Utility of the pictorial Epworth sleepiness scale in the adult down syndrome population

Hill, Elizabeth A.; Fairley, Donna M.; McConnell, Ewan; Morrison, Ian; Celmina, Marta; Kotoulas, Seraphim; Riha, Renata L.

doi:10.1016/j.sleep.2019.10.003

Cited by 8 publications

(8 citation statements)

References 11 publications

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“…The STOP-BANG score has been recommended to detect moderate to severe OSA [ 22 ]. The Epworth Sleepiness Scale (ESS) and its pictorial form (pESS) [ 48 ] have low sensitivity but are the most widely used tests to assess sleepiness [ 2 , 14 , 17 , 19 , 22 ]. It remains to be proven whether adjusting questions on the ESS to the particular abilities and lifestyles of individuals with DS could improve OSA detection [ 48 ].…”

Section: Sleep Disordersmentioning

confidence: 99%

“…The Epworth Sleepiness Scale (ESS) and its pictorial form (pESS) [ 48 ] have low sensitivity but are the most widely used tests to assess sleepiness [ 2 , 14 , 17 , 19 , 22 ]. It remains to be proven whether adjusting questions on the ESS to the particular abilities and lifestyles of individuals with DS could improve OSA detection [ 48 ]. In this sense, Skotko et al [ 45 ] proposed an algorithm model that could predict which patients with DS were unlikely to have severe OSA, in order to avoid unnecessary sleep studies.…”

Section: Sleep Disordersmentioning

confidence: 99%

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Sleep Disorders in Adults with Down Syndrome

Giménez

Altuna

Blessing

et al. 2021

JCM

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Sleep disorders, despite being very frequent in adults with Down syndrome (DS), are often overlooked due to a lack of awareness by families and physicians and the absence of specific clinical sleep guidelines. Untreated sleep disorders have a negative impact on physical and mental health, behavior, and cognitive performance. Growing evidence suggests that sleep disruption may also accelerate the progression to symptomatic Alzheimer’s disease (AD) in this population. It is therefore imperative to have a better understanding of the sleep disorders associated with DS in order to treat them, and in doing so, improve cognition and quality of life, and prevent related comorbidities. This paper reviews the current knowledge of the main sleep disorders in adults with DS, including evaluation and management. It highlights the existing gaps in knowledge and discusses future directions to achieve earlier diagnosis and better treatment of sleep disorders most frequently found in this population.

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Section: Sleep Disordersmentioning

confidence: 99%

Section: Sleep Disordersmentioning

confidence: 99%

Sleep Disorders in Adults with Down Syndrome

Giménez

Altuna

Blessing

et al. 2021

JCM

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“…Based on a questionnaire study we conducted in over 5000 adults with DS [15], we expected over 100 people to respond to an invitation to participate in the CPAP trial. Due to unreasonable delays by the local ethics committee and funding constraints, this recruitment rate was not achieved in the time period of the study (2011)(2012)(2013)(2014)(2015).…”

Section: Discussionmentioning

confidence: 99%

“…Recruitment was undertaken in the context of a larger study conducted by us on the objective and subjective prevalence of OSAHS in adults with DS [ 15 ]. Briefly, questionnaires and pre-paid reply envelopes were sent to 5266 UK-based adults with Down syndrome and their caregivers between 14.02.2011 and 10.01.2014.…”

Section: Methodsmentioning

confidence: 99%

Prospective Trial of CPAP in Community-Dwelling Adults with Down Syndrome and Obstructive Sleep Apnea Syndrome

et al. 2020

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Adults with Down syndrome (DS) are predisposed to obstructive sleep apnoea (OSA), but the effectiveness and acceptability of continuous positive airway pressure treatment (CPAP) in this group has rarely been formally assessed. This study was designed as a pilot randomised, parallel controlled trial for one month, continuing as an uncontrolled cohort study whereby the control group also received the intervention. Symptomatic, community-dwelling DS individuals exhibiting ≥10 apnoeas/hypopneas per hour in bed on a Type 3 home sleep study were invited to participate in this study, with follow-up at 1, 3, 6, and 12 months from baseline. Measurements of sleepiness, behaviour, cognitive function and general health were undertaken; the primary outcome was a change in the pictorial Epworth Sleepiness Scale (pESS) score. Twenty-eight participants (19 male) were enrolled: age 28 ± 9 year; body mass index 31.5 ± 7.9 kg/m2; 39.6 ± 32.2 apnoeas/hypopneas per hour in bed; pESS 11 ± 6/24. The pilot randomised controlled trial at one month demonstrated no change between the groups. At 12 months, participant (p = 0.001) pESS and Disruptive (p < 0.0001), Anxiety/Antisocial (p = 0.024), and Depressive (p = 0.008) behaviour scores were reduced compared to baseline. Improvement was noted in verbal (p = 0.001) and nonverbal intelligence scores (p = 0.011). General health scores also improved (p = 0.02). At the end of the trial, 19 participants continued on treatment. Use of CPAP in adults with DS and OSA led to a number of significant, sustained improvements in sleepiness and behavioural/emotional outcomes at 12 months.

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“…These questionnaires were answered by the patients’ proxies, in agreement with other studies in individuals with DS. [4,5,20]…”

Section: Methodsmentioning

confidence: 99%

STOP-Bang questionnaire should be used in all adults with Down Syndrome to screen for moderate to severe obstructive sleep apnea

Carvalho

Amorim

Santana

et al. 2019

Preprint

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Study Objectives To determine the prevalence of obstructive sleep apnea (OSA) in adults with Down syndrome (DS), to investigate factors related to OSA severity and to identify which sleep questionnaire is the most appropriate for the screening of OSA in this population. Methods Cross-sectional study that consecutively included 60 adults with DS. All patients underwent type III polysomnography and clinical and laboratory data were collected; sleep assessment questionnaires were applied. Multiple linear regression models evaluated the associations between OSA severity (measured by the respiratory event index - REI) and clinical and laboratory data and sleep questionnaires (Epworth Sleepiness Scale, Pittsburgh Sleep Quality Index, BERLIN and STOP-Bang questionnaires). Results Results show that 60 (100%) adults with DS had OSA, with moderate-severe OSA identified in 49 (81.6%). At the multivariate linear regression, REI significantly correlated with hematocrit levels, BMI and STOP-Bang questionnaire (SBQ) results (P <0.001). The positive STOP-Bang ≥3 points) showed 100% of sensitivity (95%CI: 92.75-100%), 45.45% of specificity (95%CI: 16.75-76.62), positive predictive value of 89.09% (95%CI: 82.64-93.34%), negative predictive value of 100%, accuracy of 90% (95%CI: 79.49-96.24%) and OR of 24.29. Conclusions Adults with DS have a very high prevalence of OSA. Hematocrit levels, BMI and SBQ showed a strong correlation with OSA severity. The SBQ performed well in identifying moderate to severe OSA in this population. Considered together, these results point to the need to perform OSA screening in all adults with DS, and STOP-Bang may play a role in this screening. Keywords Down syndrome; obstructive sleep apnea; self-reported sleep quality; sensitivity and specificity; surveys and questionnaires; polysomnography.

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Utility of the pictorial Epworth sleepiness scale in the adult down syndrome population

Cited by 8 publications

References 11 publications

Sleep Disorders in Adults with Down Syndrome

Sleep Disorders in Adults with Down Syndrome

Prospective Trial of CPAP in Community-Dwelling Adults with Down Syndrome and Obstructive Sleep Apnea Syndrome

STOP-Bang questionnaire should be used in all adults with Down Syndrome to screen for moderate to severe obstructive sleep apnea

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