Epworth Sleepiness Scale Total Score Research Articles

The Epworth Sleepiness Scale in epilepsy: Internal consistency and disease-related associations

BackgroundThe Epworth Sleepiness Scale (ESS) is the most common instrument for measuring subjective sleep propensity in people with epilepsy but has not yet been validated in this population. Study objectivesWe aimed to systematically assess the validity, performance, and internal consistency of the ESS, as well as correlations between the ESS and disease-specific variables and patient-reported outcome measures in a cohort of adults with epilepsy (AWE). MethodsNinety-five AWE completed sleep and seizure diaries, in-laboratory polysomnography (PSG) and patient-reported outcome measures, including the ESS, Insomnia Severity Index (ISI), and the Beck Depression Inventory (BDI). Demographic information and data from 95 matched controls referred for PSG for suspected obstructive sleep apnea (OSA) was taken from the electronic medical record. Frequencies of high ESS item ratings (item score ≥2) were calculated for each group. Cronbach’s α and factor analysis were performed to assess the internal consistency and validity of the ESS within cases and controls. Multivariable linear models were used to assess the association between ESS and predictors of interest, adjusting for demographic and disease-specific variables, including seizure type, frequency, and anti-seizure medication (ASM) therapy. ResultsWhile suspected OSA controls had significantly greater mean ESS total scores (9.9 vs 7.9, p = 0.004) and proportion with ESS >10 (42% vs 25%, p = 0.014), there were no significant differences in the severity of item responses, with the exception of “lying down to rest in the afternoon when circumstances permit,” for which more controls rated as likely/very likely (79% vs 64%), p = 0.024). AWE with ESS >10 had higher mean standardized ASM dose (2.5 vs 1.7, p = 0.026). All ESS items were significantly correlated with the total score within each group. Cronbach’s α was 0.75 for cases and 0.85 for controls, indicating good internal consistency of the ESS for both groups. After adjusting for demographic and sleep characteristics, higher ESS scores were associated with greater insomnia scores on the ISI (p = 0.024) and depressive symptoms on the BDI (p = 0.018). ConclusionsThis study provides validity for the use of the ESS in adult populations with epilepsy.

Observation of acupoint application of gel plaster on insomnia

To observe the effect of acupoint application of gel plaster on quality of sleep and life in patients with insomnia. A total of 63 patients with insomnia were randomized into a gel plaster group (32 cases, 1 case dropped off) and a placebo plaster group (31 cases). Acupoint application of gel plaster was applied at Yintang (GV 29) and Yongquan (KI 1) in the gel plaster group, placebo plaster was applied at the same acupoints in the placebo plaster group. The treatment was given from bedtime to early moming of the next day, 5 days were as one course, with 2-day interval, totally 4 courses were required in the both groups. Pittsburgh sleep quality index (PSQI), Epworth sleepiness scale (ESS) and Flinders fatigue scale were used to evaluate the sleep quality and fatigue level of the patients in the both groups before and after treatment and at 2 weeks of follow-up. The variations of insomnia TCM syndrome score and the 36-item short-form health survey (SF-36) score before and after treatment were observed. Compared before treatment, the scores of PSQI, ESS and FFS after treatment and at follow-up were decreased in the both groups (P<0.01), and the variations of PSQI total scores and ESS scores in the gel plaster group were larger than those in the placebo plaster group (P<0.05). Compared before treatment, the insomnia TCM syndrome scores were decreased (P<0.01), the scores of physiological function, physiological role, general health, role emotion, mental health of SF-36 were improved after treatment in the both groups (P<0.05), and the social function score after treatment in the gel plaster group was superior to that in the placebo plaster group (P<0.05). Acupoint application of gel plaster can effectively improve the quality of sleep and life in patients with insomnia.

Preliminary Validation of the Sleep and Concussion Questionnaire as an Outcome Measure for Sleep Following Brain Injury

ABSTRACT Background Sleep and wakefulness disturbances are common with traumatic brain injury (TBI); however, there are no condition-specific measures to evaluate sleep following TBI. Objective To assess the convergent validity of the Sleep and Concussion Questionnaire (SCQ), a condition-specific (TBI) measure is compared to polysomnography and existing self-report sleep questionnaires. Participants Included Thirty-two adults diagnosed with mild TBI, 3–24 months post-injury, average age, 38.9 years, predominantly female (63%) and with symptoms of chronic insomnia. Methods Participants underwent polysomnographic evaluation of sleep and completed the SCQ, Insomnia Severity Index (ISI), Epworth Sleepiness Scale (ESS), and the Fatigue Severity Scale (FSS). Correlations were assessed using Pearson’s correlations. The sample was sufficiently powered (0.85) to detect a moderate to strong correlation of 0.5 or greater. Results SCQ sub-questions were meaningfully correlated with corresponding objective sleep parameters (time awake, number of awakenings, sleep efficiency, sleep onset latency, wake after sleep onset) as measured with polysomnography. Additional significant correlations were seen between total scores on the SCQ and ISI and between SCQ sub questions and total ESS scores. Conclusions This work provides initial evidence of the convergent validity of the SCQ with objective sleep parameters and existing self-report measures in patients after mild TBI.

Gender differences in Epworth Sleepiness Scale revealed by paired patient–spouse scoring

PurposeEvaluation of daytime sleepiness in the clinical sleep practice is commonly performed by administering the Epworth Sleepiness Scale (ESS). Our study investigates gender differences of ESS responses in patients (PTs) with a primary complaint of nighttime sleep disruption as they relate to ESS responses obtained from PTs' spouses (Ss). MethodsOne hundred and sixty-four patient–spouse (PT-S) pairs were recruited for the study and asked to independently complete ESS questionnaires consisting of 8 sleepiness scenarios (Q1–Q8). Descriptive summaries were frequencies and percentages for categorical data, and medians and quartiles for continuous variables. Differences between PT-S pairs and different data sets were evaluated using a two-tail independent T test and Wilcoxon's Rank Sum Test. All analyses were done in SAS for Windows 9.4. ResultsEighty-five male and 75 female PTs were recruited for the study. Female PTs reported significantly higher total ESS scores than male PTs (12.16 vs 9.64, p < 0.0001) and had significantly higher sleepiness for scenarios Q1, Q4, Q6, and Q8. When compared with their Ss' responses, male PTs underestimated, while female PTs overestimated their sleepiness with statistical significance observed for total ESS score as well as for all sleepiness scenarios except for Q5 (“lying down to rest in the afternoon”). African-American (AA) males reported significantly higher total ESS scores than Caucasian (C) males, while AA females reported lower total ESS scores than C females. Discrepancy between PT-S ESS scores was higher in C than in AA PTs. ConclusionsSignificant gender differences were noted when PT-S ESS responses were compared. Demonstrated gender differences were further influenced by the PT's race.

0401 Sleep Characteristic Differences During Early Postpartum in White and African American Women

Abstract Introduction In the general population, poor sleep quality and shorter sleep duration is associated with several adverse health outcomes. African American adults are more likely to report poorer sleep quality and shorter total sleep duration compared to White adults. However, there is limited information comparing sleep characteristics in White and African American women during postpartum, when many women experience reduced sleep quality. The purpose of this study was to compare sleep quality at 6-8 weeks postpartum in White and African American women. Methods White (n=84) and African American (n=37) women, who gave birth to a singleton at ≥ 37 weeks of gestation, completed the Pittsburg Sleep Quality Index (PSQI) and the Epworth Sleepiness Scale (ESS) at 6-8 weeks postpartum. The PSQI was used to assess global sleep quality, time in bed, and 7 components regarding sleep. The components included: Subjective sleep quality, sleep latency, sleep duration, habitual sleep efficiency, sleep disturbances, use of sleeping medication, and daytime dysfunction. The ESS total score was used to assess daytime sleepiness. Results The global PSQI score was higher for African American women (8.8 ± 3.3, mean ± SD), indicating poorer sleep quality than White women (7.1 ± 3.0, p=.006). African American women had higher sleep latency and shorter sleep duration compared to White women (p=.0179 and p&amp;lt;.0001, respectively). Time in bed was not statistically different for African American women compared to White women (485.6 ± 143.7 and 530.8 ± 85 minutes/night, p=.08). No other components of the PSQI were significantly different between the two racial groups. African American women scored higher on the ESS than White women (8.9 ± 3.1, 6.6 ± 3.2, p=.0002) indicating greater daytime sleepiness. Conclusion These results suggest that African American women experience lower sleep quality and greater daytime sleepiness in early postpartum compared to White women. Support National Institute On Minority Health And Health Disparities of the National Institutes of Health under Award Number R21MD012740.

0851 Sleep Disturbance But Not Sleep Duration Is Associated With Perceived Stress And Self-esteem In Postpartum Women

Abstract Introduction Healthy sleep is known to contribute to psychosocial well-being. Pregnancy and postpartum could have profound influences on women’s psychosocial well-being related to physiological changes and interrupted sleep due to caring for the infant. The purpose of this study was to determine the associations between self-reported sleep characteristics and psychosocial well-being. Methods Forty-seven women who delivered a singleton infant after ≥ 37 weeks of gestation were interviewed at 6-8 weeks, 4 months, and 6 months after delivery. The Pittsburgh Sleep Quality Index (PSQI) was used to obtain sleep duration, sleep disturbance, and the global PSQI score, and the Epworth Sleepiness Scale total score was used to assess daytime sleepiness. The Edinburgh Postnatal Depression Scale, Perceived Stress Scale, and Rosenberg Self-Esteem Scale were used to assess psychosocial well-being, and a summary score of each instrument was calculated. Results The self-reported nightly sleep duration decreased over time (535 ± 95, 505 ± 78, 488 ± 66 minutes, respectively at each timepoint, mean ± SD, p = 0.007). Other sleep characteristics did not change. There were also no significant changes over time in the scores of depressive symptoms, stress, or self-esteem. At 6-8 weeks postpartum, sleep disturbance was associated with stress (r = 0.32, p = 0.026) and self-esteem (r = -0.38, p = 0.008) so that women who had greater sleep disturbances perceived greater stress and lower self-esteem. These associations did not exist 4 months or 6 months after delivery. Sleep duration, global PSQI score, and sleepiness were not associated with any of the psychosocial measures. Conclusion Sleep disturbance is an important correlate of psychosocial well-being in early postpartum. The decreased sleep duration likely indicates recovering from pregnancy and delivery, and adapting to routine lifestyle. Support National Institute On Minority Health And Health Disparities of the National Institutes of Health under Award Number R21MD012740

The effect of OSAS risk, excessive daytime sleepiness, insomnia severity and sleep quality on dry eye syndrome

The purpose of this study was to investigate the association between sleep disturbances and dry eye syndrome (DES). 201 patients with DES were included in this study. Tear fluid break-up time (TBUT) and Schirmer I tests were performed. Patients with DES filled out Ocular Surface Disease Index (OSDI) questionnaire. The respondents completed the Pittsburgh Sleep Quality Index (PSQI), the Insomnia Severity Index (ISI), the Epworth Sleepiness Scale (ESS), and the STOP-Bang questionnaire. OSDI, PSQI, ISI and ESS were recorded and compared within DES severity. The study population consisted of 87.6% (n = 176) female with age 52.33 ± 14.49 (18–80) years. The total ESS score was significantly correlated with the OSDI score (p = 0.045), although the ESS total score was not statistically correlated with the Schirmer I test and TBUT test scores (p = 0.239, p = 0.463). A positive correlation was identified between the total ISI score and the OSDI score (p = 0.001). The total ISI score was negatively correlated with the Schirmer I test and TBUT test scores (p = 0.003, p = 0.001). The total PSQI score was positively correlated with the OSDI score (p < 0.0001), and the total PSQI score was negatively correlated with the Schirmer I test and TBUT test scores (both p < 0.0001). The total STOP-Bang score was not statistically correlated with the OSDI score, or the Schirmer I test and TBUT test scores (p = 0.105, p = 0.399, p = 0.061, respectively). A relationship was found between DES and sleep disorders based on subjective questionnaires. Our finding suggests that the treatment of DES and sleep disorders with a multidisciplinary approach will lead to an increase in the quality of life of patients.

Abstract P544: Sleep Apnea Severity is More Strongly Associated With Cardiovascular Health Than a Composite Measure of Sleep Health in Adults With Sleep Apnea and Diabetes

Introduction: Sleep health is multi-dimensional. The RSATED Sleep Health composite score, hereafter referred to as RSATED, includes regularity, satisfaction, alertness, timing, efficiency, and duration. RSATED has been associated with cardiovascular (CV) health in a nationally representative sample. However, the association between RSATED and CV health in adults with obstructive sleep apnea (OSA) and type 2 diabetes mellitus (T2DM) have not been examined. Purpose: This secondary analysis examined the associations between RSATED and CV health measures including body mass index (BMI), lipid levels, and physical activity. Methods: We used baseline data from the Diabetes Sleep Treatment Trial, a randomized controlled trial that examined if adults with co-existing OSA and T2DM treated with continuous positive airway pressure had better glycemic control compared to participants that received a non-therapeutic treatment. Data collected included questionnaires, anthropometric measurements, a lipid panel, objective physical activity (PA) data (BodyMedia), apnea-hypopnea index (AHI; ApneaLink Pro), and a modified Consensus Sleep Diary. RSATED was calculated using up to 7 days of sleep data and Epworth Sleepiness Scale (ESS). Individual components were given a score of 0 or 1 with 1 representing “good” sleep. “Good” sleep was defined as: &gt;80% of awakenings occurring during the same time range (regularity); mean sleep quality of “good” or “very good” (satisfaction); ESS total score ≤10 (alertness); &gt;80% of sleep midpoint occurring between 2-4 am (timing); sleep efficiency ≥85% (efficiency); and mean sleep duration of 7-9 hrs/night (duration). The total score could range from 0-6; higher scores represented better sleep. The associations between RSATED and CV health measures were examined using linear regression models. All models were adjusted for AHI, marital status, race, age, and education. Results: A total of 350 individuals underwent screening. Of the 253 participants with complete data, the majority were female (52.2%) and white (54.2%) with a mean (± SD) age of 56.6 ± 10.5 yrs, BMI of 34.2 ± 7.1, and AHI of 14.1 ± 15.1. Mean RSATED was 2.8 ± 1.2 (range 0-5). The RSATED score was not associated with any of the CV health measures. However, there was a trend for significance for better sleep health to be associated with greater vigorous PA (b = 0.46, p = .08). Whereas, greater AHI was associated with higher BMI, higher total cholesterol, greater sedentary time, and less moderate- and vigorous-intensity PA (p-values from .05 to &lt;.0001). Conclusions: Among adults with co-existing OSA and T2DM, AHI was more strongly associated with measures of CV health than RSATED. While sleep health is essential, the underlying impact of OSA on CV health and its treatment should remain a priority. Future studies should continue to examine the associations between sleep health and other measures of health and wellness.

The estimation of excessive daytime sleepiness in post-stroke patients - a polysomnographic study

Abstract Excessive daytime sleepiness (EDS) has been reported in stroke patients. EDS in acute stroke was studied repeatedly, but there is a modest amount of data in post-stroke patients. The aim of this study was to assess the frequency of EDS and characterize sleep architecture in patients >3 months after stroke and identify factors which may affect EDS. 66 patients were enrolled, of which 33 had experienced stroke. All underwent a standardized overnight, diagnostic single night polysomnography, including electrocephalogram (EEG) leads, electrooculograms (EOG), chin electromyogram (EMG), and electrocardiogram (ECG). Epworth Sleepiness Scale (ESS) was used to measure subjects’ level of daytime sleepiness. We observed similar total ESS score, total sleep time (TST), sleep efficiency, as well as respiratory disturbance index /apnea-hypopnea index (RDI/AHI), oxygen desaturation index (ODI) and mean heart rate in both groups. We observed positive linear correlation between EDS and mean heart rate in the stroke group (r = 0.46, p In summary, in stroke patients subjective daytime sleepiness is associated with heart rate, but not with the severity of OSA. Thus ESS (Epworth Scale Score) may be not as useful as a marker of obstructive sleep apnea (OSA) presence or severity in post stroke patient as in the general population.

Natural history of excessive daytime sleepiness: a population-based 5-year longitudinal study.

To document the rates of persistent, remitted, and intermittent excessive daytime sleepiness (EDS) in a longitudinal 5-year community study of adults and to assess how changes in risk factors over time can predict improvement of daytime sleepiness (DS). Participants were recruited in 2007-2008 as part of a population-based epidemiological study implemented in Canada. They completed postal assessments at baseline and at each yearly follow-up. An Epworth Sleepiness Scale total score >10 indicated clinically significant EDS; a 4-point reduction between two consecutive evaluations defined DS improvement. Socio-demographic, lifestyle, health characteristics, and sleep-related measures (e.g. insomnia symptoms, sleep duration, sleep medication) were self-reported at each time point. Cox proportional-hazard models were used to predict EDS and DS remissions over 5 years. Among the 2167 participants, 33% (n = 714) met criteria for EDS at baseline, of whom 33% had persistent EDS, 44% intermittent EDS, and 23% remitted EDS over the follow-up. Furthermore, 61.4% of 2167 initial participants had stable DS, 27.1% sustained DS improvement and 8.5% transient improvement over the follow-up. The main predictors of EDS remission or DS improvement were normal weight, taking less hypnotics, having hypertension, increased nighttime sleep duration, and decreased insomnia, and depressive symptoms. EDS waxes and wanes over time with frequent periods of remission and is influenced by behavioral characteristics and changes in psychological, metabolic, and nighttime sleep patterns. Targeting these predictors in future interventions is crucial to reduce DS in the general adult population.

Long-term effects of bilateral subthalamic nucleus stimulation on sleep in patients with Parkinson's disease.

ObjectivesDeep brain stimulation (DBS) of the subthalamic nucleus (STN) has been reported to have a positive effect on sleep-wake disturbance in Parkinson's disease (PD). We aimed to investigate the long-term effects of STN DBS on sleep in patients with PD.MethodsSixty-one patients with PD who had undergone bilateral STN DBS were followed for 3 years with assessments including the Parkinson’s disease sleep scale (PDSS), Epworth sleepiness scale (ESS), total sleep hours per day, Unified PD Rating Scale part I-III, Hoehn & Yahr stage, levodopa equivalent dose, quality of life measure, and depression scale measured preoperatively and at 6 months after postoperatively, and annually thereafter.ResultsAmong the 61 patients at baseline, 46 patients completed the last follow-up assessment. The total PDSS score significantly improved after STN DBS from baseline up to 3 years after STN DBS (79.0±30, 100.0±23.3, 98.8±23.0, 97.1±29.6, and 93.3±28.0 at baseline, 6, 12, 24, and 36 months, respectively, p = 0.006 for the change over time). Among the eight PDSS domains, the domains for overall quality of a night’s sleep, sleep onset and maintenance insomnia, and nocturnal motor symptoms showed significant improvement after STN DBS (p = 0.036, 0.029, and < 0.001, respectively, for the change over time). The total sleep hours per day were increased, but the total ESS score did not show significant change after STN DBS (p = 0.001 and 0.055, respectively, for the change over time). Changes in the total PDSS were associated with changes in the depression and motivation items in the Unified PD Rating Scale part I, depression scale, and quality of life measure, but those variables at baseline were not predictive of changes in the total PDSS after STN DBS.ConclusionIn the largest systematic long-term follow-up study, the improvement in subjective sleep quality after bilateral STN DBS was sustained in PD patients. Improved nocturnal sleep and nocturnal motor symptoms were correlated with an improved mood and quality of life. However, STN DBS did not reduce excessive daytime sleepiness despite reductions in antiparkinsonian medications.

The estimation of excessive daytime sleepiness in post-stroke patients - a polysomnographic study

Excessive daytime sleepiness (EDS) has been reported in stroke patients. EDS in acute stroke was studied repeatedly, but there is a modest amount of data in post-stroke patients. The aim of this study was to assess the frequency of EDS and characterize sleep architecture in patients >3 months after stroke and identify factors which may affect EDS.66 patients were enrolled, of which 33 had experienced stroke. All underwent a standardized overnight, diagnostic single night polysomnography, including electrocephalogram (EEG) leads, electrooculograms (EOG), chin electromyogram (EMG), and electrocardiogram (ECG). Epworth Sleepiness Scale (ESS) was used to measure subjects’ level of daytime sleepiness.We observed similar total ESS score, total sleep time (TST), sleep efficiency, as well as respiratory disturbance index /apnea-hypopnea index (RDI/AHI), oxygen desaturation index (ODI) and mean heart rate in both groups. We observed positive linear correlation between EDS and mean heart rate in the stroke group (r = 0.46, p < 0.05) as well as between EDS and REM duration (r = 0.23, p < 0.05). In the non-stroke group EDS didn’t correlate with the heart rate or with the REM duration. In the non-stroke group EDS correlated positively with RDI/AHI and ODI index (r = 0.46; p = <0.05 r = 0.41, p < 0.05 and maximal desaturation (r = 0.55, p < 0.05), this correlation was not observed in post-stroke group. In the both groups we observed negative linear correlation between BMI and saturation (stroke group - mean as well as minimal saturation (r = −0.458, p < 0.05; r = −0.578, p < 0.05), non stroke group - minimal but not mean saturation rate (r = −0.544, p < 0.05). We also noticed in both groups positive correlation between BMI and both AHI and ODI index (stroke group respectively: r = 0.430, p < 0.05; r = 0.451, p < 0.05; non-stroke group - BMI and ODI: r = 0.405, p < 0.05). The positive BMI correlation with RDI/AHI was not significant in the non-stroke group. We noticed that BMI correlates with non-REM sleep N1 (r = 0.760, p < 0.05) in post-stroke group, while it correlates negatively with REM sleep (r = -0.709, p < 0.05). There was no such correlation in the non-stroke group.In summary, in stroke patients subjective daytime sleepiness is associated with heart rate, but not with the severity of OSA. Thus ESS (Epworth Scale Score) may be not as useful as a marker of obstructive sleep apnea (OSA) presence or severity in post stroke patient as in the general population.

Psychometric properties of the Epworth sleepiness scale in Ethiopian university students

BackgroundDaytime sleepiness is highly prevalent across the globe. The Epworth sleepiness scale (ESS) is the most widely used tool for screening daytime sleepiness. The psychometric properties of the ESS have not been comprehensively examined in African populations.Material and methodsA cross-sectional design with simple random sampling was used in the present study. The study recruited 600 students from Mizan-Tepi University, Ethiopia, of which 329 (age = 18–28 years and body mass index = 21.19 ± 3.17 kg/m2) completed the study. ESS, a semi-structured socio-demographics questionnaire and a clinical interview to diagnose insomnia according to the International Classification of Sleep Disorders were employed.ResultsAll except one item of the ESS showed a floor effect, while only one item score showed ceiling effect. However, no ceiling/floor effect was observed in the ESS total score. The Cronbach’s alpha (0.75) and composite reliability (0.75), indicated good internal consistency, while a moderate item-total score correlation (r = 0.55–0.67) implied favorable internal homogeneity. The known-group validity was established by significantly higher scores for all the ESS item scores and the ESS total scores among those with symptoms of insomnia than among non-symptomatic students. Fit indices along with the consideration of inter-factor correlation coefficient, measures of item retention favored the unidimensional structure of the ESS.ConclusionThe ESS has excellent psychometric validity for screening daytime sleepiness in Ethiopian university students.

Differences in sleep between concussed and nonconcussed college students: a matched case-control study.

To describe sleep 2-3 days postconcussion through symptom recovery and make comparison to well-matched nonconcussed controls. Twenty college students were physician diagnosed with a concussion and compared with 20 nonconcussed controls matched on age, sex, physical activity, and sleep quality. A wrist-worn ActiGraph GT9X Link was provided during initial evaluation (within 72 hr postinjury for concussed) and worn continuously until symptom resolution (duration matched for nonconcussed). All participants completed a sleep symptom severity checklist, the Pittsburgh Sleep Quality Index (PSQI), and the Epworth Sleepiness Scale (ESS). Separate 2(group) × 3(time points) mixed model ANOVAs were conducted to compare actigraphy sleep outcomes (sleep onset latency [SOL], normalized wake after sleep onset [WASOnorm], total sleep time [TST], sleep efficiency, and number of awakenings) across recovery stages (2-3 days postinjury, mid-point, and end of recovery). Intraindividual coefficient of variation was calculated for each sleep outcome. Mann-Whitney U tests compared PSQI global score, ESS total score, and sleep symptom severity between groups (α = 0.05). At 2-3 days postinjury, concussed individuals took longer to fall asleep compared with controls (p = 0.002). Greater intraindividual variability in WASOnorm (p = 0.017) and TST (p = 0.044) existed in concussed individuals across recovery. Poorer sleep quality (p < 0.001), excessive daytime sleepiness (p = 0.014), and worse sleep symptoms (p < 0.001) existed in concussed compared with controls. Concussed individuals took longer to fall asleep 2-3 days postconcussion, experienced greater variation in sleep fragmentation and sleep time until symptom resolution, and reported worse sleep quality. Our preliminary findings may guide researchers interested in better understanding sleep postconcussion.

Moderate OSAS and turbinate decongestion: surgical efficacy in improving the quality of life and compliance of CPAP using Epworth score and SNOT-20 score.

Drug-induced sleep endoscopy (DISE) is an important procedure in diagnostic pathway of patients affected by moderate OSAS. However, the Italian National Health System does not provide any compatible Diagnosis-related-group (DRG) code codification for DISE, which makes it impossible to obtain regional reimbursement. In order to overcome this problem, DISE is usually associated with other codified surgical procedures. The aim of our study is to assess the association of turbinate decongestion (TD) and DISE in order to combine in a single operating session diagnostic and therapeutic procedures. The objective of our work is to assess the role of nasal surgery on symptoms of moderate OSA. Recent studies have confirmed that isolated nasal surgery improves quality of life (QOL), but not the apnoea hypopnoea index (AHI) during polygraph registration. We enrolled 30 patients, aged between 29 and 64 years (mean 50.53 ± 9.20), 26 males and 4 females, with a mean BMI of 26.07 ± 2.81 kg/m2, who were affected by moderate OSAS. All patients underwent otolaryngologycal pre-operative evaluation, home respiratory polygraph and subjective evaluation through Sino-Nasal-Outcome Test (SNOT-20) and Epworth Sleepiness Scale (ESS). During the same surgery session, they underwent DISE and TD. Patients were re-evaluated six months later using the same questionnaires. We observed a significant improvement (p #x003C; 0.05) in both the mean ESS index (6.03 ± 2.75 vs 4.16 ± 4.63) and total SNOT score (22.53 ± 12.16 vs 13.23 ± 10.82). Significant differences (p #x003C; 0.05) were also identified for partial SNOT questions 1-11 (9.1 ± 5.11 vs 6.13 ± 4.12) and 11-20 (13.36 ± 10.20 vs 7.13 ± 9.644). The results of the present study confirm that TD alone can improve sleepiness, QOL and nasal symptoms. Thus, in absence of a National Health System recognition for DISE, the association of this procedure with TD can be useful for diagnostic and therapeutic management of OSAS, improving CPAP compliance and adherence, reducing sleepiness, ameliorating nasal symptoms and therefore QOL.

Wanted: abetter cut-off value for the Epworth Sleepiness Scale.

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.

The Influence of Sleep Disorders on Voice Quality

To verify the influence of sleep quality on the voice. Descriptive and analytical cross-sectional study. Data were collected by an online or printed survey divided in three parts: (1) demographic data and vocal health aspects; (2) self-assessment of sleep and vocal quality, and the influence that sleep has on voice; and (3) sleep and voice self-assessment inventories-the Epworth Sleepiness Scale (ESS), the Pittsburgh Sleep Quality Index (PSQI), and the Voice Handicap Index reduced version (VHI-10). A total of 862 people were included (493 women, 369 men), with a mean age of 32 years old (maximum age of 79 and minimum age of 18 years old). The perception of the influence that sleep has on voice showed a difference (P < 0.050) between measures of sleep quality and vocal self-assessment. There were higher scores on the ESS, PSQI, and VHI-10 protocols if sleep and vocal self-assessment were poor. The results indicate that the greater the effect that sleep has on voice, the greater the perceived voice handicap. The aspects that influence a voice handicap are vocal self-assessment, ESS total score, and self-assessment of the influence that sleep has on voice. The absence of daytime sleepiness is a protective factor (odds ratio [OR] > 1) against perceived voice handicap; the presence of daytime sleepiness is a damaging factor (OR < 1). Sleep quality influences voice. Perceived poor sleep quality is related to perceived poor vocal quality. Individuals with a voice handicap observe a greater influence of sleep on voice than those without.

Impact of shift work on sleep and daytime performance among health care professionals.

Objectives:To evaluate sleep quality and daytime sleepiness in health care professionals who are performing shift work.Methods:This cross-sectional study was conducted on 510 health care professionals at Prince Sultan Military Medical City and King Khalid University Hospital, King Saud University, Riyadh, Kingdom of Saudi Arabia between December 2015 and April 2016. Data were collected using the Pittsburgh Sleep Quality Index (PSQI) and the Epworth Sleepiness Scale (ESS). Participants were divided into 2 groups: shift workers and non-shift workers.Results:We compared both groups regarding the effect of shift work on the total score of PSQI and ESS. We found that the PSQI global score (p<0.001) and the total ESS score (p=0.003) were significantly higher in shift work health care professionals.Conclusion:Shift work among health care professionals is associated with poor sleep quality but not excessive daytime sleepiness. Health care professionals performing shift work have PSQI and ESS scores slightly higher than non-shift work health professionals.

The influence of hypertension on daytime sleepiness in obstructive sleep apnea

Daytime sleepiness is a common symptom among hypertensive patients. The aim of this study was to determine subjective sleepiness assessed by Epworth Sleepiness Scale (ESS) and to asses sleep architecture in 304 patients with arterial hypertension. All patients underwent a standardized diagnostic overnight, polysomnography. The control group consisted of 67 normotensives. The hypertensive patients had a decreased sleep efficiency, mean and minimum oxygen saturation levels, and increased apnea/hypopnea index and oxygen desaturation index compared with normotensive patients. The lower ratio of N3 sleep, higher of N2 sleep, and decreased sleep efficiency was observed in hypertensives without obstructive sleep apnea (OSA). In the moderate to severe OSA groups, the total ESS score was significantly lower in hypertensives compared with normotensives. The ESS scores decreased with age in hypertensives, but not in normotensives. The study showed that ESS total score is lower in hypertensives than in normotensives with OSA, making the OSA more difficult to suspect. Thus, the low ESS score in hypertensives should not discourage further evaluation.

Investigation of Sleep Quality and Sleep Disorders in Students of Medicine.

This study was performed on Suleyman Demirel University medical students to determine the quality of sleep and to investigate factors that affect of sleep quality. Suleyman Demirel University Medical students at 1, 2, 3, 4, 5 and 6 classes included to this cross-sectional analytical study (n= 720). Refused to fill to the survey (188), and students were not come to faculty (195), applied survey to 337 students (46.8%). Epworth sleepiness scale (ESS), Pittsburgh (PSQI) and Berlin sleep questionnaires, and 13 pieces closed and open-ended socio-demographic questions were conduct a questionnare under observation. The collected data were analyzed by using descriptive statistics, chi-square, two independent groups t test, Pearson and Spearman's correlation, Mann-Whitney U, Kruskal-Wallis and ANOVA tests. 337 students participated in the study, 42.1% were male, 57.9% were female, mean age was 21.3 ± 2.1 years. Depending on Body mass index (BMI) 31 were poor, 212 normal, 53 overweight, and 4 obese students. In 118 students (35.3%), and these students have a chronic disease associated with 15.6% used the drug because of illness and 38 percent of students (11.6%) were smokers. 18.1 ± 16.1 min for pupils in times of falling asleep, sleep duration per night. 6.6 ± 1.3h, the mean departure time was 7.7 ± 1.8. Scale with a total score of Pittsburgh class (p= 0.000), age (p= 0.003), BMI (p= 0.015) had a significant correlation between. Pittsburgh PUKI scores and without a significant difference in gender (p= 0.054), the use of stimulant substances (p= 0.032), weight (p= 0.021) and snoring (p= 0.002) with no significant difference were found. ESS total score and gender (p= 0.025), drug use (p= 0.035) and sports activities (p= 0.038). Ten students had snoring (3.0%), 5 students (1.5%) had witnessed apnea. Snoring 17.2% to in ESS > 10 points on it. Pittsburgh, the mean scores of those who witnessed apnea (14.0 ± 5.3), witnessed apnea, according to non-students (10.2 ± 6.4) were higher (p= 0.191).The effects PSQI and ESS results on the term were statistically significant by the multivariate regression analysis [F(10.602)= 4.56; p< 0.05; Wilkis Lamda 0.864, partial n2= 0.07]. To estimate of the value of PSQI by the stepwise regression analysis was performed; age and fall asleep properties has been included of the model (R2= 89%, p< 0.05). To estimate of the value of PSQI by the stepwise regression analysis was performed; fall asleep property has been included of the model in the the male gender (R2= 80%, p< 0.05). To estimate of the value of ESS by the stepwise regression analysis was performed; term property has been included of the model (R2= 65%, p< 0.05). Medical school students participating in our study, although female-male ratio close to each other, we found that higher ESS and Pittsburgh scores in female more than male. In this case may be related to physiological, genetic, environmental, cultural and psychological differences.