue, and reduced quality of life.
“However, OSA commonly results in similar symptoms, including frequent post-apneic nocturnal awakenings, perceptions of nonrestorative sleep, daytime sleepiness and fatigue, and reduced quality of life [39,60].”
From Co-morbid insomnia and sleep apnea (COMISA): Prevalence, consequences, methodological considerations, and recent randomized controlled trials (2019) · cites this paper as [60]

A New Method for Measuring Daytime Sleepiness: The Epworth Sleepiness Scale
Johns, M. W. (1991) · Sleep · doi:10.1093/sleep/14.6.540 · Cited by 17,364 · see citing works
A manual for standardized terminology, techniques and scoring system for sleep stages in human subjects
Rechtschaffen, A. (1968) · Medical Entomology and Zoology · Cited by 11,772 · see citing works
The Occurrence of Sleep-Disordered Breathing among Middle-Aged Adults
Young, T., Palta, M., Dempsey, J., Skatrud, J., Weber, S., & Badr, S. (1993) · New England Journal of Medicine · doi:10.1056/nejm199304293281704 · Cited by 10,183 · see citing works
A manual of standardized terminology, techniques and scoring system for sleep stages of human subjects
Hobson, J. A. (1969) · Electroencephalography and Clinical Neurophysiology · doi:10.1016/0013-4694(69)90021-2 · Cited by 5,215 · see citing works
Sleep–Related Breathing Disorders in Adults: Recommendations for Syndrome Definition and Measurement Techniques in Clinical Research
(1999) · Sleep · doi:10.1093/sleep/22.5.667 · Cited by 5,147 · see citing works
The International Classification of Sleep Disorders
Daroff, R. B. (1991) · Neurology · doi:10.1212/wnl.41.1.160 · Cited by 5,025 · see citing works
Sleep-related breathing disorders in adults: recommendations for syndrome definition and measurement techniques in clinical research. The Report of an American Academy of Sleep Medicine Task Force.
McNicholas, W. T., Strohl, K. P., White, D. P., Levy, P. A., Schmidt, W., Wheatley, J. R., Redline, S. S., Carley, D. W., Buysse, D. J., Young, T. B., et al. (1999) · PubMed · Cited by 3,665 · see citing works
Cecil Textbook of Medicine.
(1985) · Annals of Internal Medicine · doi:10.7326/0003-4819-103-3-486_3 · Cited by 2,063 · see citing works
The Sleep Apnea Syndromes
Guilleminault, C., Tilkian, A., & Dement, W. C. (1976) · Annual Review of Medicine · doi:10.1146/annurev.me.27.020176.002341 · Cited by 1,812 · see citing works
Estimation of the Clinically Diagnosed Proportion of Sleep Apnea Syndrome in Middle-aged Men and Women
Young, T., Evans, L., Finn, L., & Palta, M. (1997) · Sleep · doi:10.1093/sleep/20.9.705 · Cited by 1,765 · see citing works
Guidelines for the Multiple Sleep Latency Test (MSLT): A Standard Measure of Sleepiness
Carskadon, M. A. (1986) · SLEEP · doi:10.1093/sleep/9.4.519 · Cited by 1,607 · see citing works
Population-Based Study of Sleep-Disordered Breathing as a Risk Factor for Hypertension
Young, T. B. (1997) · Archives of Internal Medicine · doi:10.1001/archinte.1997.00440360178019 · Cited by 967 · see citing works
Cumulative effects of sleep restriction on daytime sleepiness.
Carskadon, M., & Dement, W. (1981) · Psychophysiology · doi:10.1111/j.1469-8986.1981.tb02921.x · Cited by 505 · see citing works
The Epworth Sleepiness Scale may not reflect objective measures of sleepiness or sleep apnea
Chervin, R. D., & Aldrich, M. S. (1999) · Neurology · doi:10.1212/wnl.52.1.125 · Cited by 395 · see citing works
Self-citation
Automobile Accidents in Patients with Sleep Disorders
Aldrich, M. S. (1989) · SLEEP · doi:10.1093/sleep/12.6.487 · Cited by 350 · see citing works
Factors Impairing Daytime Performance in Patients With Sleep Apnea/Hypopnea Syndrome
Cheshire, K. (1992) · Archives of Internal Medicine · doi:10.1001/archinte.1992.00400150068012 · Cited by 334 · see citing works
Effects of Total Sleep Loss on Sleep Tendency
Carskadon, M. A., & Dement, W. C. (1979) · Perceptual and Motor Skills · doi:10.2466/pms.1979.48.2.495 · Cited by 330 · see citing works
The Multiple Sleep Latency Test: What Does It Measure?
Carskadon, M. A., & Dement, W. C. (1982) · SLEEP · doi:10.1093/sleep/5.s2.s67 · Cited by 322 · see citing works
Textbook of Internal Medicine.
(1991) · Annals of Internal Medicine · doi:10.7326/0003-4819-114-9-813_8 · Cited by 310 · see citing works
Comparison of the results of the Epworth Sleepiness Scale and the Multiple Sleep Latency Test
Chervin, R. D., Aldrich, M. S., Pickett, R., & Guilleminault, C. (1997) · Journal of Psychosomatic Research · doi:10.1016/s0022-3999(96)00239-5 · Cited by 308 · see citing works
Self-citation
Randomised placebo controlled trial of daytime function after continuous positive airway pressure (CPAP) therapy for the sleep apnoea/hypopnoea syndrome
Engleman, H. M., Martin, S. E., Kingshott, R. N., Mackay, T. W., Deary, I. J., & Douglas, N. J. (1998) · Thorax · doi:10.1136/thx.53.5.341 · Cited by 308 · see citing works
Sleep-disordered Breathing and Neuropsychological Deficits
Kim, H., Young, T. B., Matthews, C. G., WEBER, S. M., Woodard, A. R., & Palta, M. (1997) · American Journal of Respiratory and Critical Care Medicine · doi:10.1164/ajrccm.156.6.9610026 · Cited by 276 · see citing works
Sleep Apnea Syndrome Due to Upper Airway Obstruction
Guilleminault, C. (1977) · Archives of Internal Medicine · doi:10.1001/archinte.1977.03630150020008 · Cited by 276 · see citing works
The Clinical Use of the Multiple Sleep Latency Test
Thorpy, M. J. (1992) · SLEEP · doi:10.1093/sleep/15.3.268 · Cited by 272 · see citing works
A Community Study of Snoring and Sleep-Disordered Breathing. Prevalence
Olson, L. G., King, M. T., Hensley, M. J., & Saunders, N. A. (1995) · American Journal of Respiratory and Critical Care Medicine · doi:10.1164/ajrccm.152.2.7633731 · Cited by 243 · see citing works
Sleep Loss in Young Adolescents
Mary, A. C., Harvey, K., & William, C. D. (1981) · SLEEP · doi:10.1093/sleep/4.3.299 · Cited by 207 · see citing works
Disorders of Excessive Daytime Somnolence: Polygraphic and Clinical Data for 100 Patients
den Hoed, J. V., KRAEMER, H. C., Guilleminault, C., Zarcone, V. P., Miles, L. E. M., Dement, W. C., & Mitler, M. M. (1981) · SLEEP · doi:10.1093/sleep/4.1.23 · Cited by 165 · see citing works
Abnormalities of sleep in patients with the chronic fatigue syndrome.
Morriss, R. K., Sharpe, M., Sharpley, A. L., Cowen, P. J., Hawton, K. E., & Morris, J. (1993) · BMJ · doi:10.1136/bmj.306.6886.1161 · Cited by 139 · see citing works
Sleep disturbance in chronic fatigue syndrome
Krupp, L., Jandorf, L. H., Coyle, P. K., & Mendelson, W. B. (1993) · Journal of Psychosomatic Research · doi:10.1016/0022-3999(93)90134-2 · Cited by 135 · see citing works
Sleep Disorders in Patients with Chronic Fatigue
Buchwald, D., Pascualy, R. A., Bombardier, C. H., & Kith, P. (1994) · Clinical Infectious Diseases · doi:10.1093/clinids/18.supplement_1.s68 · Cited by 116 · see citing works
Sleep Loss in Elderly Volunteers
Carskadon, M. A., & Dement, W. C. (1985) · SLEEP · doi:10.1093/sleep/8.3.207 · Cited by 105 · see citing works
Cecil Textbook of Medicine
Bernicker, E. (1998) · JAMA · doi:10.1001/jama.280.15.1368 · Cited by 79 · see citing works
Textbook of Internal Medicine
Gray, F. D. (1989) · JAMA · doi:10.1001/jama.1989.03430230144048 · Cited by 78 · see citing works
Correlates of sleep latency on the multiple sleep latency test in a clinical population
Chervin, R. D., KRAEMER, H. C., & Guilleminault, C. (1995) · Electroencephalography and Clinical Neurophysiology · doi:10.1016/0013-4694(95)00075-a · Cited by 67 · see citing works
Self-citation
Patterns of Sleepiness in Various Disorders of Excessive Daytime Somnolence
Zorick, F. J., Roehrs, T., Koshorek, G., Sicklesteel, J., Hartse, K. M., Wittig, R. M., & Roth, T. G. (1982) · SLEEP · doi:10.1093/sleep/5.s2.s165 · Cited by 42 · see citing works
Assessment of sleepiness in clinical practice
Chervin, R. D., & Guilleminault, C. (1995) · Nature Medicine · doi:10.1038/nm1295-1252 · Cited by 20 · see citing works
Self-citation
Weakness and Fatigue
Holbrook, J. H. (1990) · Europe PMC (PubMed Central) · Cited by 4 · see citing works

Flagged first, then by citations

Sorted by citations

The epidemiology of adult obstructive sleep apnea
Punjabi, N. M. (2008) · Proceedings of the American Thoracic Society · doi:10.1513/pats.200709-155mg · Cited by 2,361 · see citing works
Adult obstructive sleep apnoea
Jordan, A. S., McSharry, D. G., & Malhotra, A. (2014) · The Lancet · doi:10.1016/s0140-6736(13)60734-5 · Cited by 1,735 · see citing works
Diagnosis and Management of Obstructive Sleep Apnea: A Review
Gottlieb, D. J., & Punjabi, N. M. (2020) · JAMA · doi:10.1001/jama.2020.3514 · Cited by 1,482 · see citing works
Distinguishing sleepiness and fatigue: focus on definition and measurement
Shen, J., Barbera, J., & Shapiro, C. M. (2006) · Sleep Medicine Reviews · doi:10.1016/j.smrv.2005.05.004 · Cited by 687 · see citing works
Metrics of sleep apnea severity: beyond the apnea-hypopnea index
Malhotra, A., Ayappa, I., Ayas, N., Collop, N., Kirsch, D., Mcardle, N., Mehra, R., Pack, A. I., Punjabi, N., White, D. P., et al. (2021) · SLEEP · doi:10.1093/sleep/zsab030 · Cited by 489 · see citing works
Sleepiness in patients with moderate to severe sleep-disordered breathing
Kapur, V. K., Baldwin, C. M., Resnick, H. E., Gottlieb, D. J., & Nieto, F. J. (2005) · SLEEP · doi:10.1093/sleep/28.4.472 · Cited by 338 · see citing works
Co-morbid insomnia and sleep apnea (COMISA): Prevalence, consequences, methodological considerations, and recent randomized controlled trials
Sweetman, A., Lack, L., & Bastien, C. (2019) · Brain Sciences · doi:10.3390/brainsci9120371 · Cited by 253 · see citing works
“However, OSA commonly results in similar symptoms, including frequent post-apneic nocturnal awakenings, perceptions of nonrestorative sleep, daytime sleepiness and fatigue, and reduced quality of life [39,60].”
Background
Bi-directional relationships between co-morbid insomnia and sleep apnea (COMISA)
Sweetman, A., Lack, L., McEvoy, R. D., Smith, S., Eckert, D. J., Osman, A., Carberry, J. C., Wallace, D., Nguyen, P. D., & Catcheside, P. (2021) · Sleep Medicine Reviews · doi:10.1016/j.smrv.2021.101519 · Cited by 203 · see citing works
Developing a successful treatment for co-morbid insomnia and sleep apnoea
Sweetman, A. M., Lack, L. C., Catcheside, P. G., Antic, N. A., Chai-Coetzer, C. L., Smith, S. S., Douglas, J. A., & McEvoy, R. D. (2017) · Sleep Medicine Reviews · doi:10.1016/j.smrv.2016.04.004 · Cited by 185 · see citing works
Comorbidity between sleep apnea and insomnia
Benetó, A., Gomez-Siurana, E., & Rubio-Sanchez, P. (2009) · Sleep Medicine Reviews · doi:10.1016/j.smrv.2008.09.006 · Cited by 171 · see citing works
Cognitive and behavioral therapy for insomnia increases the use of continuous positive airway pressure therapy in obstructive sleep apnea participants with comorbid insomnia: A randomized clinical trial
Sweetman, A., Lack, L., Catcheside, P. G., Antic, N. A., Smith, S., Chai-Coetzer, C. L., Douglas, J., O’grady, A., Dunn, N., Robinson, J., et al. (2019) · Sleep · doi:10.1093/sleep/zsz178 · Cited by 149 · see citing works
Effect of oral appliance therapy on neurobehavioral functioning in obstructive sleep apnea: a randomized controlled trial
Naismith, S. L., Winter, V. R., Hickie, I. B., & Cistulli, P. A. (2005) · Journal of Clinical Sleep Medicine · doi:10.5664/jcsm.26365 · Cited by 140 · see citing works
Sleep disordered breathing and daytime quality of life in children with allergic rhinitis during treatment with intranasal budesonide
Mansfield, L. E., Diaz, G., Posey, C. R., & Flores-Neder, J. (2004) · Annals of Allergy, Asthma & Immunology · doi:10.1016/s1081-1206(10)61554-2 · Cited by 106 · see citing works
Obstructive sleep apnea and quality of life: comparison of the SAQLI, FOSQ, and SF-36 questionnaires
University of Arizona, T., Silva, G., Goodwin, J., Vana, K., & Quan, S. (2016) · Southwest Journal of Pulmonary and Critical Care · doi:10.13175/swjpcc082-16 · Cited by 95 · see citing works
The effect of cognitive and behavioral therapy for insomnia on week-to-week changes in sleepiness and sleep parameters in patients with comorbid insomnia and sleep apnea: a randomized controlled trial
Sweetman, A., McEvoy, R. D., Smith, S., Catcheside, P. G., Antic, N. A., Chai-Coetzer, C. L., Douglas, J., O’Grady, A., Dunn, N., Robinson, J., et al. (2020) · Sleep · doi:10.1093/sleep/zsaa002 · Cited by 62 · see citing works
Obstructive sleep apnea symptoms beyond sleepiness and snoring: effects of nasal APAP therapy
Cruz, I. A. C., Drummond, M., & Winck, J. C. (2012) · Sleep and Breathing · doi:10.1007/s11325-011-0502-4 · Cited by 50 · see citing works
Sleep and Circadian Rhythm Disorders in Parkinson’s Disease
Gros, P., & Videnovic, A. (2017) · Current Sleep Medicine Reports · doi:10.1007/s40675-017-0079-y · Cited by 29 · see citing works
Efeito de uma sessão de treinamento de força sobre a qualidade do sono de adolescentes
Santiago, L. D. C. S., Lyra, M. J., Cunha Filho, M., Cruz, P. W. D. S., Santos, M. A. M. D., & Falcão, A. P. S. T. (2015) · Revista Brasileira de Medicina do Esporte · doi:10.1590/1517-869220152101144430 · Cited by 8 · see citing works

0583 Associations Among Daytime Sleepiness, Obesity and AHI In Patients With Obstructive Sleep Apnea
Zhang, Y., Ren, R., Zhou, J., Tan, L., Li, T., Li, X., & Tang, X. (2018) · SLEEP · doi:10.1093/sleep/zsy061.582 · Cited by 1 · see citing works
Correlation of Epworth Sleepiness Scale with multiple sleep latency test and its diagnostic accuracy in assessing excessive daytime sleepiness in patients with obstructive sleep apnea hypopnea syndrome
Cai, S., Chen, R., Zhang, Y., Xiong, K., Lian, Y., Li, J., Shen, J., & Liu, C. (2013) · Chinese Medical Journal · doi:10.3760/cma.j.issn.0366-6999.20130690 · Cited by 38 · see citing works
Daytime Sleepiness in Parkinson’s Disease: A Reappraisal
Cock, V. C. D., Bayard, S., Jaussent, I., Charif, M., Grini-Mazouzi, M., Langenier, M. C., Yu, H., Lopez, R., Gény, C., Carlander, B., et al. (2014) · PLoS ONE · doi:10.1371/journal.pone.0107278 · Cited by 75 · see citing works
Characteristics associated with hypersomnia and excessive daytime sleepiness identified by extended polysomnography recording
Evangelista, E., Rassu, A. L., Barateau, L., Lopez, R., Chenini, S., Jaussent, I., & Dauvilliers, Y. A. (2020) · SLEEP · doi:10.1093/sleep/zsaa264 · Cited by 36 · see citing works
Efficacy of Modafinil in 10 Taiwanese Patients With Narcolepsy: Findings Using the Multiple Sleep Latency Test and Epworth Sleepiness Scale
Yeh, S., & Schenck, C. H. (2010) · The Kaohsiung Journal of Medical Sciences · doi:10.1016/s1607-551x(10)70068-1 · Cited by 10 · see citing works

Authors: Chervin, R. D.
Affiliations: University of Michigan (US)
Corresponding author: Chervin, Ronald D.
ORCID: Chervin, Ronald D.
Venue: Chest
Publisher: Elsevier BV
Published: 2000-08
Volume: 118
Issue: 2
Pages: 372-379
ISSN: 0012-3692 (ISSN-L)
DOI: 10.1378/chest.118.2.372
OpenAlex: W2167365741
Cited by: 571
References: 37
Citations by year: 2026: 15 · 2025: 23 · 2024: 28 · 2023: 25 · 2022: 25 · 2021: 29 · 2020: 25 · 2019: 21 · 2018: 32 · 2017: 25 · 2016: 30 · 2015: 25 · 2014: 22 · 2013: 28 · 2012: 17
FWCI: 6.14
Type: journal article
Language: en
Open access: closed
Licence: www.elsevier.com/tdm/userlicense/1.0/ (tdm)
Locations: CHEST Journal (publishedVersion)
PubMed (publishedVersion)
Funders: National Institute of Neurological Disorders and Stroke (K02 NS02009, K02NS002009)
Topics: Health Sciences › Medicine › Physiology › Obstructive Sleep Apnea Research
Social Sciences › Psychology › Experimental and Cognitive Psychology › Sleep and related disorders
Social Sciences › Psychology › Experimental and Cognitive Psychology › Sleep and Work-Related Fatigue
Keywords: obstructive sleep apnea, sleepiness, fatigue, lack of energy, symptom terminology, patient-reported symptoms, multiple sleep latency test, apnea-hypopnea index, sex differences, sleep apnea diagnosis
MeSH terms: Circadian Rhythm, Diagnosis, Differential, Physical Exertion, Fatigue, Female, Humans, Disorders of Excessive Somnolence, Male, Middle Aged, Prognosis, Surveys and Questionnaires, Retrospective Studies, Sleep Apnea Syndromes, Polysomnography, Observation

About these checks

Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.

Statistics and arithmetic are recomputed, not judged.

Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.

What counts as a claim ›How we measure confidence ›How we check this ›

Are you an author, or do you see a problem with this page? Request a review

Sleepiness, fatigue, tiredness, and lack of energy in obstructive sleep apnea

Abstract

Integrity signals

Claims the paper makes

Claims other papers make about this one

Cites

Cited by

Related

Record

About these checks