Sleep and Breathing

, Volume 15, Issue 4, pp 763–773

Repeating administration of Epworth Sleepiness Scale is clinically useful

  • Denis Martinez
  • Tiago Cataldo Breitenbach
  • Magali Santos Lumertz
  • Denise Lerias Alcântara
  • Neusa Sicca da Rocha
  • Cristiane Maria Cassol
  • Maria do Carmo Sfreddo Lenz
Original Article

DOI: 10.1007/s11325-010-0434-4

Cite this article as:
Martinez, D., Cataldo Breitenbach, T., Santos Lumertz, M. et al. Sleep Breath (2011) 15: 763. doi:10.1007/s11325-010-0434-4

Abstract

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.

Key words

Epworth Sleepiness ScaleHypersomnolenceSleep apneaPolysomnographyItem response theorySleep-disordered breathing

Abreviations used in manuscript

AHI

Apnea–hypopnea index

chi2

Chi-square

DIF

Differential item functioning

ESS

Epworth Sleepiness Scale

ESS1

ESS administered at evening, before polysomnography

ESS2

ESS administered in the morning, after polysomnography

IRT

Item response theory

OSAHS

Obstructive sleep apnea–hypopnea syndrome

PSG

Polysomnography

SaO2

Arterial oxygen saturation

SDB

Sleep-disordered breathing

Copyright information

© Springer-Verlag 2010

Authors and Affiliations

  • Denis Martinez
    • 1
  • Tiago Cataldo Breitenbach
    • 2
  • Magali Santos Lumertz
    • 3
  • Denise Lerias Alcântara
    • 4
  • Neusa Sicca da Rocha
    • 2
  • Cristiane Maria Cassol
    • 2
  • Maria do Carmo Sfreddo Lenz
    • 4
  1. 1.Division of Cardiology, Hospital de Clinicas de Porto Alegre (HCPA), Sleep ClinicUniversidade Federal do Rio Grande do Sul (UFRGS)Porto AlegreBrazil
  2. 2.Hospital de Clínicas de Porto Alegre (HCPA)Universidade Federal do Rio Grande do Sul (UFRGS)Porto AlegreBrazil
  3. 3.Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA)Porto AlegreBrazil
  4. 4.Sleep ClinicPorto AlegreBrazil