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Related Experiment Video

Updated: Sep 11, 2025

Collecting Sleep, Circadian, Fatigue, and Performance Data in Complex Operational Environments
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Changes in Self-Reported Excessive Daytime Sleepiness Are Associated With 5-Year All-Cause Mortality Risk Among

Katherine G Bay1,2,3,4, Arash Maghsoudi1,2,4, Amin Ramezani5

  • 1Center for Innovations in Quality, Effectiveness and Safety (IQuESt), Houston, Texas, USA.

Journal of Sleep Research
|August 19, 2025
PubMed
Summary

Excessive daytime sleepiness (EDS) identified by the Epworth Sleepiness Scale (ESS) can predict mortality risk in Veterans. Developing EDS after normal scores increases mortality risk, especially for those over 55.

Keywords:
Epworth sleepiness scaleall‐cause mortalityexcessive daytime sleepinessnatural language processing

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Area of Science:

  • Sleep Medicine
  • Clinical Epidemiology
  • Gerontology

Background:

  • Excessive daytime sleepiness (EDS) is associated with poor health outcomes.
  • The Epworth Sleepiness Scale (ESS) is a validated tool for assessing EDS.
  • Understanding the link between changes in ESS scores and mortality is crucial for clinical practice.

Purpose of the Study:

  • To evaluate the association between changes in ESS scores and 5-year all-cause mortality risk.
  • To identify if EDS serves as a clinical marker for mortality in Veterans.
  • To analyze mortality risk based on transitions between normal and abnormal ESS scores.

Main Methods:

  • Retrospective cohort study of Veterans using VA sleep services (1999-2018).
  • Extracted ESS values using a natural language processing (NLP) pipeline.
  • Analyzed 5-year all-cause mortality using Cox proportional hazards models, adjusting for covariates.

Main Results:

  • Among 17,967 Veterans, 11.75% died within 5 years.
  • The Normal-Abnormal ESS group showed a 25% higher mortality risk (aHR: 1.25) compared to Normal-Normal.
  • Mortality risk increased with age, particularly after 55.
  • Persistent EDS (Abnormal-Abnormal) and improvement (Abnormal-Normal) were not significantly linked to mortality.

Conclusions:

  • The Epworth Sleepiness Scale (ESS) can identify Veterans at increased risk of mortality.
  • A transition from normal to abnormal ESS scores is a significant predictor of 5-year all-cause mortality.
  • EDS may serve as a clinical marker for mortality risk, especially in older Veterans (≥55 years).