Skip to main content
SpringerLink
Log in

Modified Epworth Sleepiness Scale in Chinese children with obstructive sleep apnea: a retrospective study

  • Original Article
  • Published:
Sleep and Breathing Aims and scope Submit manuscript

Abstract

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.

Results

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.

Conclusion

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.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Johns MW (1991) A new method for measuring daytime sleepiness: the Epworth Sleepiness Scale. Sleep 14:540–545

    CAS  PubMed  Google Scholar 

  2. Gottlieb DJ, Whitney CW, Bonekat WH, Iber C, James GD, Lebowitz M et al (1999) Relation of sleepiness to respiratory disturbance index: the Sleep Heart Health Study. Am J Respir Crit Care Med 159:502–507

    CAS  PubMed  Google Scholar 

  3. Johns MW (1992) Reliability and factor analysis of the Epworth Sleepiness Scale. Sleep 15:376–381

    CAS  PubMed  Google Scholar 

  4. Johns MW (2000) Sensitivity and specificity of the multiple sleep latency test (MSLT), the maintenance of wakefulness test and the Epworth Sleepiness Scale: failure of the MSLT as a gold standard. J Sleep Res 9:5–11. doi:10.1046/j.1365-2869.2000.00177.x

    Article  CAS  PubMed  Google Scholar 

  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 160:1381–1387

    Google 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 575–600

    Google Scholar 

  7. Frank Y, Kravath RE, Pollak CP, Weitzman ED (1983) Obstructive sleep apnea and its therapy: clinical and polysomnographic manifestations. Pediatrics 71:737–742

    CAS  PubMed  Google 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

    Article  CAS  PubMed  Google Scholar 

  9. Guilleminault C, Korobkin R, Winkle R (1981) A review of 50 children with obstructive sleep apnea syndrome. Lung 159:275–287. doi:10.1007/BF02713925

    Article  CAS  PubMed  Google 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 163–191

    Google Scholar 

  11. Melendres MC, Lutz JM, Rubin ED, Marcus CL (2004) Daytime sleepiness and hyperactivity in children with suspected sleep-disordered breathing. Pediatrics 114:768–775. doi:10.1542/peds.2004-0730

    Article  PubMed  Google Scholar 

  12. Iglowstein I, Jenni OG, Molinari L, Iglowstein I, Jenni OG, Molinari L et al (2003) Sleep duration from infancy to adolescence: reference values and generational trends. Pediatrics 111:302–307. doi:10.1542/peds.111.2.302

    Article  PubMed  Google Scholar 

  13. Leung SS, Cole TJ, Tse LY, Lau JT (1998) Body mass index reference curves for Chinese children. Ann Hum Biol 25:169–174. doi:10.1080/03014469800005542

    Article  CAS  PubMed  Google 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 Angeles

    Google Scholar 

  15. Inhaka R, Gentleman R (1996) A language for data analysis and graphics. J Comput Graph Statist 5:299–314. doi:10.2307/1390807

    Article  Google Scholar 

  16. Bland JM, Altman DG (1997) Cronbach’s alpha. BMJ 314:572

    CAS  PubMed  Google Scholar 

  17. Ng DK, Kwok KL, Cheung JM, Leung SY, Chow PY, Wong WH et al (2005) Prevalence of sleep problems in Hong Kong primary school children: a community-based telephone survey. Chest 128:1315–1323. doi:10.1378/chest.128.3.1315

    Article  PubMed  Google Scholar 

  18. Goh DYT, Galster P, Marcus C (2000) Sleep architecture and respiratory disturbances in children with obstructive sleep apnea. Am J Respir Crit Care Med 162:682–686

    CAS  PubMed  Google 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

    Article  PubMed  Google Scholar 

  20. Pepin JL, Delavie N, Pin I, Deschaux C, Argod J, Bost M et al (2005) Pulse transit time improves detection of sleep respiratory events and microarousals in children. Chest 127:722–730. doi:10.1378/chest.127.3.722

    Article  PubMed  Google Scholar 

  21. Goodwin JL, Kaemingk KL, Mulvaney SA, Morgan WJ, Quan SF (2005) Clinical screening of school children for polysomnography to detect sleep-disordered breathing—the Tucson Children's Assessment of Sleep Apnea Study (TuCASA). J Clin Sleep Med 1:247–254

    PubMed  Google Scholar 

  22. Marcus CL, Omlin KJ, Basinki DJ, Bailey SL, Rachal AB, VonPechmann WS et al (1992) Normal polysomnographic values for children and adolescents. Am Rev Respir Dis 146:1235–1239

    CAS  PubMed  Google Scholar 

  23. Morton S, Rosen C, Larkin E, Tishler P, Aylor J, Redline S (2001) Predictors of sleep-disordered breathing in children with a history of tonsillectomy and/or adenoidectomy. Sleep 24:823–829

    CAS  PubMed  Google Scholar 

  24. Leung LC, Ng DK, Lau MW, Chan CH, Kwok KL, Chow PY et al (2006) Twenty-four-hour ambulatory BP in snoring children with obstructive sleep apnea syndrome. Chest 130:1009–1017. doi:10.1378/chest.130.4.1009

    Article  PubMed  Google 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

    Article  PubMed  Google Scholar 

  26. Ng DK, Kwok KL, Chow PY, Cheung MY (2004) Diagnostic access for sleep apnea in Hong Kong. Am J Respir Crit Care Med 170:196

    PubMed  Google Scholar 

  27. Drake C, Nickel C, Burduvali E, Roth T, Jefferson C, Pietro B (2003) The pediatric daytime sleepiness scale (PDSS): sleep habits and school outcomes in middle-school children. Sleep 26:455–458

    PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Pediatrics, Kwong Wah Hospital, Hong Kong, China

    Eric Y. T. Chan, Daniel K. Ng, Chung-hong Chan, Ka-li Kwok, Pok-yu Chow, Josephine M. Cheung & Suk-yu Leung

Authors
  1. Eric Y. T. Chan
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Daniel K. Ng
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Chung-hong Chan
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Ka-li Kwok
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Pok-yu Chow
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Josephine M. Cheung
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Suk-yu Leung
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Daniel K. Ng.

Additional information

All authors worked and the study was carried out in Kwong Wah Hospital in Hong Kong. There was no conflict of interest and no specific source of funding for the study.

Appendix: Modified Epworth Sleepiness Scale

Appendix: Modified Epworth Sleepiness Scale

How likely are you or your child to doze off or fall asleep in the following situations, in contrast to feeling just tired? This refers to your usual way of life in recent times. Even if you or your child have not done some of these things recently, try to work out how they would have affected you or your child. Use the following scale to choose the most appropriate number for each situation:

  1. 0

    no chance of dozing

  2. 1

    slight chance of dozing

  3. 2

    moderate chance of dozing

  4. 3

    high chance of dozing

Situation

Chance of dozing

Sitting and reading

 

Watching TV

 

Sitting inactive in a public place (e.g., movie theater or a meeting)

 

As a passenger in a car for an hour without a break

 

Lying down to rest in the afternoon when circumstances permit

 

Sitting and talking to someone

 

Sitting quietly after lunch

 

In a car, while stopped for a few minutes in traffic

 

Chinese translation is available upon request.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Chan, E.Y.T., Ng, D.K., Chan, Ch. et al. Modified Epworth Sleepiness Scale in Chinese children with obstructive sleep apnea: a retrospective study. Sleep Breath 13, 59–63 (2009). https://doi.org/10.1007/s11325-008-0205-7

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11325-008-0205-7

Keywords

Search

Navigation