Summary: A large retrospective study of more than 40,000 female veterans found that excessive daytime sleepiness is linked to a higher risk of death from any cause in women aged 50–65. After adjusting for demographic and health-related factors, women in this midlife group who scored highly on the Epworth Sleepiness Scale had a 16% greater likelihood of all-cause mortality compared with those reporting normal sleepiness levels.
This elevated risk was specific to the middle-age group and was not seen in younger or older women in the cohort. The authors propose that this pattern could reflect hormonal, metabolic, or resilience-related changes that occur during midlife and may increase vulnerability to the health consequences of excessive sleepiness.
Key findings
- Age-specific effect: The association between excessive daytime sleepiness and mortality appeared only in women aged 50–65.
- Measured risk: High Epworth Sleepiness Scale scores were associated with a 16% increase in adjusted odds of all-cause death for midlife women.
- Potential mechanisms: Authors highlight possible roles for hormonal and metabolic changes or differences in physiological resilience during midlife.
Study overview
The analysis used medical records from 40,250 female veterans who sought sleep-related care between 1999 and 2022. The average age of participants was 48 years. Clinical notes were examined using validated methods to extract Epworth Sleepiness Scale scores, which measure the likelihood of dozing off in everyday situations and are commonly used to quantify daytime sleepiness.
Researchers adjusted their models for age within strata, race and ethnicity, body mass index, and existing comorbid conditions to isolate the relationship between reported sleepiness and mortality. After accounting for these variables, the increased mortality risk remained significant only in the 50–65 age group. No statistically significant relationship was found among younger adults or among older women.
Clinical implications
Lead author Arash Maghsoudi, PhD, an instructor at Baylor College of Medicine, emphasizes that midlife may be a critical window for screening and intervention. He suggests clinicians should routinely assess daytime sleepiness using a standardized tool such as the Epworth Sleepiness Scale in women approaching their 50s and into their early 60s. Identifying and treating causes of excessive sleepiness—such as sleep apnea, insomnia, medication side effects, or other medical issues—could potentially improve quality of life and reduce health risks.
The American Academy of Sleep Medicine characterizes excessive daytime sleepiness as the inability to stay awake and alert during major waking episodes of the day. It is a patient-reported outcome that is linked to impaired functioning, higher accident risk, and a range of adverse health outcomes, underscoring the value of timely recognition and management.
Interpretation and future directions
The absence of a similar association in older women—who generally have higher burdens of chronic disease—was particularly notable. The authors propose that biological changes occurring in midlife, possibly related to menopause, metabolic shifts, or variations in physiological resilience, could influence how sleepiness affects long-term health. They call for mechanistic studies to explore these pathways and for prospective research to determine whether interventions that reduce excessive daytime sleepiness can alter mortality risk.
Funding
This research received support from the National Heart, Lung, and Blood Institute (National Institutes of Health), the Center for Innovations in Quality, Effectiveness, and Safety (a joint Baylor College of Medicine and VA Health Systems Research Center of Innovation program), and the Michael E. DeBakey VA Medical Center in Houston.
About this sleep research news
Author: Hannah Miller
Source: AASM
Contact: Hannah Miller – AASM
Image: The image is credited to Neuroscience News
Original research: Findings to be presented at SLEEP 2025