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The prevalence of daytime sleepiness and background factors associated with it were investigated in a study carried out at the UKK Institute. The inquiry took the form of a questionnaire mailed to 1600 people of middle age. Daytime sleepiness was found to be associated with disturbed night sleep. Women were more tired than men, but men slept more frequently during the day. Those suffering from tiredness complained of poor health more than other respondents. Traffic accidents and other mishaps attributable to tiredness had occurred in 1.3% of cases, and almost 5% of male respondents had dozed off while driving at least five times in their lives. The findings indicate a need for increased attention to disturbance of sleep and daytime sleepiness in routine health screening.

Good sleep is part of good quality of life. Sleep disturbances are rather common and they reflect various somatic and psychic diseases. Sleep length is associated with mortality. According to several epidemiological surveys short sleepers and long sleepers seem to have poorer life expectancy than those sleeping 7-8h/night [2,4,8]. Also myocardial infarctions are more common among those sleeping more than 10 h or less than 6 h/night than among those sleeping 7-8h [5].In an epidemiological study based on a population of 31140 Finnish adults, the percentage of poor sleepers increased from 4.6% among 18-to 29-year-old men to 19.4% among men older than 60 years of age. In women the respective percentages were 4.2% and 23.2%. In that study [6], as in some other studies [1], the respondents were asked if they regarded their sleep as "good," "fairly good," "fairly poor," "poor," or "could not say." Poor sleepers were those who considered their sleep as "poor" or'''fairly poor" [6].Based on the same population the sleep quality of 10778 Finnish adults aged 35-59 years was ascertained in a postal questionnaire in 1975. In that age group 38% were good sleepers, 50% were fairly good sleepers, and 12% were poor sleepers. Individuals were followed for 6 years until the end of 1981 using the computerized nationwide registries to collect death certificates and hospital records [3]. The age-adjusted risk ratios (RRs) for poor sleep compared with good sleep in natural death was 2.6 for men (P < 0.001) and 0.9 (NS) for women. The risk ratio of violent deaths for poor sleep compared with good sleep was 4.6 (P < 0.001) for men and 2.6 (NS) for women. The RR of ischemic heart disease was 2.0 (P < 0.01) for men and 2.2 (P < 0.01) for women. The results of that prospective study [3] show that poor sleep quality is an indicator of mental and somatic disease.Relationship of sleep quality and subjective health status was studied in an urban population in Tampere, Finland. Instead of a simple question about sleep quality we have started to construct better indices of sleep quality [7].A sample of 1600 Finnish adults, aged 36-50 years, was randomly selected from the municipal health files of Tampere. Subsamples of 200 men and of

The health‐related physical activity of Finns was studied during the 1980s by analysing changes in activity in a 10‐year follow‐up of a representative population cohort aged 20–65 years at the onset of the study. The proportion of apparently healthy people exercising at least twice a week for fitness and health increased from about 40% to over 50%. The increase was particularly large among women and young people. Occupational physical activity, education and marital status did not affect the trends. In contrast, regular vigorous exercise remained unchanged. These findings are consistent with other observations showing a steady increase in health‐related physical activity among adult Finns during the past 20 years. However, in terms of the health potential of exercise, a majority of the population remains less than optimally active.

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The prevalence and natural evolution of sleepiness were investigated in a 5‐year follow‐up study in a middle‐aged population in Finland. In the original study a structured sleep questionnaire was completed by 1190 subjects and a 5‐year follow‐up questionnaire was returned by 626. The prevalence of sleepiness, meaning here an unintentional tendency to fall asleep weekly in the course of everyday living, was 9.6% in the first survey and 10.6% 5 years later in the same cohort; 3.7% had been sleepy in both surveys. Sleep fragmentation, leg jerking and awakenings during sleep were common findings among sleepy subjects in both surveys. Shift‐workers and those who had irregular working hours ran a risk of chronic sleepiness. Sleepiness was also associated with poor subjective health, obesity, depression, nervousness and tension. In particular, chronically sleepy subjects had an increased risk of sleepiness‐related traffic accidents and premature retirement. Contrary to common findings from sleep laboratories, neither snoring nor self‐ or spouse‐reported breathing pauses during sleep were significantly associated with long‐term sleepiness in a non‐selected middle‐aged population. It is suggested that more attention should be paid to subjects suffering from excessive daytime sleepiness even if they do not have a history of respiratory or other known organic sleep disorder.

Introduction– The natural evolution of snoring was studied in a middle‐aged population in Finland. Material and methods– A questionnaire was mailed to a stratified random sample of 1600 people aged 36–50 years in 1985 with a response rate of 75.2%; 53% of them completed also the 5‐year‐follow‐up questionnaire. Clinical examinations (N = 36) and whole‐night polygraphic recordings (N = 22) were made to habitual (every or almost every night) snorers and daily sleepy persons. Results– A total of 626 persons completed the 5‐year‐follow‐up questionnaire. The prevalence of habitual snoring among men was 28.3–43.8% and among women 6.3–18.8%, increasing with age. Sleepiness was common: doze‐off at the wheel was reported by 23% of snorers and traffic accidents because of sleepiness by 4.5%. Hypertension was clearly more common (p = 0.002) among habitual snorers, but the self‐reported rates of strokes and coronary heart disease were not increased in this study. None of the snorers had been investigated because of their snoring or sleepiness during the five years. In polygraphic recordings 11/22 showed an oxygen desaturation index (ODI4) more than 5/h; active treatment was started for 8 of them. The observed prevalence of sleep apnea syndrome with ODI4> 10 was 1.1% in this study. Conclusions– Snorers, even with clear sleepiness, are passive in seeking help for their symptoms. Physicians should actively diagnose this treatable condition impairing the quality of life and increasing the risk of traffic accidents and vascular diseases.