Epworth Sleepiness Scale

The Epworth Sleepiness Scale (ESS) is a scale[1][2] intended to measure daytime sleepiness that is measured by use of a very short questionnaire. This can be helpful in diagnosing sleep disorders. It was introduced in 1991 by Dr Murray Johns of Epworth Hospital in Melbourne, Australia.[3]

Epworth Sleepiness Scale
Purposediagnose sleep disorder

The questionnaire

The questionnaire asks the subject to rate his or her probability of falling asleep on a scale of increasing probability from 0 to 3 for eight different situations that most people engage in during their daily lives, though not necessarily every day.[3] The scores for the eight questions are added together to obtain a single number. A number in the 0–9 range is considered to be normal while a number in the 10–24 range indicates that expert medical advice should be sought.[3] For instance, scores of 11–15 are shown to indicate the possibility of mild to moderate sleep apnea, where a score of 16 and above indicates the possibility of severe sleep apnea or narcolepsy.[3] Certain questions in the scale were shown to be better predictors of specific sleep disorders, though further tests may be required to provide an accurate diagnosis.[3]

The questionnaire was originally created with the intent to preserve the exact wording of the questionnaire to provide a standardized test and to preserve its validity; the author of the ESS recommends that the administrator of the questionnaire does not discuss the results of the ESS with the subject until it is completed, as this may affect the subject's responses on the questionnaire.[4]

An interactive calculator is available that utilizes the 1997 version of the ESS. It automatically provides the score based on the responses to the ESS questions: ESS interactive calculator.[5]

Calibration

The Epworth Sleepiness Scale has been validated primarily in obstructive sleep apnea, though it has also shown success in detecting narcolepsy and idiopathic hypersomnia.[3] It is used to measure excessive daytime sleepiness and is repeated after the administration of treatment (e.g., CPAP) to document improvement of symptoms.[6] In narcolepsy, the Epworth Sleepiness Scale has both a high specificity (100%) and sensitivity (93.5%).[7]

The Epworth Sleepiness Scale has been used to compare the sensitivity and specificity of other similar measurements of sleep quality.[8][9] The Pittsburgh Sleep Quality Index is a related scoring tool of sleep quality. Both scores are internally highly reproducible.[10]

References
  1. Ibáñez, Vanessa; Silva, Josep; Cauli, Omar (February 2018). "A survey on sleep questionnaires and diaries". Sleep Medicine. 42: 90–96. doi:10.1016/j.sleep.2017.08.026. hdl:10251/104017. ISSN 1389-9457. PMID 29458752.
  2. Ibáñez, Vanessa; Silva, Josep; Cauli, Omar (2018-05-25). "A survey on sleep assessment methods". PeerJ. 6: e4849. doi:10.7717/peerj.4849. ISSN 2167-8359. PMC 5971842. PMID 29844990.
  3. Johns MW (1991). "A new method for measuring daytime sleepiness: the Epworth sleepiness scale" (PDF). Sleep. 14 (6): 540–5. doi:10.1093/sleep/14.6.540. PMID 1798888. Archived from the original (PDF) on 2015-02-26.
  4. "The Epworth Sleepiness Scale: What the Epworth Sleepiness Scale is and how to use it". Archived from the original on 2012-03-17. Retrieved 2012-03-09.
  5. The Epworth Sleepiness Scale: About the ESS
  6. Hardinge FM, Pitson DJ, Stradling JR (1995). "Use of the Epworth Sleepiness Scale to demonstrate response to treatment with nasal continuous positive airways pressure in patients with obstructive sleep apnoea". Respir Med. 89 (9): 617–20. doi:10.1016/0954-6111(95)90230-9. PMID 7494915.
  7. Johns, MW (March 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". Journal of Sleep Research. 9 (1): 5–11. doi:10.1046/j.1365-2869.2000.00177.x. PMID 10733683. Archived from the original on 2012-12-10. Retrieved 2008-07-22.
  8. Levine DW, Kripke DF, Kaplan RM, Lewis MA, Naughton MJ, Bowen DJ, Shumaker SA (2003). "Reliability and validity of the Women's Health Initiative Insomnia Rating Scale". Psychological Assessment. 15 (2): 137–148. doi:10.1037/1040-3590.15.2.137. PMID 12847774.
  9. Koffel E (2011). "Further validation of the Iowa Sleep Disturbances Inventory". Psychological Assessment. 23 (3): 587–598. doi:10.1037/a0022818. PMID 21500920.
  10. Knutson KL, Rathouz PJ, Yan LL, Liu K, Lauderdale DS (2006). "Stability of the Pittsburgh Sleep Quality Index and the Epworth Sleepiness Questionnaires over 1 year in early middle-aged adults: the CARDIA study". Sleep. 29 (11): 1503–6. doi:10.1093/sleep/29.11.1503. PMID 17162998.
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