SEATTLE – A recent observational study has indicated that excessive daytime sleepiness (EDS) is linked to a notably higher risk of death from all causes in women.

The study found that women between the ages of 50 and 65 who scored high on the Epworth Sleepiness Scale (ESS) were 16% more likely to die from any cause compared to women with normal sleepiness levels, after adjusting for various health and demographic factors. This correlation was not observed in younger women or those older than 65.

“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, PhD, with Baylor College of Medicine in Houston, in a news release.

The findings were presented on June 9 at SLEEP 2025.

data Gap Addressed

Previous research has linked EDS to all-cause mortality, but these studies have largely focused on men.

Arash Maghsoudi and his team examined the medical records of 40,250 female veterans (average age, 48 years) from 1999 to 2022. The study focused on individuals with sleep-related International Classification of Diseases, 9th/10th Revision codes, or those who had used clinical sleep services.

A validated natural language processing tool was used to extract ESS scores from clinical notes,categorizing scores as normal (0-10) or high (11-24).

participants were divided into three age groups: Young (under 50 years), middle-aged (50 to 64 years), and older adults (65 years and older). Adjustments were made for age, race, ethnicity, BMI, and Charlson Comorbidity Index.

The overall cohort did not show a statistically significant adjusted odds ratio for all-cause mortality in those with high ESS scores compared to those with normal ESS scores.

However, middle-aged women with high ESS scores showed a significantly higher likelihood of all-cause mortality (adjusted odds ratio, 1.16). No significant associations were found in the younger or older age groups.

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

“Sleepiness matters.”

‘Intriguing’ Data

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,commented on the research,stating that the finding that subjectively reported EDS in middle-aged women is associated with mortality reinforces the American Academy of Sleep Medicine (AASM) position that “sleepiness matters.”

The AASM recently published a position statement emphasizing how sleepiness can disrupt daily functioning and act as an indicator of other conditions like mental health issues, sleep disorders, or medication side effects, as previously reported.

“For these reasons, it is crucial for clinicians to ask their patients about sleepiness,” said Indira 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,” Indira Gurubhagavatula said.

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

Having mentioned that, “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,” Indira Gurubhagavatula told Medscape Medical News.

She also cautioned that the study focused on women veterans, whose risks for sleepiness and mortality may differ from those in other populations. The results may not be generalizable 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,” Indira Gurubhagavatula concluded.

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