Excessive daytime sleepiness is associated with higher odds of all-cause mortality in middle-aged women but not in younger or older women, according to a new study at Sleep 2025.
Results show that the adjusted odds of all-cause mortality were 16% higher in women between the ages of 50 and 65 years who had high scores on the Epworth Sleepiness Scale, compared with women who had normal levels of sleepiness. The results were adjusted for age, race, ethnicity, body mass index, and comorbidities. No significant associations were observed in younger women or older women.
RT’s Three Key Takeaways:
- Middle-Aged Risk – Excessive daytime sleepiness is linked to a 16% higher risk of all-cause mortality specifically in women aged 50 to 65, but not in younger or older women.
- Clinical Screening – Researchers recommend routine use of the Epworth Sleepiness Scale to assess and manage daytime sleepiness in middle-aged women.
- Biological Factors – The lack of association in older women suggests that hormonal, metabolic, or resilience factors may influence sleepiness-related health risks during midlife.
“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,” said lead author Arash Maghsoudi, who has a doctorate in biomedical engineering and is an instructor at the Baylor College of Medicine in Houston.
Sleepiness is a critical patient-reported outcome that is associated with increased risk for adverse health effects and diminished quality of life, according to an American Academy of Sleep Medicine position statement. Excessive sleepiness is defined as the inability to stay awake and alert during the major waking episodes of the day.
The study involved a retrospective analysis of the medical records of 40,250 female veterans from 1999 to 2022, focusing on individuals who had a sleep disorder or had received sleep-related care. The study sample had a mean age of 48 years. Clinical notes were analyzed to extract scores on the Epworth Sleepiness Scale, a validated natural language processing tool that assesses the likelihood of dozing off or falling asleep during routine daily activities.
According to Maghsoudi, it is noteworthy that there was no association between excessive daytime sleepiness and mortality in older women who tend to have more comorbidities.
“It implies hormonal, metabolic, or resilience factors that warrant mechanistic follow-up for women in middle age,” he said.
