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Repeating administration of Epworth Sleepiness Scale is clinically useful

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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.

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Abbreviations

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

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Acknowledgement

The authors declare that they have no conflict of interest.

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Correspondence to Denis Martinez.

Additional information

The project was supported partly by a research grant from institutional agency FIPE-HCPA. Magali Lumertz, a researcher, was supported by a government student grant from governmental agency FAPERGS. Tiago Breitenbach was supported by a government student grant from governmental agency BIC-CNPq-UFRGS, and Cristiane Maria Cassol was supported by government student grant from governmental agency CAPES.

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Martinez, D., Cataldo Breitenbach, T., Santos Lumertz, M. et al. Repeating administration of Epworth Sleepiness Scale is clinically useful. Sleep Breath 15, 763–773 (2011). https://doi.org/10.1007/s11325-010-0434-4

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  • DOI: https://doi.org/10.1007/s11325-010-0434-4

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