1101 Association of Depression and Subjective-Objective Discrepancy in Excessive Daytime Sleepiness

Abstract Introduction Excessive daytime sleepiness (EDS) is common, affecting 10 to 25% of the general population. Comorbid depression may alter patient’s perception and limit awareness of sleepiness and thereby lead to potentially poor clinical outcomes. This study aims to evaluate if depression is associated with subjective-objective discrepancy in EDS. Methods We reviewed medical records of patients who presented with excessive daytime sleepiness (EDS) and underwent an overnight polysomnogram (PSG) followed by a next-day Multiple Sleep Latency Test (MSLT) at three University of Pittsburgh Medical Center sleep laboratories, between March 2023 and December 2024. Subjective–objective discrepancy was defined as an Epworth Sleepiness Scale (ESS) score ≥10 with a mean sleep latency ≥8 minutes on the MSLT. Patients were classified as having depression if it was documented in the sleep evaluation or if prescribed an antidepressant in the 6 months preceding MSLT. Results Among the first 151 patients (mean age 32.9 ± 11.5 years; 119 women [78%], 32 men [22%]; 88% White) who underwent PSG/MSLT, 70 (46%) had evidence of subjective-objective discrepancy. Depression was present in 67% of those with and 58% of those without discrepancy (p=0.25). No significant differences were observed between those with and without discrepancy in age (34.2 ± 12.9 vs. 31.8 ± 10.1, p=0.19), gender (women: 79% vs.79%, p=0.9), race (White: 90% vs. 86%, p=0.36), body mass index (28.1 ± 7.7 vs. 28.5 ± 6.7, p=0.75), ESS score (14.8 ± 3.4 vs. 15.2 ± 3.2, p=0.5), or average sleep duration (7.5±1.5 vs. 7.7±1.7, p=0.4) on sleep diaries. In gender-stratified analyses, men with subjective-objective discrepancy had a higher prevalence of depression (80% vs. 47%, p=0.05) with a trend towards significance, but no difference was observed in women (64% vs. 61%, p=0.76). After adjusting for age and race, there was a trend towards depression being associated with subjective–objective discrepancy in men (OR = 4.7, 95% CI: 0.95-23.6, p = 0.06), but not women (OR = 1.2, 95% CI 0.58-2.6, p=0.6). Conclusion Depression may be associated with subjective–objective discrepancy in sleepiness among men. Therefore, male patients presenting with EDS should be evaluated for depression as part of their clinical assessment. Support (if any)