Epworth Sleepiness Scale

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Epworth Sleepiness Scale
Purposediagnose sleep disorder

The Epworth Sleepiness Scale (ESS) is a scale [1] [2] intended to measure daytime sleepiness that is measured by use of a very short questionnaire. This can be helpful in diagnosing sleep disorders. It was introduced in 1991 by Dr Murray Johns of Epworth Hospital in Melbourne, Australia. [3]

Contents

The questionnaire

The questionnaire asks the subject to rate his or her probability of falling asleep on a scale of increasing probability from 0 to 3 for eight different situations that most people engage in during their daily lives, though not necessarily every day. [3] The scores for the eight questions are added together to obtain a single number. A number in the 0–9 range is considered to be normal while a number in the 10–24 range indicates that expert medical advice should be sought. [3] For instance, scores of 11–15 are shown to indicate the possibility of mild to moderate sleep apnea, where a score of 16 and above indicates the possibility of severe sleep apnea or narcolepsy. [3] Certain questions in the scale were shown to be better predictors of specific sleep disorders, though further tests may be required to provide an accurate diagnosis. [3]

The questionnaire was originally created with the intent to preserve the exact wording of the questionnaire to provide a standardized test and to preserve its validity; the author of the ESS recommends that the administrator of the questionnaire does not discuss the results of the ESS with the subject until it is completed, as this may affect the subject's responses on the questionnaire. [4]

An interactive calculator is available that utilizes the 1997 version of the ESS. It automatically provides the score based on the responses to the ESS questions: ESS interactive calculator. [5]

Calibration

The Epworth Sleepiness Scale has been validated primarily in obstructive sleep apnea, though it has also shown success in detecting narcolepsy and idiopathic hypersomnia. [3] It is used to measure excessive daytime sleepiness and is repeated after the administration of treatment (e.g., CPAP) to document improvement of symptoms. [6] In narcolepsy, the Epworth Sleepiness Scale has both a high specificity (100%) and sensitivity (93.5%). [7]

The Epworth Sleepiness Scale has been used to compare the sensitivity and specificity of other similar measurements of sleep quality. [8] [9] The Pittsburgh Sleep Quality Index is a related scoring tool of sleep quality. Both scores are internally highly reproducible. [10]

The test has limitations that can affect the test's accuracy. The test is based on subjectivity and therefore may not be accurate when factors such as the test takers opinions on their sleep, how others view their sleepiness, education level, and others are considered. [11] The test can be biased as pre-emptive discussion of results can have an effect on the responses while the test is being taken. [4]

Related Research Articles

<span class="mw-page-title-main">Sleep apnea</span> Disorder involving pauses in breathing during sleep

Sleep apnea is a sleep-related breathing disorder in which repetitive pauses in breathing, periods of shallow breathing, or collapse of the upper airway during sleep results in poor ventilation and sleep disruption. Each pause in breathing can last for a few seconds to a few minutes and occurs many times a night. A choking or snorting sound may occur as breathing resumes. Common symptoms include daytime sleepiness, snoring, and non restorative sleep despite adequate sleep time. Because the disorder disrupts normal sleep, those affected may experience sleepiness or feel tired during the day. It is often a chronic condition.

<span class="mw-page-title-main">Sleep disorder</span> Medical disorder of a persons sleep patterns

A sleep disorder, or somnipathy, is a medical disorder of an individual's sleep patterns. Some sleep disorders are severe enough to interfere with normal physical, mental, social and emotional functioning. Sleep disorders are frequent and can have serious consequences on patients' health and quality of life. Polysomnography and actigraphy are tests commonly ordered for diagnosing sleep disorders.

Somnolence is a state of strong desire for sleep, or sleeping for unusually long periods. It has distinct meanings and causes. It can refer to the usual state preceding falling asleep, the condition of being in a drowsy state due to circadian rhythm disorders, or a symptom of other health problems. It can be accompanied by lethargy, weakness and lack of mental agility.

Hypersomnia is a neurological disorder of excessive time spent sleeping or excessive sleepiness. It can have many possible causes and can cause distress and problems with functioning. In the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), hypersomnolence, of which there are several subtypes, appears under sleep-wake disorders.

A microsleep is a sudden temporary episode of sleep or drowsiness which may last for a few seconds where an individual fails to respond to some arbitrary sensory input and becomes unconscious. Episodes of microsleep occur when an individual loses and regains awareness after a brief lapse in consciousness, often without warning, or when there are sudden shifts between states of wakefulness and sleep. In behavioural terms, MSs may manifest as droopy eyes, slow eyelid-closure, and head nodding. In electrical terms, microsleeps are often classified as a shift in electroencephalography (EEG) during which 4–7 Hz activity replaces the waking 8–13 Hz background rhythm.

<span class="mw-page-title-main">Polysomnography</span> Multi-parameter study of sleep and sleep disorders

Polysomnography (PSG), a type of sleep study, is a multi-parameter study of sleep and a diagnostic tool in sleep medicine. The test result is called a polysomnogram, also abbreviated PSG. The name is derived from Greek and Latin roots: the Greek πολύς, the Latin somnus ("sleep"), and the Greek γράφειν.

<span class="mw-page-title-main">Obstructive sleep apnea</span> Sleeping and breathing disorder

Obstructive sleep apnea (OSA) is the most common sleep-related breathing disorder and is characterized by recurrent episodes of complete or partial obstruction of the upper airway leading to reduced or absent breathing during sleep. These episodes are termed "apneas" with complete or near-complete cessation of breathing, or "hypopneas" when the reduction in breathing is partial. In either case, a fall in blood oxygen saturation, a disruption in sleep, or both, may result. A high frequency of apneas or hypopneas during sleep may interfere with the quality of sleep, which – in combination with disturbances in blood oxygenation – is thought to contribute to negative consequences to health and quality of life. The terms obstructive sleep apnea syndrome (OSAS) or obstructive sleep apnea–hypopnea syndrome (OSAHS) may be used to refer to OSA when it is associated with symptoms during the daytime.

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Somnology is the scientific study of sleep. It includes clinical study and treatment of sleep disorders and irregularities. Sleep medicine is a subset of somnology.

The Multiple Sleep Latency Test (MSLT) is a sleep disorder diagnostic tool. It is used to measure the time elapsed from the start of a daytime nap period to the first signs of sleep, called sleep latency. The test is based on the idea that the sleepier people are, the faster they will fall asleep.

Excessive daytime sleepiness (EDS) is characterized by persistent sleepiness and often a general lack of energy, even during the day after apparently adequate or even prolonged nighttime sleep. EDS can be considered as a broad condition encompassing several sleep disorders where increased sleep is a symptom, or as a symptom of another underlying disorder like narcolepsy, circadian rhythm sleep disorder, sleep apnea or idiopathic hypersomnia.

<span class="mw-page-title-main">Sleep medicine</span> Medical specialty devoted to the diagnosis and therapy of sleep disturbances and disorders

Sleep medicine is a medical specialty or subspecialty devoted to the diagnosis and therapy of sleep disturbances and disorders. From the middle of the 20th century, research has provided increasing knowledge of, and answered many questions about, sleep–wake functioning. The rapidly evolving field has become a recognized medical subspecialty in some countries. Dental sleep medicine also qualifies for board certification in some countries. Properly organized, minimum 12-month, postgraduate training programs are still being defined in the United States. In some countries, the sleep researchers and the physicians who treat patients may be the same people.

The sleep–wake activity inventory (SWAI) is a subjective multidimensional questionnaire intended to measure sleepiness.

<span class="mw-page-title-main">Sleep study</span> Sleep Medicine

A sleep study is a test that records the activity of the body during sleep. There are five main types of sleep studies that use different methods to test for different sleep characteristics and disorders. These include simple sleep studies, polysomnography, multiple sleep latency tests (MSLTs), maintenance of wakefulness tests (MWTs), and home sleep tests (HSTs). In medicine, sleep studies have been useful in identifying and ruling out various sleep disorders. Sleep studies have also been valuable to psychology, in which they have provided insight into brain activity and the other physiological factors of both sleep disorders and normal sleep. This has allowed further research to be done on the relationship between sleep and behavioral and psychological factors.

<span class="mw-page-title-main">Narcolepsy</span> Human sleep disorder

Narcolepsy is a chronic neurological disorder that involves a decreased ability to regulate sleep–wake cycles. Symptoms often include periods of excessive daytime sleepiness and brief involuntary sleep episodes. Narcolepsy paired with cataplexy is evidenced to be an autoimmune disorder. These experiences of cataplexy can be brought on by strong emotions. Less commonly, there may be vivid hallucinations or an inability to move while falling asleep or waking up. People with narcolepsy tend to sleep about the same number of hours per day as people without it, but the quality of sleep tends to be lessened.

Pitolisant, sold under the brand name Wakix among others, is a medication used for the treatment of excessive daytime sleepiness in adults with narcolepsy. It is a histamine 3 (H3) receptor antagonist/inverse agonist (an antihistamine drug specific to that kind of receptors). It represents the first commercially available medication in its class, so that the US Food and Drug Administration (FDA) declares it a first-in-class medication. Pitolisant enhances the activity of histaminergic neurons in the brain that function to improve a person's wakefulness.

Idiopathic hypersomnia(IH) is a neurological disorder which is characterized primarily by excessive sleep and excessive daytime sleepiness (EDS). Idiopathic hypersomnia was first described by Bedrich Roth in 1976, and it can be divided into two forms: polysymptomatic and monosymptomatic. The condition typically becomes evident in early adulthood and most patients diagnosed with IH will have had the disorder for many years prior to their diagnosis. As of August 2021, an FDA-approved medication exists for IH called Xywav, which is oral solution of calcium, magnesium, potassium, and sodium oxybates; in addition to several off-label treatments (primarily FDA-approved narcolepsy medications).

The Stanford Sleepiness Scale(SSS), developed by William C. Dement and colleagues in 1972, is a one-item self-report questionnaire measuring levels of sleepiness throughout the day. The scale has been validated for adult populations and is generally used to track overall alertness at each hour of the day. The SSS is used in both research and clinical settings to assess the level of intervention or effectiveness of a specific treatment in order to compare a client's progress.

<span class="mw-page-title-main">Solriamfetol</span> Medication used for the treatment of excessive sleepiness

Solriamfetol, sold under the brand name Sunosi, is a wakefulness-promoting medication used in the treatment of excessive sleepiness related to narcolepsy and sleep apnea. It is taken by mouth.

<span class="mw-page-title-main">Behavioral sleep medicine</span>

Behavioral sleep medicine (BSM) is a field within sleep medicine that encompasses scientific inquiry and clinical treatment of sleep-related disorders, with a focus on the psychological, physiological, behavioral, cognitive, social, and cultural factors that affect sleep, as well as the impact of sleep on those factors. The clinical practice of BSM is an evidence-based behavioral health discipline that uses primarily non-pharmacological treatments. BSM interventions are typically problem-focused and oriented towards specific sleep complaints, but can be integrated with other medical or mental health treatments. The primary techniques used in BSM interventions involve education and systematic changes to the behaviors, thoughts, and environmental factors that initiate and maintain sleep-related difficulties.

Pediatric narcolepsy refers to conditions of narcolepsy during childhood and adolescence. In a pediatric setting, people with narcolepsy still exhibit the classical tetrad symptoms of narcolepsy, and thus is possible for both type 1 and type 2 narcolepsy to develop in adolescence.

References

  1. ↑ Ibáñez, Vanessa; Silva, Josep; Cauli, Omar (February 2018). "A survey on sleep questionnaires and diaries". Sleep Medicine. 42: 90–96. doi:10.1016/j.sleep.2017.08.026. hdl: 10251/104017 . ISSN   1389-9457. PMID   29458752.
  2. ↑ Ibáñez, Vanessa; Silva, Josep; Cauli, Omar (2018-05-25). "A survey on sleep assessment methods". PeerJ. 6: e4849. doi: 10.7717/peerj.4849 . ISSN   2167-8359. PMC   5971842 . PMID   29844990.
  3. 1 2 3 4 5 6 Johns MW (1991). "A new method for measuring daytime sleepiness: the Epworth sleepiness scale" (PDF). Sleep. 14 (6): 540–5. doi: 10.1093/sleep/14.6.540 . PMID   1798888. Archived from the original (PDF) on 2015-02-26.
  4. 1 2 "The Epworth Sleepiness Scale: What the Epworth Sleepiness Scale is and how to use it". Archived from the original on 2012-03-17. Retrieved 2012-03-09.
  5. ↑ The Epworth Sleepiness Scale: About the ESS
  6. ↑ Hardinge FM, Pitson DJ, Stradling JR (1995). "Use of the Epworth Sleepiness Scale to demonstrate response to treatment with nasal continuous positive airways pressure in patients with obstructive sleep apnoea". Respir Med. 89 (9): 617–20. doi: 10.1016/0954-6111(95)90230-9 . PMID   7494915.
  7. ↑ Johns, MW (March 2000). "Sensitivity and specificity of the multiple sleep latency test (MSLT), the maintenance of wakefulness test and the epworth sleepiness scale: failure of the MSLT as a gold standard". Journal of Sleep Research. 9 (1): 5–11. doi: 10.1046/j.1365-2869.2000.00177.x . PMID   10733683.
  8. ↑ Levine DW, Kripke DF, Kaplan RM, Lewis MA, Naughton MJ, Bowen DJ, Shumaker SA (2003). "Reliability and validity of the Women's Health Initiative Insomnia Rating Scale". Psychological Assessment. 15 (2): 137–148. doi:10.1037/1040-3590.15.2.137. PMID   12847774.
  9. ↑ Koffel E (2011). "Further validation of the Iowa Sleep Disturbances Inventory". Psychological Assessment. 23 (3): 587–598. doi:10.1037/a0022818. PMID   21500920.
  10. ↑ Knutson KL, Rathouz PJ, Yan LL, Liu K, Lauderdale DS (2006). "Stability of the Pittsburgh Sleep Quality Index and the Epworth Sleepiness Questionnaires over 1 year in early middle-aged adults: the CARDIA study". Sleep. 29 (11): 1503–6. doi: 10.1093/sleep/29.11.1503 . PMID   17162998.
  11. ↑ "Epworth Sleepiness Scale". Sleep Foundation. 2022-10-25. Retrieved 2024-04-16.
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