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Can physiological sleepiness underlie consciously perceived sleepiness assessed with the Epworth sleepiness scale?

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Abstract

Methods of evaluation of substates of sleep and sleepiness differ in, at least, two respects. Although sleepiness has not been separated from other wake and sleep substates using yes-or-no criteria for sleep scoring, it would be consciously perceived and, therefore, assessed with a questionary. However, such subjective method was challenged by the finding suggesting a disconnect between two most widely used subjective and objective indicators of excessive daytime sleepiness (EDS), a score on the Epworth sleepiness scale (ESS) > 10 and a reduced latency to sleep onset (SOL), respectively. We examined whether these two EDS indicators differ in their association with physiological sleepiness, i.e., the polysomnographic indexes of elevated sleep pressure. In the afternoon hours, polysomnographic recordings were obtained throughout 54 50-min and 56 90-min napping attempts of 27 and 28 university students, respectively. Within some but not all 10-min intervals of the 50- or 90-min naps, each EDS indicator was validated against different objective polysomnographic indexes suggesting an association of EDS with elevated sleep pressure. Significant differences in sleep indexes were found between participants with short and longer SOL, but they disappeared right before the appearance of such differences between participants with higher and lower ESS score (usually at the 4th 10-min interval). This mismatch in timing of appearance of significant differences might be a plausible explanation for the lack of significant association between the ESS and SOL. Therefore, the physiologic underpinnings of the ESS can be uncovered despite such a disconnect between these two EDS indicators.

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Data availability

The datasets analyzed during the current study are available from the corresponding author on reasonable request.

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Acknowledgements

The authors are very grateful to Dr. Dmitry S. Sveshnikov, Dr. Zarina V. Bakaeva, Dr. Olga V. Mankaeva, and Prof. Vladimir I. Torshin from the Medical Institute at the Peoples' Friendship University for help in organization of the survey and polysomnographic recordings of their students. The North-Caucasus Federal University provided technical and other similar support to AAP.

Funding

The Russian Science Foundation funded RAE (Grant #22-72-10061).

Author information

Authors and Affiliations

  1. Laboratory of Sleep/Wake Neurobiology, Institute of Higher Nervous Activity and Neurophysiology of the Russian Academy of Sciences, Moscow, Russia

    Vladimir B. Dorokhov, Alexandra N. Puchkova, Dmitry E. Shumov, Eugenia O. Gandina, Anton O. Taranov, Olga N. Tkachenko, Natalya V. Ligun, Gleb N. Arseniev & Arcady A. Putilov

  2. Department of Normal Physiology, Medical Institute of the Peoples’ Friendship University of Russia, Moscow, Russia

    Elena B. Yakunina

  3. Laboratory of Smart Sleep, Saratov State University, Saratov, Russia

    Anastasiya E. Runnova

  4. Department of Psychology, Lomonosov Moscow State University, Moscow, Russia

    Aleksandr E. Manaenkov

  5. Laboratory of Medical Electronics, Kotelnikov Institute of Radio Engineering and Electronics of the Russian Academy of Sciences, Moscow, Russia

    Valery. V. Dementienko

  6. Research Group for Math-Modeling of Biomedical Systems, Research Institute for Molecular Biology and Biophysics of the Federal Research Centre for Fundamental and Translational Medicine, Novosibirsk, Russia

    Arcady A. Putilov

  7. Laboratory of Nanobiotechnology and Biophysics, North-Caucasus Federal University, Stavropol, Russia

    Arcady A. Putilov

  8. 11, Nipkowstr., 12489, Berlin, Germany

    Arcady A. Putilov

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  1. Vladimir B. Dorokhov
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  2. Elena B. Yakunina
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  8. Natalya V. Ligun
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  9. Gleb N. Arseniev
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  13. Arcady A. Putilov
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Contributions

Conceptualization AAP; funding acquisition EBY, and VBD; data curation VBD, EBY, ANP, DES, EOG, AOT, ONT, NVL, GNA, AER, AEM, VVD, and AAP, resources AAP, DSS, and VBD; project administration AAP and VBD; supervision AAP; software DES, ANP, and AAP; investigation VBD, ANP, and AAP; methodology AAP, VBD, and ANP; sleep scoring: ANP and EOG; spectra calculation: DES; validation AAP; visualization AAP; writing—review and editing AAP, VBD, EBY, ANP, DES, EOG, AOT, ONT, NVL, GNA, AER, AEM, and VVD.

Corresponding author

Correspondence to Arcady A. Putilov.

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Conflict of interest

The authors declare no competing interests. The funders had no role in the design of the study, the collection, analyses, or interpretation of data, the writing of the manuscript, and the decision to publish the results.

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Brain Physiology Meets Complex Systems. Guest editors: Thomas Penzel, Teemu Myllylä, Oxana V. Semyachkina-Glushkovskaya, Alexey Pavlov, Anatoly Karavaev.

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Dorokhov, V.B., Yakunina, E.B., Puchkova, A.N. et al. Can physiological sleepiness underlie consciously perceived sleepiness assessed with the Epworth sleepiness scale?. Eur. Phys. J. Spec. Top. 232, 569–582 (2023). https://doi.org/10.1140/epjs/s11734-023-00771-2

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