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05.06.2023 | original article

Revisiting the Epworth sleepiness scale

Is excessive daytime sleepiness still a valid screening tool for obstructive sleep apnea in a population at risk?

verfasst von: Hrvoje Puretić, MD, Assist. Prof. Marijana Bosnar Puretić, MD, PhD, Assoc. Prof. Gordana Pavliša, MD, PhD, Prof. Marko Jakopović, MD, PhD

Erschienen in: Wiener klinische Wochenschrift

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Summary

Objective

Obstructive sleep apnea (OSA) is a common medical problem with numerous comorbidities and high costs. Since the introduction of the Epworth sleepiness scale (ESS), excessive daytime sleepiness (EDS) has been considered the most common and prominent symptom of OSA. Aim of this study was to re-evaluate the ESS for detection of OSA in a population at risk compared to the gold standard overnight polysomnography (PSG).

Methods

A total of 266 patients (mean age 57.9 ± 11.6 years; 189 men and 77 women), referred to our sleep laboratory for probable OSA, were given ESS followed by an overnight PSG. The ESS values were compared to PSG apnea hypopnea index (AHI) with sensitivity (SE), specificity (SP), positive predictive value (PPV), negative predictive value (NPV) and diagnostic accuracy (DA) calculated for ESS. The positive cut-off value for ESS was ≥ 10 and for AHI ≥ 5.

Results

Only 92 (34.6%) subjects had a positive ESS. An OSA was diagnosed by PSG in 213 (80.1%) subjects: 46 having mild, 37 moderate and 130 severe apnea. Most subjects with positive ESS (88.0%) were found to have OSA but most subjects with a negative ESS (75.9%) were also positive for OSA (42% with AHI ≥ 30). The area under the receiver operating characteristic (ROC) curve for ESS was 0.60 (95% confidence interval, CI 0.54–0.66; p = 0.020) with SE 38.0%, SP 79.3%, PPV 88.0%, NPV 24.1% and DA 46.2%.

Conclusion

It was found that excessive daytime sleepiness, measured by ESS, is not a valuable screening tool for OSA, especially when the test is negative. Other screening tests that involve additional parameters, beside daytime sleepiness alone, should be considered.

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Titel: Revisiting the Epworth sleepiness scale
Is excessive daytime sleepiness still a valid screening tool for obstructive sleep apnea in a population at risk?
verfasst von: Hrvoje Puretić, MD
Assist. Prof. Marijana Bosnar Puretić, MD, PhD
Assoc. Prof. Gordana Pavliša, MD, PhD
Prof. Marko Jakopović, MD, PhD
Publikationsdatum: 05.06.2023
Verlag: Springer Vienna
Erschienen in: Wiener klinische Wochenschrift
Print ISSN: 0043-5325
Elektronische ISSN: 1613-7671
DOI: https://doi.org/10.1007/s00508-023-02213-4