Sleep and Breathing

, Volume 17, Issue 1, pp 343–350 | Cite as

Limits of the Epworth Sleepiness Scale in older adults

  • Fannie Onen
  • Thierry Moreau
  • Nalaka S. Gooneratne
  • Clémence Petit
  • Bruno Falissard
  • S. Hakki Onen
Original Article



Excessive daytime sleepiness (EDS) in older adults is associated with obstructive sleep apnea, falls, reduced quality of life, and mortality. The Epworth Sleepiness Scale (ESS) is widely used to assess sleepiness. However, EDS assessment with the ESS may not be accurate in older adults. We aimed to (1) describe the responsiveness of nondemented older subjects to the ESS and (2) compare the self-report ESS scores to those of close relatives (CR) proxy and identify factors influencing any discrepancies between them.


This is a cross-sectional observational study including 104 independently living nondemented older subjects with daytime sleepiness complaints and 104 nondemented CRs. Cognitive tests (Mini-Mental State Examination) and the ESS were completed separately by subjects and CRs to assess the subject’s daytime sleepiness.


Almost 60 % of subjects and CRs were not able to answer at least one question on the ESS. Despite the fact that all subjects complained of EDS, only 24 % of them had an abnormal ESS score (>10). Subjects rated their sleepiness lower (7.10 ± 4.31) than their CR proxy did (9.70 ± 5.14) (p < 0.0001). In multivariate analysis, an increase in age and a decrease in cognitive status of the subjects appeared related to the difference in ESS between subject and CR.


The majority of older adults were not able to answer all of the ESS items. The ESS may underestimate sleepiness severity in older subjects. Despite EDS complaints in all subjects, only one quarter of them had a pathological ESS score.


Epworth Sleepiness Scale Daytime sleepiness Elderly Close relative Proxy 



This study was supported by a research grant (HRA-0022011) from the International Association of Sleep Research in Gerontology.

Conflicts of interest

This is not an industry-supported research. There are no author conflicts of interest related to this manuscript.


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Copyright information

© Springer-Verlag 2012

Authors and Affiliations

  • Fannie Onen
    • 1
    • 2
    • 6
  • Thierry Moreau
    • 3
    • 4
  • Nalaka S. Gooneratne
    • 5
    • 6
  • Clémence Petit
    • 7
  • Bruno Falissard
    • 2
    • 8
  • S. Hakki Onen
    • 9
    • 10
    • 11
  1. 1.Service de Gériatrie (14ème étage)CHU Hôpital Bichat Claude Bernard, APHPParisFrance
  2. 2.INSERM 669Université Paris DescartesParisFrance
  3. 3.Equipe de Biostatistiques, Centre de recherche en épidémiologie et santé des populations (CESP) U1018INSERMVillejuifFrance
  4. 4.Université Paris-Sud UMRS 1018VillejuifFrance
  5. 5.Division of Geriatric Medicine, Department of MedicineUniversity of PennsylvaniaPhiladelphiaUSA
  6. 6.Center for Sleep and Circadian Neurobiology, School of MedicineUniversity of PennsylvaniaPhiladelphiaUSA
  7. 7.Centre National de Santé, CCASParisFrance
  8. 8.Département de Santé PubliqueHôpital Paul Brousse, APHP and Université Paris-SudVillejuifFrance
  9. 9.Hospices Civils de Lyon, Geriatric Sleep Medicine CenterHôpital Gériatrique Antoine CharialFranchevilleFrance
  10. 10.CHU de Clermont-Ferrand, CIC-INSERMClermont-FerrandFrance
  11. 11.INSERM U1028, Université Lyon1Lyon Cedex 08France

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