Body Mass Index, Gender, and Ethnic Variations Alter the Clinical Implications of the Epworth Sleepiness Scale in Patients with Suspected Obstructive Sleep Apnea

Abstract

Introduction:The Epworth Sleepiness Scale (ESS) is often used in the evaluation of obstructive sleep apnea (OSA), though questions remain about the influence gender, ethnicity, and body morphometry have in the responses to this questionnaire. The aim of this study was to examine differences in ESS scores between various demographic groups of patients referred for polysomnography, and the relationship of these score to sleep-disordered breathing Methods:Nineteen hundred consecutive patients referred for polysomnographic diagnosis of OSA completed questionnaires, including demographic data and ESS. OSA was determined based on a respiratory disturbance index (RDI) ≥15 by polysomnography.Results:In this high risk population for OSA, the ESS was 10.7 ± 5.6. The highest ESS scores were seen in obese males; non-obese females and non-obese Caucasian males scored the lowest. ESS was weakly correlated with RDI (r = 0.17, P < 0.0001). The sensitivity of ESS for the diagnosis of OSA was 54% and the specificity was 57%. The positive (PPV) and negative (NPV) predictive values were 64% and 47%, respectively. In obese subjects, the sensitivity and specificity were 55% and 53%, compared with 47% and 63% in non-obese subjects. In obese, Hispanic males, the sensitivity, specificity, and PPV were 59%, 54%, and 84%, respectively. In non-obese, Caucasian females, the sensitivity, specificity, and NPV were 43%, 59%, and 72%.Conclusions:The ESS appears to be affected by many factors, including gender, ethnicity, and body morphometry. The ability of the ESS to predict OSA is modest, despite a significant correlation with the severity of OSA. The test characteristics improve significantly when applied to select populations, especially those at risk for OSA.

Reliability of the Epworth Sleepiness Scale and the Berlin Questionnaire for screening obstructive sleep apnea syndrome in the context of the examination of candidates for drivers

“…The findings confirm the opinions of Hasselbacher et al that the ESS sensitivity is so low that the scale cannot be used as a screening tool when other clinical data is not provided [13].…”

“…In this study, the ESS was found to show low sensitivity (53.2%) and specificity (58.8%) for diagnosis of moderate and severe OSAS (AHI ≥ 15/h). The similar results were reported by Hesselbacher et al for the American population; the ESS sensitivity for the diagnosis of the OSAS was 54% while its specificity 57% [13]. According to Hobson et al, the ESS sensitivity increased to 70% when items regarding driving a vehicle were excluded [14].…”

Integrating a Patient Safety Conference into Graduate Medical Education

“…If necessary, other program faculty members are interviewed. At the same time, it is prudent to recognize that ethnic differences are known to impact the interpretation of the Epworth Scale and hence it is not a perfect test for assessment of alertness [8]. Ultimately, if fact-finding warrants, the trainee is referred to an internist for further assessment.…”

Correlation of Epworth Sleepiness Scale with polysomnography changes in the assessment of excessive daytime sleepiness in patients with obstructive sleep apnea hypopnea syndrome

“…22,26 Pois, sabe-se que a ESE é afetada por inú-meros fatores, incluindo gênero, etnia e morfometria corporal, 29 o que torna o seu uso susceptível a erros.…”