Repeating administration of Epworth Sleepiness Scale is clinically useful.
OBJECTIVE
We aimed to verify whether it is clinically useful to repeat the Epworth Sleepiness Scale (ESS) in individuals with suspected sleep-disordered breathing (SDB).


METHODS
In this cross-sectional, prospective study, results of the repeated administration of the ESS were analyzed. In 929 consecutive patients, ESS was obtained as usual in the laboratory routine, immediately before the sleep study (ESS1) and was repeated in the morning, after the polysomnography (ESS2). ROC curve, classical psychometry, and item response theory (IRT) Rasch analysis were used to assess measurement properties of ESS.


RESULTS
The ESS1 score was (mean ± SD), 11 ± 5.1, and the ESS2, 13 ± 4.7 (p < 0.001). Change in ESS score is explained in multivariate analysis by age, but not by gender, educational level, change in Stanford Sleepiness Scale, symptoms of sleep disorder, or polysomnography results. Accuracy of an ESS score >10 to predict apnea-hypopnea index ≥5 increased from 56% (ESS1) to 72% (ESS2). IRT psychometric properties (unidimensionality, invariance, local independence) were maintained in ESS2.


CONCLUSIONS
Repeating the administration of the Epworth Sleepiness Scale in a clinical setting increases its score and diagnostic accuracy and correlation with SDB variables, without changing the psychometric properties of the scale. This experiment indicates the clinical usefulness of repeating the ESS. The scale can be repeated at a negligible cost, before dismissing individual patients on the basis of a low ESS score, discontinuing a potentially lifesaving diagnostic and therapeutic process.
Division of Cardiology, Hospital de Clinicas de Porto Alegre, Sleep Clinic, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil. dm@ufrgs.br
Denis
D
Martinez
Tiago Cataldo
TC
Breitenbach
Magali Santos
MS
Lumertz
Denise Lerias
DL
Alcântara
Neusa Sicca
NS
da Rocha
Cristiane Maria
CM
Cassol
Maria do Carmo Sfreddo
Mdo C
Lenz
D000328:Adult; D006970:Disorders of Excessive Somnolence / Q000175:diagnosis; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D017286:Polysomnography; D011594:Psychometrics / Q000706:statistics & numerical data; D012016:Reference Values; D015203:Reproducibility of Results; D020181:Sleep Apnea, Obstructive / Q000175:diagnosis*; D011795:Surveys and Questionnaires