title: Modified Epworth Sleepiness Scale in Chinese children with obstructive sleep apnea: a retrospective study.
abstract: OBJECTIVE
  The purpose of this study is to assess whether Chinese children with high apnea-hypopnea index (AHI) are sleepier by a modified Epworth Sleepiness Scale (ESS).
  
  
  METHODS
  Records were retrospectively reviewed. We included children who were between 3 and 12 years old, admitted for overnight polysomnogram because of suspected obstructive sleep apnea syndrome (OSAS). A modified ESS was used to assess excessive daytime sleepiness (EDS) of the children.
  
  
  RESULTS
  One hundred ninety-two Chinese children were included. Children with high AHI, defined as AHI > 5.0, were sleepier than children with AHI less than or equal to 5. After adjustment by age, gender, and obesity, children with high AHI remained significantly sleepier. Modified ESS was significantly correlated with AHI (rho = 0.124, 95% CI = 0.004-0.281). Modified ESS score of >8 was the best cutoff point with the sensitivity and specificity of 0.29 and 0.91, respectively. The odds ratio of children with modified ESS > 10 having high AHI was 4.231 (95%CI = 1.248 to 14.338) and children with modified ESS > 8 had the highest odds ratio, 4.295(95%CI = 1.66 to 11.1), of having high AHI.
  
  
  CONCLUSIONS
  Chinese children with high AHI appear to be sleepier than children with low AHI. Children with suspected OSAS and high modified ESS, i.e., ESS > 8, had significantly higher odds ratio of having high AHI. Increased sleepiness is a specific but not a sensitive symptom in snoring children with high AHI. Screening for EDS in snoring children may help us identify those with high AHI and prioritize the management of those children.
authors.affiliation: Department of Pediatrics, Kwong Wah Hospital, Hong Kong, China.
authors.forename: Eric Y T
authors.initials: EY
authors.lastname: Chan
authors.forename: Daniel K
authors.initials: DK
authors.lastname: Ng
authors.forename: Chung-hong
authors.initials: CH
authors.lastname: Chan
authors.forename: Ka-li
authors.initials: KL
authors.lastname: Kwok
authors.forename: Pok-yu
authors.initials: PY
authors.lastname: Chow
authors.forename: Josephine M
authors.initials: JM
authors.lastname: Cheung
authors.forename: Suk-yu
authors.initials: SY
authors.lastname: Leung
mesh_terms: D044466:Asian People / Q000706:statistics & numerical data*; D015992:Body Mass Index; D002648:Child; D002675:Child, Preschool; D002940:Circadian Rhythm; D003710:Demography; D006970:Disorders of Excessive Somnolence / Q000175:diagnosis* / Q000453:epidemiology*; D005260:Female; D006801:Humans; D008297:Male; D017286:Polysomnography; D015995:Prevalence; D012189:Retrospective Studies; D012720:Severity of Illness Index; D020181:Sleep Apnea, Obstructive / Q000175:diagnosis* / Q000453:epidemiology*; D011795:Surveys and Questionnaires