Abstract
Various demographic and clinical predictors attributing to the severity of obstructive sleep apnea (OSA) in Indian subjects have not been extensively studied. Therefore, we aimed to study the various demographic, clinical and other predictors, if any, to corroborate the severity of OSA in the Indian population. We also validated the Epworth Sleepiness Scale (ESS) in the South Indian population, thereby assessing its utility in measuring excessive day time sleepiness (EDS) in this population which has not hitherto been performed. We recruited 145 consecutive subjects with polysomnography (PSG)-proven OSA attending our Comprehensive Sleep Disorder Clinic. Their demographic and clinical details were extracted using a standard proforma and EDS was assessed using ESS. We observed that EDS assessed by ESS positively correlated with the severity of OSA, and increasing body mass index (BMI) but not with age. We also noted that men were more prone to severe OSA than females. When individual questions of ESS were analyzed, only 3 out of 8 were able to strongly differentiate mild-to-moderate OSA from the severe group. We concluded that, severity of OSA correlated well with ESS, but not with age and BMI in Indian population and ESS could be a good indicator to assess the severity of EDS.
Similar content being viewed by others
References
Young T, Palta M, Dempsey J, Skatrud J, Weber S, Badr S. The occurrence of sleep-disordered breathing among middle-aged adults. N Engl J Med. 1993;328:1230–5.
Gislason T, Almqvist M, Eriksson G, Taube A, Boman G. Prevalence of sleep apnea syndrome among Swedish men—an epidemiological study. J Clin Epidemiol. 1988;41:571–6.
Bixler EO, Vgontzas NA, Lin HM, Rein J, Vela-Bueno A, Kales A. Prevalence of sleep-disordered breathing in women—effects of gender. Am J Respir Crit Care Med. 2001;163:608–13.
Durán J, Esnaola S, Rubio R, Iztueta A. Obstructive sleep apnea–hypopnea and related clinical features in a population-based sample of subjects aged 30–70 year. Am J Resp Crit Care Med. 2001;163:685–9.
Vijayan VK, Patial V. Prevalence of obstructive sleep apnea syndrome in Delhi, India. Chest J. 2006;130:92S.
Sharma SK, Kumpawat S, Banga A, Goel A. Prevalence and risk factors of obstructive sleep apnea syndrome in a population in Delhi, India. Chest J. 2006;130:149–56.
Iber C, Ancoli-Israel S, Chesson A, Quan SF. The AASM manual for the scoring of sleep and associated events: rules, terminology and technical specifications. 1st ed. Westchester: American Academy of Sleep Medicine; 2007.
Sharma SK, Ahluwalia G. Epidemiology of adult obstructive sleep apnea in India. Indian J Med Res. 2010;131:121–5.
WHO/IASO/IOTF. The Asia-Pacific perspective: redefining obesity and its treatment. Melbourne: Health Communications Australia; 2000.
Johns MW. A new method for measuring daytime sleepiness: the Epworth Sleepiness Scale. Sleep. 1991;14:540–5.
International Classification of Sleep Disorders. Diagnostic and coding manual. Westchester: American Academy of Sleep Medicine; 2005.
Young T, Shahar E, Nieto J, et al. Predictors of sleep disordered breathing in community dwelling adults the sleep heart health study. Arch Intern Med. 2002;162:893–900.
Reddy EV, Kadhiravan T, Mishra HK, Sreenivas V, Handa KK, Sinha S, et al. Prevalence and risk factors of obstructive sleep apnea among middle-aged urban Indians: a community-based study. Sleep Med. 2009;10:913–8.
Guilleminault C, Quera-Salva MA, Partinen M, Jamieson A. Women and the obstructive sleep apnea syndrome. Chest. 1988;93:104–9.
Stradling JR, Crosby JH. Predictors and prevalence of obstructive sleep apnoea and snoring in 1001 middle aged men. Thorax. 1991;46:85–90.
Ip MS, Lam B, Lauder IJ, Tsang KW, Chung KF, Mok YW, Lam WK. A community study of sleep-disordered breathing in middle-aged Chinese men in Hong Kong. Chest. 2001;119:62–9.
Ip MS, Lam B, Tang LC, Lauder IJ, Ip TY, Lam WK. A community study of sleep-disordered breathing in middle-aged Chinese women in Hong Kong: prevalence and gender differences. Chest. 2004;125:127–34.
Bixler EO, Vgontzas AN, Ten Have T, Tyson K, Kales A. Effects of age on sleep apnea in men: i. Prevalence and severity. Am J Respir Crit Care Med. 1998;157:144–8.
Sharma SK, Reddy EV, Sharma A, Kadhiravan T, Mishra HK, Sreenivas V, et al. Prevalence and risk factors of syndromes in urban Indians. Sleep Med. 2010;11:562–8.
WHO Expert Consultation. Appropriate-body mass index for Asian populations and its implications for policy and intervention strategies. Lancet. 2004;363:157–63.
Udwadia ZF, Doshi AV, Lonkar SG, Singh CI. Prevalence of sleep-disordered breathing and sleep apnea in middle-aged Urban Indian men. AJRCCM. 2004;169:168–73.
Pradeep Kumar VG, Bhatia M, Tripathi M, Srivastava AK, Jain S. Obstructive sleep apnoea: a case-control study. Neurol India. 2003;51:497–9.
Johns MW. Daytime sleepiness, snoring, and obstructive sleep apnea: the Epworth Sleepiness Scale. Chest. 1993;103:30–6.
Rosenthal LD, Dolan DC. The Epworth Sleepiness Scale in the identification of obstructive sleep apnea. J Nerv Ment Dis. 2008;196:429–31.
Whitney CW, Enright PL, Newman AB, Bonekat W, Foley D, Quan SF. Correlates of daytime sleepiness in 4578 elderly persons: the cardiovascular health study. Sleep. 1998;21:27–36.
Onen F, Moreau T, Gooneratne NS, Petit C, Falissard B, Onen SH. Limits of the Epworth Sleepiness Scale in older adults sleep breath. 2012;12:700–8.
Zhang JN, Peng B, Zhao TT, Xiang M, Fu W, Peng Y. Modification of the Epworth Sleepiness Scale in Central China. Qual Life Res. 2011;20:1721–6.
Sauter C, Asenbaum S, Popovic R, Bauer H, Lamm C, Klösch G, et al. Excessive daytime sleepiness in patients suffering from different levels of obstructive sleep apnoea syndrome. J Sleep Res. 2000;9:293–301.
Mediano O, Barcelo A, de la Pen˜a M, Gozal D, Agustı A, Barbe F. Daytime sleepiness and polysomnographic variables in sleep apnea patients. Eur Resp J. 2007;30:110–3.
Hesselbacher S, Subramanian S, Allen J, Surani S, Surani S. Body mass index gender, and ethnic variations alter the clinical implications of the Epworth Sleepiness Scale in patients with suspected obstructive sleep apnea. Open Respir Med J. 2012;6:20–7.
Kanabar K, Sharma SK, Sreenivas V, Biswas A, Soneja M. Validation of Hindi version of the Epworth Sleepiness Scale (ESS) at AIIMS, New Delhi in sleep-disordered breathing. Sleep Breath. 2016;. doi:10.1007/s11325-016-1344-x.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Funding
No funding was received for this research.
Conflict of interest
All authors certify that they have no affiliations with or involvement in any organization or entity with any financial interest (such as honoraria; educational grants; participation in speakersʼ bureaus; membership, employment, consultancies, stock ownership, or other equity interest; and expert testimony or patent-licensing arrangements), or non-financial interest (such as personal or professional relationships, affiliations, knowledge or beliefs) in the subject matter or materials discussed in this manuscript.
Ethical approval
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.
Informed consent
Informed consent was obtained from all individual participants included in the study.
Rights and permissions
About this article
Cite this article
Sreedharan, S.E., Vijayakumari, A.A., Agrawal, P. et al. Does obstructive sleep apnea correlate with Epworth Sleepiness Scale in an Indian population?. Sleep Biol. Rhythms 15, 89–95 (2017). https://doi.org/10.1007/s41105-016-0085-3
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s41105-016-0085-3