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Published in: BMC Pulmonary Medicine 1/2017

Open Access 01-12-2017 | Research article

Determinants of excessive daytime sleepiness in two First Nation communities

Authors: Ina van der Spuy, Chandima P. Karunanayake, James A. Dosman, Kathleen McMullin, Gaungming Zhao, Sylvia Abonyi, Donna C. Rennie, Joshua Lawson, Shelley Kirychuk, Judith MacDonald, Laurie Jimmy, Niels Koehncke, Vivian R. Ramsden, Mark Fenton, Gregory P. Marchildon, Malcolm King, Punam Pahwa

Published in: BMC Pulmonary Medicine | Issue 1/2017

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Abstract

Background

Excessive daytime sleepiness may be determined by a number of factors including personal characteristics, co-morbidities and socio-economic conditions. In this study we identified factors associated with excessive daytime sleepiness in 2 First Nation communities in rural Saskatchewan.

Methods

Data for this study were from a 2012–13 baseline assessment of the First Nations Lung Health Project, in collaboration between two Cree First Nation reserve communities in Saskatchewan and researchers at the University of Saskatchewan. Community research assistants conducted the assessments in two stages. In the first stage, brochures describing the purpose and nature of the project were distributed on a house by house basis. In the second stage, all individuals age 17 years and older not attending school in the participating communities were invited to the local health care center to participate in interviewer-administered questionnaires and clinical assessments. Excessive daytime sleepiness was defined as Epworth Sleepiness Scale score > 10.

Results

Of 874 persons studied, 829 had valid Epworth Sleepiness Scale scores. Of these, 91(11.0%) had excessive daytime sleepiness; 12.4% in women and 9.6% in men. Multivariate logistic regression analysis indicated that respiratory comorbidities, environmental exposures and loud snoring were significantly associated with excessive daytime sleepiness.

Conclusions

Excessive daytime sleepiness in First Nations peoples living on reserves in rural Saskatchewan is associated with factors related to respiratory co-morbidities, conditions of poverty, and loud snoring.
Literature
1.
go back to reference Ford ES, Cunningham TJ, Giles WH, Croft JB. Trends in insomnia and excessive daytime sleepiness among U.S. adults from 2002 to 2012. Sleep Med. 2015;16(3):372–8.CrossRefPubMedPubMedCentral Ford ES, Cunningham TJ, Giles WH, Croft JB. Trends in insomnia and excessive daytime sleepiness among U.S. adults from 2002 to 2012. Sleep Med. 2015;16(3):372–8.CrossRefPubMedPubMedCentral
2.
go back to reference Young T, Peppard PE, Gottlieb DJ. Epidemiology of obstructive sleep apnea. A population health perspective. Am J Respir Crit Care Med. 2002;165(9):1217–39.CrossRefPubMed Young T, Peppard PE, Gottlieb DJ. Epidemiology of obstructive sleep apnea. A population health perspective. Am J Respir Crit Care Med. 2002;165(9):1217–39.CrossRefPubMed
3.
go back to reference Joo S, Baik I, Yi H, Jung K, Kim J, Shin C. Prevalence of excessive daytime sleepiness and associated factors in the adult population of Korea. Sleep Med. 2009;10(2):182–8.CrossRefPubMed Joo S, Baik I, Yi H, Jung K, Kim J, Shin C. Prevalence of excessive daytime sleepiness and associated factors in the adult population of Korea. Sleep Med. 2009;10(2):182–8.CrossRefPubMed
4.
go back to reference Nugent AM, Gleadhill I, McCrum E, Patterson CC, Evans A, MacMahon J. Sleep complaints and risk factors for excessive daytime sleepiness in adult males in Northern Ireland. J Sleep Res. 2001;10(1):69–74.CrossRefPubMed Nugent AM, Gleadhill I, McCrum E, Patterson CC, Evans A, MacMahon J. Sleep complaints and risk factors for excessive daytime sleepiness in adult males in Northern Ireland. J Sleep Res. 2001;10(1):69–74.CrossRefPubMed
5.
6.
go back to reference Vashum KP, McEvoy MA, Hancock SJ, et al. Prevalence of and associations with excessive daytime sleepiness in an Australian older population. Asia Pac J Public Health. 2015;27(2):NP2275–84.CrossRefPubMed Vashum KP, McEvoy MA, Hancock SJ, et al. Prevalence of and associations with excessive daytime sleepiness in an Australian older population. Asia Pac J Public Health. 2015;27(2):NP2275–84.CrossRefPubMed
7.
go back to reference Larsson LG, Lindberg A, Franklin KA, Lundbäck B. Gender differences in symptoms related to sleep apnea in a general population and in relation to referral to sleep clinic. Chest. 2003;124(1):204–11.CrossRefPubMed Larsson LG, Lindberg A, Franklin KA, Lundbäck B. Gender differences in symptoms related to sleep apnea in a general population and in relation to referral to sleep clinic. Chest. 2003;124(1):204–11.CrossRefPubMed
8.
go back to reference Dagan Y, Doljansky JT, Green A, Weiner A. Body mass index (BMI) as a first-line screening criterion for detection of excessive daytime sleepiness among professional drivers. Traffic Inj Prev. 2006;7(1):44–8.CrossRefPubMed Dagan Y, Doljansky JT, Green A, Weiner A. Body mass index (BMI) as a first-line screening criterion for detection of excessive daytime sleepiness among professional drivers. Traffic Inj Prev. 2006;7(1):44–8.CrossRefPubMed
9.
go back to reference Mokhber S, Ravanbakhsh PZ, Jesmi F, Pishgahroudsari M, Jolfaei AG, Pazouki A. Comparing the excessive daytime sleepiness of obese and non-obese patients. Iran Red Crescent Med J. 2016;18(7):e21964.CrossRefPubMedPubMedCentral Mokhber S, Ravanbakhsh PZ, Jesmi F, Pishgahroudsari M, Jolfaei AG, Pazouki A. Comparing the excessive daytime sleepiness of obese and non-obese patients. Iran Red Crescent Med J. 2016;18(7):e21964.CrossRefPubMedPubMedCentral
10.
go back to reference Hayley AC, Williams LJ, Kennedy GA, Berk M, Brennan SL, Pasco JA. Excessive daytime sleepiness and body composition: a population-based study of adults. PLoS One. 2014;9(11):e112238.CrossRefPubMedPubMedCentral Hayley AC, Williams LJ, Kennedy GA, Berk M, Brennan SL, Pasco JA. Excessive daytime sleepiness and body composition: a population-based study of adults. PLoS One. 2014;9(11):e112238.CrossRefPubMedPubMedCentral
11.
go back to reference Fanfulla F, Grassi M, Marandola P, Taino G, Fulgoni P, Imbrani M. Excessive daytime sleepiness works together with other sleep disorders in determining sleepiness-related events in shift workers. G Ital Med Lav Ergon. 2013;35(3):151–6.PubMed Fanfulla F, Grassi M, Marandola P, Taino G, Fulgoni P, Imbrani M. Excessive daytime sleepiness works together with other sleep disorders in determining sleepiness-related events in shift workers. G Ital Med Lav Ergon. 2013;35(3):151–6.PubMed
12.
go back to reference Kalchiem-Dekel O, Westreich R, Regev A, Novack V, Goldberg M, Maimon N. Snoring intensity and excessive daytime sleepiness in subjects without obstructive sleep apnea. Laryngoscope. 2016;126(7):1696–701.CrossRefPubMed Kalchiem-Dekel O, Westreich R, Regev A, Novack V, Goldberg M, Maimon N. Snoring intensity and excessive daytime sleepiness in subjects without obstructive sleep apnea. Laryngoscope. 2016;126(7):1696–701.CrossRefPubMed
13.
go back to reference Theorell-Haglöw J, Akerstedt T, Schwarz J, Lindberg E. Predictors for development of excessive daytime sleepiness in women: a population-based 10-year follow-up. Sleep. 2015;38(12):1995–2003.CrossRefPubMedPubMedCentral Theorell-Haglöw J, Akerstedt T, Schwarz J, Lindberg E. Predictors for development of excessive daytime sleepiness in women: a population-based 10-year follow-up. Sleep. 2015;38(12):1995–2003.CrossRefPubMedPubMedCentral
14.
go back to reference Svensson M, Franklin KA, Theorell-Haglöw J, Lindberg E. Daytime sleepiness relates to snoring independent of the apnea-hypopnea index in women from the general population. Chest. 2008;134(5):919–24.CrossRefPubMed Svensson M, Franklin KA, Theorell-Haglöw J, Lindberg E. Daytime sleepiness relates to snoring independent of the apnea-hypopnea index in women from the general population. Chest. 2008;134(5):919–24.CrossRefPubMed
15.
go back to reference Klobučníková K, Šiarnik P, Čarnická Z, Kollár B, Turčáni P. Causes of excessive daytime sleepiness in patients with acute stroke - a polysomnographic study. J stroke. Cerebrovascular Dis. 2016;25(1):83–6.CrossRef Klobučníková K, Šiarnik P, Čarnická Z, Kollár B, Turčáni P. Causes of excessive daytime sleepiness in patients with acute stroke - a polysomnographic study. J stroke. Cerebrovascular Dis. 2016;25(1):83–6.CrossRef
16.
go back to reference Gander PH, Marshall NS, Harris R, Reid P. The Epworth sleepiness scale: influence of age, ethnicity, and socioeconomic deprivation. Epworth sleepiness scores of adults in New Zealand. Sleep. 2005;28(2):249–53.CrossRefPubMed Gander PH, Marshall NS, Harris R, Reid P. The Epworth sleepiness scale: influence of age, ethnicity, and socioeconomic deprivation. Epworth sleepiness scores of adults in New Zealand. Sleep. 2005;28(2):249–53.CrossRefPubMed
17.
go back to reference Cai S, Chen R, Zhang Y, et al. 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. Chin Med J. 2013;126(17):3245–50.PubMed Cai S, Chen R, Zhang Y, et al. 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. Chin Med J. 2013;126(17):3245–50.PubMed
18.
go back to reference Ramar K, Guilleminault C. Excessive daytime sleepiness and obstructive sleep apnea syndrome. Sleep Med Clin. 2006;1:63–78.CrossRef Ramar K, Guilleminault C. Excessive daytime sleepiness and obstructive sleep apnea syndrome. Sleep Med Clin. 2006;1:63–78.CrossRef
19.
go back to reference Ulfberg J, Carter N, Talback M, Edling C. Excessive daytime sleepiness at work and subjective work performance in the general population and among heavy snorers and patients with obstructive sleep apnea. Chest. 1996;110(3):659–63.CrossRefPubMed Ulfberg J, Carter N, Talback M, Edling C. Excessive daytime sleepiness at work and subjective work performance in the general population and among heavy snorers and patients with obstructive sleep apnea. Chest. 1996;110(3):659–63.CrossRefPubMed
20.
go back to reference Zwahlen D, Jackowski C, Pfäffli M. Sleepiness, driving, and motor vehicle accidents: a questionnaire-based survey. J Forensic Legal Med. 2016;44:183–7.CrossRef Zwahlen D, Jackowski C, Pfäffli M. Sleepiness, driving, and motor vehicle accidents: a questionnaire-based survey. J Forensic Legal Med. 2016;44:183–7.CrossRef
21.
go back to reference Ward KL, Hillman DR, James A, et al. Excessive daytime sleepiness increases the risk of motor vehicle crash in obstructive sleep apnea. J Clin Sleep Med. 2013;9(10):1013–21.PubMedPubMedCentral Ward KL, Hillman DR, James A, et al. Excessive daytime sleepiness increases the risk of motor vehicle crash in obstructive sleep apnea. J Clin Sleep Med. 2013;9(10):1013–21.PubMedPubMedCentral
22.
go back to reference King N, Pickett W, Hagel L, Lawson J, Trask C, Dosman JA. Impact of excessive daytime sleepiness on the safety and health of farmers in Saskatchewan. Can Respir J. 2014;21(6):363–9.CrossRefPubMedPubMedCentral King N, Pickett W, Hagel L, Lawson J, Trask C, Dosman JA. Impact of excessive daytime sleepiness on the safety and health of farmers in Saskatchewan. Can Respir J. 2014;21(6):363–9.CrossRefPubMedPubMedCentral
23.
go back to reference Uehli K, Mehta AJ, Miedinger D, et al. Sleep problems and work injuries: a systematic review and meta-analysis. Sleep Med Rev. 2014;18:61–73.CrossRefPubMed Uehli K, Mehta AJ, Miedinger D, et al. Sleep problems and work injuries: a systematic review and meta-analysis. Sleep Med Rev. 2014;18:61–73.CrossRefPubMed
24.
25.
go back to reference Paine SJ, Gander PH, Harris RB, Reid P. Prevalence and consequences of insomnia in New Zealand: disparities between Maori and non-Maori. Aust N Z J Public Health. 2005;29(1):22–8.CrossRefPubMed Paine SJ, Gander PH, Harris RB, Reid P. Prevalence and consequences of insomnia in New Zealand: disparities between Maori and non-Maori. Aust N Z J Public Health. 2005;29(1):22–8.CrossRefPubMed
26.
go back to reference Sin DD, Wells H, Svenson LW, Man SFP. Asthma and COPD among aboriginals in Alberta. Canada Chest. 2002;121(6):1841–6.CrossRefPubMed Sin DD, Wells H, Svenson LW, Man SFP. Asthma and COPD among aboriginals in Alberta. Canada Chest. 2002;121(6):1841–6.CrossRefPubMed
35.
go back to reference Froese CL, Butt A, Mulgrew A, et al. Depression and sleep-related symptoms in an adult, indigenous, north American population. J Clin Sleep Med. 2008;4(4):356–61.PubMedPubMedCentral Froese CL, Butt A, Mulgrew A, et al. Depression and sleep-related symptoms in an adult, indigenous, north American population. J Clin Sleep Med. 2008;4(4):356–61.PubMedPubMedCentral
37.
go back to reference Pahwa P, Abonyi S, Karunanayake C, et al. A community-based participatory research methodology to address, redress, and reassess disparities in respiratory health among First Nations. BMC Res Notes. 2015;8:199. Pahwa P, Abonyi S, Karunanayake C, et al. A community-based participatory research methodology to address, redress, and reassess disparities in respiratory health among First Nations. BMC Res Notes. 2015;8:199.
38.
go back to reference Johns MWA. New method for measuring daytime sleepiness: the Epworth sleepiness scale. Sleep. 1991;14(6):540–5.CrossRefPubMed Johns MWA. New method for measuring daytime sleepiness: the Epworth sleepiness scale. Sleep. 1991;14(6):540–5.CrossRefPubMed
39.
go back to reference Johns MW. Reliability and factor analysis of the Epworth sleepiness scale. Sleep. 1992;15(4):376–81.CrossRefPubMed Johns MW. Reliability and factor analysis of the Epworth sleepiness scale. Sleep. 1992;15(4):376–81.CrossRefPubMed
40.
go back to reference Johns MW. Daytime sleepiness, snoring, and obstructive sleep apnea. The Epworth sleepiness scale. Chest. 1993;103(1):30–6.CrossRefPubMed Johns MW. Daytime sleepiness, snoring, and obstructive sleep apnea. The Epworth sleepiness scale. Chest. 1993;103(1):30–6.CrossRefPubMed
41.
go back to reference Johns MW. Sleepiness in different situations measured by the Epworth sleepiness scale. Sleep. 1994;17(8):703–10.CrossRefPubMed Johns MW. Sleepiness in different situations measured by the Epworth sleepiness scale. Sleep. 1994;17(8):703–10.CrossRefPubMed
42.
go back to reference Chaudry A, Wimer C. Poverty is not just an indicator: the relationship between income, poverty, and child well-being. Acad Pediatr. 2016;16(3 Suppl):S23–9.CrossRefPubMed Chaudry A, Wimer C. Poverty is not just an indicator: the relationship between income, poverty, and child well-being. Acad Pediatr. 2016;16(3 Suppl):S23–9.CrossRefPubMed
43.
go back to reference Kovesi T. Respiratory disease in Canadian first nations and Inuit children. Paediatr Child Health. 2012;17(7):376–80.PubMedPubMedCentral Kovesi T. Respiratory disease in Canadian first nations and Inuit children. Paediatr Child Health. 2012;17(7):376–80.PubMedPubMedCentral
45.
go back to reference Grandner MA, Patel NP, Gehrman PR, et al. Who gets the best sleep? Ethnic and socioeconomic factors related to sleep complaints. Sleep Med. 2010;11(5):470–8.CrossRefPubMedPubMedCentral Grandner MA, Patel NP, Gehrman PR, et al. Who gets the best sleep? Ethnic and socioeconomic factors related to sleep complaints. Sleep Med. 2010;11(5):470–8.CrossRefPubMedPubMedCentral
46.
go back to reference Umlauf MG, Bolland AC, Bolland KA, Tomek S, Bolland JM. The effects of age, gender, hopelessness, and exposure to violence on sleep disorder symptoms and daytime sleepiness among adolescents in impoverished neighborhoods. J youth. Adolescence. 2015;44(2):518–42. Umlauf MG, Bolland AC, Bolland KA, Tomek S, Bolland JM. The effects of age, gender, hopelessness, and exposure to violence on sleep disorder symptoms and daytime sleepiness among adolescents in impoverished neighborhoods. J youth. Adolescence. 2015;44(2):518–42.
47.
go back to reference Grandner MA, Williams NJ, Knutson KL, Roberts D, Jean-Louis G. Sleep disparity, race/ethnicity, and socioeconomic position. Sleep Med. 2016;18:7–18.CrossRefPubMed Grandner MA, Williams NJ, Knutson KL, Roberts D, Jean-Louis G. Sleep disparity, race/ethnicity, and socioeconomic position. Sleep Med. 2016;18:7–18.CrossRefPubMed
48.
go back to reference Leone T, Coast E, Narayanan S, de Graft Aikins A. Diabetes and depression comorbidity and socio-economic status in low and middle income countries (LMICs): a mapping of the evidence. Glob Health. 2012;8:39.CrossRef Leone T, Coast E, Narayanan S, de Graft Aikins A. Diabetes and depression comorbidity and socio-economic status in low and middle income countries (LMICs): a mapping of the evidence. Glob Health. 2012;8:39.CrossRef
49.
go back to reference Leigh JP, Are DJ. Low wages risk factors for hypertension? Eur J Pub Health. 2012;22(6):854–9.CrossRef Leigh JP, Are DJ. Low wages risk factors for hypertension? Eur J Pub Health. 2012;22(6):854–9.CrossRef
50.
go back to reference Szanton SL, Seplaki CL, Thorpe RJ, Jr., Allen JK, Fried LP. Socioeconomic status is associated with frailty: the Women's health and aging studies. J Epidemiol Community Health 2010; 64(1):63–67. Szanton SL, Seplaki CL, Thorpe RJ, Jr., Allen JK, Fried LP. Socioeconomic status is associated with frailty: the Women's health and aging studies. J Epidemiol Community Health 2010; 64(1):63–67.
51.
go back to reference Kaneita Y, Ohida T, Uchiyama M, et al. Excessive daytime sleepiness among the Japanese general population. J Epidemiol. 2005;15(1):1–8.CrossRefPubMed Kaneita Y, Ohida T, Uchiyama M, et al. Excessive daytime sleepiness among the Japanese general population. J Epidemiol. 2005;15(1):1–8.CrossRefPubMed
52.
go back to reference Karachaliou F, Kostikas K, Pastaka C, Bagiatis V, Gourgoulianis KI. Prevalence of sleep-related symptoms in a primary care population - their relation to asthma and COPD. Prim Care Respir J. 2007;16(4):222–8.CrossRefPubMed Karachaliou F, Kostikas K, Pastaka C, Bagiatis V, Gourgoulianis KI. Prevalence of sleep-related symptoms in a primary care population - their relation to asthma and COPD. Prim Care Respir J. 2007;16(4):222–8.CrossRefPubMed
53.
go back to reference Koutsourelakis I, Perraki E, Bonakis A, Vagiakis E, Roussos C, Zakynthinos S. Determinants of subjective sleepiness in suspected obstructive sleep apnoea. J Sleep Res. 2008;17(4):437–43.CrossRefPubMed Koutsourelakis I, Perraki E, Bonakis A, Vagiakis E, Roussos C, Zakynthinos S. Determinants of subjective sleepiness in suspected obstructive sleep apnoea. J Sleep Res. 2008;17(4):437–43.CrossRefPubMed
54.
go back to reference Lee JH, Han DH, Song JW, Chung HS. Diagnostic and therapeutic problems of pulmonary tuberculosis in elderly patients. J Korean Med Sci. 2005;20(5):784–9.CrossRefPubMedPubMedCentral Lee JH, Han DH, Song JW, Chung HS. Diagnostic and therapeutic problems of pulmonary tuberculosis in elderly patients. J Korean Med Sci. 2005;20(5):784–9.CrossRefPubMedPubMedCentral
55.
go back to reference Slater G, Pengo MF, Kosky C, Steier J. Obesity as an independent predictor of subjective excessive daytime sleepiness. Respir Med. 2013;107(2):305–9.CrossRefPubMed Slater G, Pengo MF, Kosky C, Steier J. Obesity as an independent predictor of subjective excessive daytime sleepiness. Respir Med. 2013;107(2):305–9.CrossRefPubMed
56.
go back to reference Fernandez-Mendoza J, Vgontzas AN, Kritikou I, et al. Natural history of excessive daytime sleepiness: role of obesity, weight loss, depression, and sleep propensity. Sleep. 2015;38(3):351–60.CrossRefPubMedPubMedCentral Fernandez-Mendoza J, Vgontzas AN, Kritikou I, et al. Natural history of excessive daytime sleepiness: role of obesity, weight loss, depression, and sleep propensity. Sleep. 2015;38(3):351–60.CrossRefPubMedPubMedCentral
57.
go back to reference Newman AB, Spiekerman CF, Enright P, et al. Daytime sleepiness predicts mortality and cardiovascular disease in older adults. J Am Geriatr Soc. 2000;48(2):115–23.CrossRefPubMed Newman AB, Spiekerman CF, Enright P, et al. Daytime sleepiness predicts mortality and cardiovascular disease in older adults. J Am Geriatr Soc. 2000;48(2):115–23.CrossRefPubMed
58.
go back to reference Shahar E, Whitney CW, Redline S, et al. Sleep-disordered breathing and cardiovascular disease. Cross-sectional results of the sleep heart health study. Am J Respir Crit Care Med. 2001;163(1):19–25.CrossRefPubMed Shahar E, Whitney CW, Redline S, et al. Sleep-disordered breathing and cardiovascular disease. Cross-sectional results of the sleep heart health study. Am J Respir Crit Care Med. 2001;163(1):19–25.CrossRefPubMed
59.
go back to reference Irwin ED, Reicks P, Beal A, Byrnes M, Matticks C, Beilman GA. Prospective study of the role of sleep related disordered breathing as a risk factor for motor vehicle crashes and the development of systemic complications in non-commercial drivers. World J Emerg Surg. 2014;9:2.CrossRefPubMedPubMedCentral Irwin ED, Reicks P, Beal A, Byrnes M, Matticks C, Beilman GA. Prospective study of the role of sleep related disordered breathing as a risk factor for motor vehicle crashes and the development of systemic complications in non-commercial drivers. World J Emerg Surg. 2014;9:2.CrossRefPubMedPubMedCentral
60.
go back to reference Johnson KD, Patel SR, Baur DM, et al. Association of sleep habits with accidents and near misses in United States transportation operators. J Occup Environ Med. 2014 May;56(5):510–5.CrossRefPubMedPubMedCentral Johnson KD, Patel SR, Baur DM, et al. Association of sleep habits with accidents and near misses in United States transportation operators. J Occup Environ Med. 2014 May;56(5):510–5.CrossRefPubMedPubMedCentral
61.
go back to reference Janzen B, Karunanayake C, Pahwa P, et al. Exploring diversity in socioeconomic inequalities in health among rural dwelling Canadians. J Rural Health. 2015;31(2):186–98.CrossRefPubMed Janzen B, Karunanayake C, Pahwa P, et al. Exploring diversity in socioeconomic inequalities in health among rural dwelling Canadians. J Rural Health. 2015;31(2):186–98.CrossRefPubMed
62.
go back to reference Kapur VK, Redline S, Nieto FJ, Young T, Newman AB, Henderson JA. The relationship between chronically disrupted sleep and healthcare use. Sleep. 2002;25(3):289–96.PubMed Kapur VK, Redline S, Nieto FJ, Young T, Newman AB, Henderson JA. The relationship between chronically disrupted sleep and healthcare use. Sleep. 2002;25(3):289–96.PubMed
63.
go back to reference Leung RST, Comondore VR, Ryan CM, Stevens D. Mechanisms of sleep-disordered breathing: causes and consequences. Pflugers Arch - Eur J Physiol. 2012;463:213–30.CrossRef Leung RST, Comondore VR, Ryan CM, Stevens D. Mechanisms of sleep-disordered breathing: causes and consequences. Pflugers Arch - Eur J Physiol. 2012;463:213–30.CrossRef
64.
go back to reference Guilleminault C, Lopes MC, Hagen CC, de Rosa A. The cyclic alternating pattern demonstrates increased sleep instability and correlates with fatigue and sleepiness in adults with upper airway resistance syndrome. Sleep. 2007;30(5):641–7.CrossRefPubMed Guilleminault C, Lopes MC, Hagen CC, de Rosa A. The cyclic alternating pattern demonstrates increased sleep instability and correlates with fatigue and sleepiness in adults with upper airway resistance syndrome. Sleep. 2007;30(5):641–7.CrossRefPubMed
65.
go back to reference Zanobetti A, Redline S, Schwartz J, et al. Associations of PM10 with sleep and sleep-disordered breathing in adults from seven U.S. urban areas. Am J Respir Crit Care Med. 2010;182(6):819–25.CrossRefPubMedPubMedCentral Zanobetti A, Redline S, Schwartz J, et al. Associations of PM10 with sleep and sleep-disordered breathing in adults from seven U.S. urban areas. Am J Respir Crit Care Med. 2010;182(6):819–25.CrossRefPubMedPubMedCentral
66.
go back to reference Park JH, Gold DR, Spiegelman DL, Burge HA, Milton DK. House dust endotoxin and wheeze in the first year of life. Am J Respir Crit Care Med. 2001;163(2):322–8.CrossRefPubMed Park JH, Gold DR, Spiegelman DL, Burge HA, Milton DK. House dust endotoxin and wheeze in the first year of life. Am J Respir Crit Care Med. 2001;163(2):322–8.CrossRefPubMed
67.
go back to reference Michel O, Kips J, Duchateau J, et al. Severity of asthma is related to endotoxin in house dust. Am J Respir Crit Care Med. 1996;154(6 Pt 1):1641–6.CrossRefPubMed Michel O, Kips J, Duchateau J, et al. Severity of asthma is related to endotoxin in house dust. Am J Respir Crit Care Med. 1996;154(6 Pt 1):1641–6.CrossRefPubMed
68.
go back to reference Lin Y, Li Q, Zhang X. Interaction between smoking and obstructive sleep apnea: not just participants. Chin Med J. 2012;125(17):3150–6.PubMed Lin Y, Li Q, Zhang X. Interaction between smoking and obstructive sleep apnea: not just participants. Chin Med J. 2012;125(17):3150–6.PubMed
69.
go back to reference Rosales-Mayor E, de Castro JR, Huayanay L, Zagaceta K. Validation and modification of the Epworth sleepiness scale in Peruvian population. Sleep Breath. 2012;16(1):59–69.CrossRefPubMed Rosales-Mayor E, de Castro JR, Huayanay L, Zagaceta K. Validation and modification of the Epworth sleepiness scale in Peruvian population. Sleep Breath. 2012;16(1):59–69.CrossRefPubMed
Metadata
Title
Determinants of excessive daytime sleepiness in two First Nation communities
Authors
Ina van der Spuy
Chandima P. Karunanayake
James A. Dosman
Kathleen McMullin
Gaungming Zhao
Sylvia Abonyi
Donna C. Rennie
Joshua Lawson
Shelley Kirychuk
Judith MacDonald
Laurie Jimmy
Niels Koehncke
Vivian R. Ramsden
Mark Fenton
Gregory P. Marchildon
Malcolm King
Punam Pahwa
Publication date
01-12-2017
Publisher
BioMed Central
Published in
BMC Pulmonary Medicine / Issue 1/2017
Electronic ISSN: 1471-2466
DOI
https://doi.org/10.1186/s12890-017-0536-x

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