No data are available in the literature assessing the potential use of waking electroencephalographic (EEG) activity in the detection of excessive daytime sleepiness (EDS) in patients with sleep-related breathing disorders (SRBD). The aim of this study was to evaluate whether waking EEG spectral power reflects the level of EDS in SRBD patients.The study was performed in 48 patients in whom quantitative EEG analysis, including the alpha attenuation coefficient (AAC), was performed. Sleepiness was assessed by the Epworth Sleepiness Scale, the Stanford Sleepiness Scale, the Visual Analogue Scale and the maintenance of wakefulness test.Although AAC and EEG spectral power tended to vary throughout the day, none of these variations correlated with EDS measures. Waking EEG measures were not different between snorers and apnoeic patients. Compared to nonsleepy patients, sleepy patients had greater theta and slow alpha powers, but the differences did not reach statistical significance. The EEG slowing was independent of hypoxaemia, severity of SRBD, or degree of sleep disruption.The authors conclude that waking electroencephalographic measures are not sensitive enough to predict variation in alertness or to differentiate sleepy from nonsleepy sleeprelated breathing disorders patients. The degree of electrocephalographic slowing was related neither to sleep disruption nor to severity of sleep-related breathing disorders. [5,6] may not adequately reveal diurnal impairment in sleepy patients and they do not strongly correlate with the subjective estimation [7]. Second, a decrease in mean sleep latency in the MSLT may occur even when the subjects rated themselves as alert, suggesting that subjective estimation measures different aspects of sleepiness. Thus, neither objective nor subjective measures of alertness currently characterize the phenomenon of sleepiness with complete accuracy.Some recent studies suggest that various components of the spectral electroencephalographic (EEG) activity during wakefulness may help to detect changes in alertness. The awake alpha power with eyes-open increases when performance and alertness decrease [8], and the ratio of alpha power during eyes-closed versus eyes-open, i.e. the alpha attenuation coefficient (AAC) [9], falls in sleep-deprived subjects [10] and in narcoleptics [11]. Furthermore, awake alpha and theta powers are accurate indicators of sleep propensity, enhanced theta activity and decreased alpha activity [12,13] found when sleepiness becomes manifest.Therefore, it is reasonable to suggest that changes in waking alpha and theta EEG power, similar to those described earlier, could be expected in SRBD patients. If so, the degree of waking EEG changes would be an important predictor of reduced alertness and a useful measure of sleepiness. The main aim of the current study was to investigate the relationship between waking EEG activity and daytime sleepiness in a SRBD population. The prediction was that the alpha power and the AAC would be reduced, and that the theta pow...