Correlations among Epworth Sleepiness Scale scores, multiple sleep latency tests and psychological symptoms

Abstract

SUMMARYThe aim of this study was to identify factors other than objective sleep tendency associated with scores on the Epworth Sleepiness Scale (ESS). There were 225 subjects, of whom 40% had obstructive sleep apnoea (OSA), 16% had simple snoring, and 4.9% had snoring with sleep disruption (upper airway resistance syndrome); 9.3% had narcolepsy and 7.5% had hypersomnolence without REM sleep abnormalities; 12% had chronic fatigue syndrome; 7.5% had periodic limb movement disorder and 3% had diurnal rhythm disorders. ESS, the results of overnight polysomnography and multiple sleep latency test (MSLT) and SCL-90 as a measure of psychological symptoms were recorded. The ESS score and the mean sleep latency (MSL) were correlated (Spearman =−0.30, P<0.0001). The MSL was correlated with total sleep time (TST) and with sleep efficiency but not with apnoea/hypopnoea index. There was no association between the MSL and any aspect of SCL-90 scores, except a borderline significant association with the somatisation subscale. The ESS was correlated with TST but not with sleep efficiency or apnoea/hypopnoea index. The ESS was correlated with all subscales of the SCL-90 except psychoticism. An ESS[10 had poor sensitivity and specificity as a predictor of MSL <10 min or MSL <5 min. We conclude that the MSLT and the ESS are not interchangeable. The ESS was influenced by psychological factors by which the MSL was not affected. The ESS cannot be used to demonstrate or exclude sleepiness as it is measured by MSLT.

Validation of Symptoms Related to Excessive Daytime Sleepiness

“…On the other hand, compared to the MSLT, the ESS shows limitations in detecting an objective tendency to fall asleep, in particular, when patients with SDB are investigated [13,14]. If a moderate negative correlation (Ú from -0.30 to -0.37) is found in a validation set with a broad variety of EDS etiologies [10,11], when the sample consisted of all or almost all SDB patients, no relationship can be proved [13,14].…”

An Official American Thoracic Society Clinical Practice Guideline: Sleep Apnea, Sleepiness, and Driving Risk in Noncommercial Drivers. An Update of a 1994 Statement

“…The alternatives-self-reported sleepiness, familyinitiated reports of drowsy driving, and a high (i.e., .17 out of 24) ESS score-are insufficient to identify high-risk drivers. Selfreported sleepiness is subject to interpretation and bias, and the ESS can neither confirm nor exclude sleepiness (20). Such findings are, however, useful prompts for the clinician to initiate direct questioning.…”

Reliability and validity of a Norwegian version of the Epworth sleepiness scale

“…The Epworth sleepiness scale (ESS) is a popular, selfadministered questionnaire developed for assessing subjective average sleep propensity, which is inexpensive and easy to administer [1][2][3][4][5]. In spite of the widespread use of the ESS, there is limited documentation on the reliability and validity of the questionnaire.…”

“…Several studies have expressed conflicting opinions about the association between ESS score and multiple sleep latency as measured by the multiple sleep latency test (MSLT) [6]. Some studies show a moderate association between ESS score and mean sleep latency of the MSLT [7], while the majority show no significant [8][9][10] or a negative association [4,5] between ESS score and mean sleep latency.…”