Daytime Sleepiness Tied to Risk for Early Death in Women

SEATTLE — Excessive daytime sleepiness (EDS) was associated with a significantly increased risk for all-cause mortality in women, results of a large observational study showed.

After adjusting for health and demographic factors, women aged 50 and 65 years with high scores on the Epworth Sleepiness Scale (ESS) were 16% more likely to die from any cause than their counterparts who had normal levels of sleepiness on this tool. This association was not found in younger women or in those over age 65 years.

“Identifying middle age as a critical period suggests clinicians should prioritize an Epworth Sleepiness Scale assessment and excessive daytime sleepiness management in women approaching their 50s and early 60s,” lead author Arash Maghsoudi, PhD, with Baylor College of Medicine in Houston, said in a news release.

The findings were presented on June 9 at SLEEP 2025.

Data Gap in Women

EDS has been associated with all-cause mortality in previous studies, which primarily focused on men.

Maghsoudi and colleagues analyzed the medical records of 40,250 female veterans (mean age, 48 years) from 1999 to 2022, focusing on individuals with sleep-related International Classification of Diseases, 9th/10th Revision codes, or those who had received clinical sleep services.

They used a validated natural language processing tool to extract ESS scores from clinical notes, with scores categorized as normal (0-10) or high (11-24).

Participants were further stratified into three age groups: Young (< 50 years), middle-aged (≥ 50 to < 65 years), and older adults (≥ 65 years). The results were adjusted for age, race, ethnicity, BMI, and Charlson Comorbidity Index.

In the overall cohort, the adjusted odds ratio for all-cause mortality in those with high ESS scores compared to those with normal ESS scores was not statistically significant.

However, when stratified by age, middle-aged women with high ESS scores had a significantly higher likelihood of all-cause mortality (adjusted odds ratio, 1.16), with no significant associations seen in the younger or older age groups.

The researchers said further studies are needed to explore potential mechanisms, including sex-specific responses to sleepiness and the role of age in this association.

‘Intriguing’ Data

Commenting on this research for Medscape Medical News, Indira Gurubhagavatula, MD, MPH, director of the Sleep Medicine Fellowship and professor of medicine at the University of Pennsylvania Perelman School of Medicine in Philadelphia, said the finding that subjectively reported EDS in middle-aged women is associated with mortality strengthens the American Academy of Sleep Medicine (AASM) position that “sleepiness matters.”

The AASM recently published a position statement highlighting how sleepiness can interfere with daily functioning and serve as a marker for other conditions such as mental health problems, sleep disorders, or side effects of medications, as previously reported by Medscape Medical News.

“For these reasons, it is important for clinicians to ask their patients about sleepiness,” said Gurubhagavatula, a spokesperson for AASM.

“The Epworth Sleepiness Scale is a method to get quick, subjective responses and can help guide next steps in clinical evaluation. Improving sleepiness by treating the underlying cause can help restore daytime functioning at home and work, reduce risks of chronic health conditions, and improve people’s quality of life,” Gurubhagavatula said.

She noted that mechanistic reasons for the relationship between sleepiness and mortality in middle-aged women remain unknown. “We need more studies to investigate the causal factors that would explain why this association exists,” she added.

That said, “the adjusted odds ratio is just above 1 (average 1.16) in the middle age group. If this is confirmed to be true, even though the risk seems small at an individual level, when you consider it across an entire population, the risk burden to society may be significant,” Gurubhagavatula told Medscape Medical News.

She also cautioned that the study involved women veterans, whose risks for sleepiness and mortality may be different than those in other populations. Moreover, the results may not necessarily generalize to other groups.

“The bottom line is that the report is intriguing and calls for more studies to confirm this finding and help explain the mechanism,” Gurubhagavatula concluded.

The study had no commercial funding. Maghsoudi and Gurubhagavatula reported having no relevant disclosures.