Abstract Introduction Increases in excessive daytime sleepiness (EDS) in the transition to adolescence are proposed to be indicative of maturational brain changes. However, whether maturational trajectories of EDS differ between males and females lack replication in population-based studies with repeated measures across the lifespan. Methods We analyzed longitudinal data from 699 school-age children (ages 5 to 12) at baseline from the Penn State Child Cohort who were followed-up three times during adolescence, young adulthood and early adulthood (median follow-up time 15.4y, quartiles 13.4-17.3y) providing a longitudinal age range from 5 to 33 years old. We defined EDS in a developmentally appropriate way across time-points. We fitted age-related polynomials up to the quartic term to determine the trajectory of EDS within each sex. We estimated the age at which EDS peaked and the rate of change in EDS from age 5 to peak-EDS. We also calculated the odds of EDS at maturational age segments. Results Cubic maturational trajectories were selected for both males and females and showed an increase in EDS between ages 5 to 10, peaking at ages 15-17, and declining after age 18. The predicted probability of EDS at age 5 was lower in females (0.8%) than males (8.1%), yet the increase in odds of EDS by age 10 was 11-times higher in females (odds ratio OR=43.6) compared to males (OR=3.9) (p=0.003). Females reached peak-EDS (59% vs. 46% predicted probability) 10 months earlier (age 16.4 vs. 17.3) and at a higher rate (5.1% vs. 3.1% per year) than males. The predicted probability of EDS at age 25 was lower in males (18.5%) than females (31.8%) and the decrease in odds of EDS between ages 25 to 30 was 7-times larger in males (OR=0.08) than females (OR=0.57) (p=0.004). Conclusion Our findings support sex differences in the developmental trajectories of EDS, consistent with early maturation in females but worse outcome by early adulthood. Future studies should examine the biological mechanisms, social determinants and clinical risk factors of the observed sex differences, particularly as it pertains to male EDS in childhood and female EDS in early adulthood. Support (if any) R01MH136472, R01HL136587
Rice et al. (Fri,) studied this question.