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 preserve its validity. The author of the ESS recommends that the administrator of the questionnaire does not discuss the results of the test with the subject until it is completed, as it could 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

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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.

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

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

Narcolepsy is a chronic neurological disorder that impairs the ability to regulate sleep–wake cycles, and specifically impacts REM sleep. The pentad symptoms of narcolepsy include excessive daytime sleepiness (EDS), sleep related hallucinations, sleep paralysis, disturbed nocturnal sleep (DNS) and cataplexy. There are two recognized forms of narcolepsy, narcolepsy type 1 and type 2. Narcolepsy type 1 (NT1) can be clinically characterized by symptoms of EDS and cataplexy, and/or will have CSF orexin levels of less than 110 pg/ml. Cataplexy are transient episodes of aberrant tone, most typically loss of tone, that can be associated with strong emotion. In pediatric onset narcolepsy, active motor phenomena are not uncommon. Cataplexy may be mistaken for syncope, tic disorder or seizures. Narcolepsy type 2 (NT2) does not have features of cataplexy and CSF orexin levels are normal. Sleep related hallucinations, also known as hypnogogic and hypnopompic are vivid hallucinations that can be auditory, visual or tactile and may occur independent of or in combination with an inability to move. People with narcolepsy tend to sleep about the same number of hours per day as people without it, but the quality of sleep is typically compromised. Narcolepsy is a clinical syndrome of hypothalamic disorder, but the exact cause of narcolepsy is unknown, with potentially several causes. A leading consideration for the cause of narcolepsy type 1 is that it is an autoimmune disorder. Proposed pathophysiology as an autoimmune disease suggest antigen presentation by DQ0602 to specific CD4+ T cells resulting in CD8+ T-cell activation and consequent injury to orexin producing neurons. Familial trends of narcolepsy are suggested to be higher than previously appreciated. Familial risk of narcolepsy among first degree relatives is high. Relative risk for narcolepsy in a first degree relative has been reported to be 361.8. However, it is important to note that there is a spectrum of symptoms found in this study, including asymptomatic abnormal sleep test findings to significantly symptomatic.

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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.

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<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.

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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