Repeating administration of Epworth Sleepiness Scale is clinically useful

• Published in: Sleep & breathing Vol. 15; no. 4; pp. 763 - 773
• Main Authors: Martinez, Denis, Cataldo Breitenbach, Tiago, Santos Lumertz, Magali, Lerias Alcântara, Denise, Sicca da Rocha, Neusa, Cassol, Cristiane Maria, Sfreddo Lenz, Maria do Carmo
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer-Verlag 01.12.2011; Springer; Springer Nature B.V
• Subjects: Adult; Biological and medical sciences; Clinical trials; Dentistry; Disorders of Excessive Somnolence - diagnosis; Disorders of higher nervous function. Focal brain diseases. Central vestibular syndrome and deafness. Brain stem syndromes; Female; Fundamental and applied biological sciences. Psychology; Humans; Internal Medicine; Investigative techniques of ocular function and vision; Investigative techniques, diagnostic techniques (general aspects); Male; Medical sciences; Medicine; Medicine & Public Health; Middle Aged; Nervous system (semeiology, syndromes); Neurology; Original Article; Otorhinolaryngology; Pediatrics; Pneumology/Respiratory System; Polysomnography; Psychometrics - statistics & numerical data; Reference Values; Reproducibility of Results; Sleep Apnea, Obstructive - diagnosis; Sleep disorders; Sleep. Vigilance; Surveys and Questionnaires; Vertebrates: nervous system and sense organs; Epworth Sleepiness Scale; Sleep apnea; Hypersomnolence; Polysomnography; Item response theory; Sleep-disordered breathing; Nervous system diseases; Sleep apnea syndrome; Respiratory disease; Theory; Sleep disorder; Sleep; Sleep wake cycle; Neurological disorder
• ISSN: 1520-9512; 1522-1709
• DOI: 10.1007/s11325-010-0434-4

Purpose We aimed to verify whether it is clinically useful to repeat the Epworth Sleepiness Scale (ESS) in individuals with suspected sleep-disordered breathing (SDB). Methods In this cross-sectional, prospective study, results of the repeated administration of the ESS were analyzed. In 929 consecutive patients, ESS was obtained as usual in the laboratory routine, immediately before the sleep study (ESS1) and was repeated in the morning, after the polysomnography (ESS2). ROC curve, classical psychometry, and item response theory (IRT) Rasch analysis were used to assess measurement properties of ESS. Results The ESS1 score was (mean ± SD), 11 ± 5.1, and the ESS2, 13 ± 4.7 ( p  < 0.001). Change in ESS score is explained in multivariate analysis by age, but not by gender, educational level, change in Stanford Sleepiness Scale, symptoms of sleep disorder, or polysomnography results. Accuracy of an ESS score >10 to predict apnea–hypopnea index ≥5 increased from 56% (ESS1) to 72% (ESS2). IRT psychometric properties (unidimensionality, invariance, local independence) were maintained in ESS2. Conclusions Repeating the administration of the Epworth Sleepiness Scale in a clinical setting increases its score and diagnostic accuracy and correlation with SDB variables, without changing the psychometric properties of the scale. This experiment indicates the clinical usefulness of repeating the ESS. The scale can be repeated at a negligible cost, before dismissing individual patients on the basis of a low ESS score, discontinuing a potentially lifesaving diagnostic and therapeutic process.