Modified Epworth Sleepiness Scale in Chinese children with obstructive sleep apnea: a retrospective study
- 462 Downloads
Background and objective
The purpose of this study is to assess whether Chinese children with high apnea–hypopnea index (AHI) are sleepier by a modified Epworth Sleepiness Scale (ESS).
Materials and methods
Records were retrospectively reviewed. We included children who were between 3 and 12 years old, admitted for overnight polysomnogram because of suspected obstructive sleep apnea syndrome (OSAS). A modified ESS was used to assess excessive daytime sleepiness (EDS) of the children.
One hundred ninety-two Chinese children were included. Children with high AHI, defined as AHI > 5.0, were sleepier than children with AHI less than or equal to 5. After adjustment by age, gender, and obesity, children with high AHI remained significantly sleepier. Modified ESS was significantly correlated with AHI (rho = 0.124, 95% CI = 0.004–0.281). Modified ESS score of >8 was the best cutoff point with the sensitivity and specificity of 0.29 and 0.91, respectively. The odds ratio of children with modified ESS > 10 having high AHI was 4.231 (95%CI = 1.248 to 14.338) and children with modified ESS > 8 had the highest odds ratio, 4.295(95%CI = 1.66 to 11.1), of having high AHI.
Chinese children with high AHI appear to be sleepier than children with low AHI. Children with suspected OSAS and high modified ESS, i.e., ESS > 8, had significantly higher odds ratio of having high AHI. Increased sleepiness is a specific but not a sensitive symptom in snoring children with high AHI. Screening for EDS in snoring children may help us identify those with high AHI and prioritize the management of those children.
KeywordsSleep deprivation Sleep apnea Obstructive Child Epworth Sleepiness Scale Chinese
- 5.American Thoracic Society (1999) Cardiorespiratory sleep studies in children. Establishment of normative data and polysomnographic predictors of morbidity. Am J Respir Crit Care Med 160:1381–1387Google Scholar
- 6.Arens R (2000) Obstructive sleep apnea in childhood: clinical features. In: Loughlin GM, Carroll J, Marcus CL (eds) Sleep and breathing in children a developmental approach. Marcel Dekker, New York, pp 575–600Google Scholar
- 8.Rosen CL (1999) Clinical features of obstructive sleep apnea hypoventilation syndrome in otherwise healthy children. Pediatr Pulmonol 27:403–409. doi: 10.1002/(SICI)1099-0496(199906)27:6<403::AID-PPUL7>3.0.CO;2-8 CrossRefPubMedGoogle Scholar
- 10.Carroll J, Loughlin GM (1995) Obstructive sleep apnea syndrome in infants and children: clinical features and pathophysiology. In: Ferber R, Kryger M (eds) Principles and practice of sleep medicine in the child. Saunders, Philadelphia, pp 163–191Google Scholar
- 14.Rechtschaffen A, Kales A (1968) A manual of standardized terminology, techniques and scoring systems for sleep stages of human subjects. UCLA Brain Information Service/Brain Research Institute, Los AngelesGoogle Scholar
- 19.Fuentes-Pradera MA, Botebol G, Sanchez-Armengol A, Carmona C, Garcia-Fernandez A, Castillo-Gomez J et al (2003) Effect of snoring and obstructive respiratory events on sleep architecture in adolescents. Arch Pediatr Adolesc Med 157:649–654. doi: 10.1001/archpedi.157.7.649 CrossRefPubMedGoogle Scholar
- 25.Kaemingk KL, Pasvogel AE, Goodwin JL, Mulvaney SA, Martinez F, Enright PL et al (2003) Learning in children and sleep disordered breathing: findings of the Tucson Children's Assessment of Sleep Apnea (tuCASA) prospective cohort study. J Int Neuropsychol Soc 9:1016–1026. doi: 10.1017/S1355617703970056 CrossRefPubMedGoogle Scholar