title: Under reporting of sleepiness and driving impairment in patients with sleep apnoea/hypopnoea syndrome.
abstract: Under reporting of symptoms by patients with sleep apnoea/hypopnoea syndrome (SAHS) has been reported anecdotally, but investigation of the prevalence or determinants of this is limited. To assess this, repeated ratings in 99 patients with sleep apnoea/hypopnoea syndrome of pre-treatment Epworth sleepiness score, unintended napping, driving impairment and mood were obtained, first at presentation and then after treatment with continuous positive airway pressure (CPAP) therapy of median 22 (range 2-70) weeks duration. Median Epworth score for pre-treatment sleepiness rose from 12 (range 0-24) initially to 14 (range 5-24) retrospectively (P<0.0001). More patients initially under-rated Epworth score (67%) than over-rated (29%; P<0.001). 'False negative' cases with an initially 'normal' (< or = 10) and retrospectively 'sleepy' (> or = 11) Epworth score comprised 24% of all patients and 62% of initially 'normal' scorers. Unintended napping behaviour also was rated as significantly more severe on retrospective assessment (P<0.001). Driving impairment due to sleepiness was initially reported by 23% of all drivers and retrospectively by 37% (P=0.01), with 25% of initial deniers retrospectively admitting compromised driving ability before continuous positive airway pressure. No polysomnographic predictors of symptom under reporting were found (P>0.1). These results suggest a high prevalence of symptom minimization before treatment in patients with sleep apnoea/hypopnoea syndrome.
authors.affiliation: Department of Medicine (RIE), University of Edinburgh, UK.
authors.forename: H M
authors.initials: HM
authors.lastname: Engleman
authors.forename: W S
authors.initials: WS
authors.lastname: Hirst
authors.forename: N J
authors.initials: NJ
authors.lastname: Douglas
mesh_terms: D000328:Adult; D000339:Affect; D000368:Aged; D001334:Automobile Driving; D006970:Disorders of Excessive Somnolence / Q000175:diagnosis* / Q000209:etiology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011175:Positive-Pressure Respiration / Q000379:methods; D012189:Retrospective Studies; D012720:Severity of Illness Index; D012891:Sleep Apnea Syndromes / Q000150:complications* / Q000628:therapy; D011795:Surveys and Questionnaires