Wanted: a better cut-off value for the Epworth Sleepiness Scale

Abstract

SummaryBackgroundExcessive daytime sleepiness (EDS) is the main complaint in many neurological sleep disorders, such as idiopathic hypersomnia, narcolepsy, or obstructive sleep apnea/hypopnea syndrome (OSAS). The validity of the Epworth Sleepiness Scale (ESS) as a screening tool for EDS remains controversial. We therefore investigated (1) the interrelation of the ESS total score and the mean sleep latency (MSL) during the multiple sleep latency test (MSLT) and (2) the diagnostic accuracy of the ESS total score to detect EDS in patients with the chief complaint of subjective EDS.MethodsA total of 94 patients (48 males) with subjective EDS were included in this study. Regression analyses and ROC curve analyses were carried out to assess the predictive value of the ESS score for MSL.ResultsThe ESS score significantly predicted a shortened MSL (p = 0.01, β = −0.29). After dichotomizing into two groups, the ESS score predicted MSL only in patients with hypersomnia or narcolepsy (p = 0.01, β = −0.33), but not in patients with other clinical diagnoses (e. g. OSAS; p = 0.36, β = −0.15). The ROC curve analyses indicated an optimal ESS cut-off value of 16 with a sensitivity of 70%; however, specificity remained unsatisfactory (55.6%).ConclusionsOur results suggest that the predictive value of the ESS score in patients with subjective EDS is low and patient subgroup-specific (superior in hypersomnia/narcolepsy vs. other diagnoses) and that the commonly used cut-off of 11 points may be insufficient for clinical practice.

Estimating daytime sleepiness with previous night electroencephalography, electrooculography, and electromyography spectrograms in patients with suspected sleep apnea using a convolutional neural network

“…In detecting EDS, the sensitivity (76.5%) and specificity (77.9%) were good with reasonably high positive predictive value (78.0%) and negative predictive value (76.5%). In comparison, similar sensitivities (70% and 80%) and negative predictive values (75% and 76%) have been reported with ESS using cohort-optimized cutoff values (16 and 12 points) [ 31 , 32 ]. However, the specificities (55% and 69%) were considerably lower compared to our classifier along with lower positive predictive values (61% and 74%) [ 31 , 32 ].…”

“…In comparison, similar sensitivities (70% and 80%) and negative predictive values (75% and 76%) have been reported with ESS using cohort-optimized cutoff values (16 and 12 points) [ 31 , 32 ]. However, the specificities (55% and 69%) were considerably lower compared to our classifier along with lower positive predictive values (61% and 74%) [ 31 , 32 ]. High specificity (76%) has also been reported using ESS, but with low sensitivity (64%) [ 33 ].…”

Effect of sleep restriction on somatosensory sensitivity in the oro‐facial area: An experimental controlled study

“…Scores on the Epworth Sleepiness Scale (ESS), the mechanical detection threshold and the mechanical pain threshold were assessed at baseline (day 1), after SR or no SR night (day 2), and recovery testing days (day 3) for both groups. The cut‐off value for ESS scores was 10 in accordance with Trimmel et al; higher score means more sleepiness.…”

“…The elevation in ESS scores unmistakably confirmed the subjective sleepless condition. The ESS score of 12.2 ± 6.0 obtained on after SR in SR‐arm is also believed to have produced a state of “excessive daytime sleepiness,” based on a report from Trimmel et al The present study involved only one night of SR, along with restorative sleep, producing no changes in GAD‐7 or PHQ‐9. As a result, no impact was found on psychosocial conditions such as anxiety or depression, which enabled us to assess the somatosensory impact of short‐term restriction in biological sleep.…”

A Case of A Sleepy Taxi Driver Presenting with Narcolepsy

“…The ESS is a subjective test utilized to measure patient’s sleepiness. It includes eight scenarios in which the patient rates their tendency to become sleepy on a scale of 0 (no chance of dozing), 1 (slight chance of dozing), 2 (moderate chance of dozing), and 3 (high chance of dozing) [3]. These eight scenarios are sitting and reading, watching television, sitting inactive in a public place, as a passenger in a car for an hour without a break, in a car while stopped for a few minutes in traffic, lying down to rest in the afternoon, sitting and talking to someone, and sitting quietly after a lunch without alcohol.…”