title: Limits of the Epworth Sleepiness Scale in older adults.
abstract: OBJECTIVE
  Excessive daytime sleepiness (EDS) in older adults is associated with obstructive sleep apnea, falls, reduced quality of life, and mortality. The Epworth Sleepiness Scale (ESS) is widely used to assess sleepiness. However, EDS assessment with the ESS may not be accurate in older adults. We aimed to (1) describe the responsiveness of nondemented older subjects to the ESS and (2) compare the self-report ESS scores to those of close relatives (CR) proxy and identify factors influencing any discrepancies between them.
  
  
  METHODS
  This is a cross-sectional observational study including 104 independently living nondemented older subjects with daytime sleepiness complaints and 104 nondemented CRs. Cognitive tests (Mini-Mental State Examination) and the ESS were completed separately by subjects and CRs to assess the subject's daytime sleepiness.
  
  
  RESULTS
  Almost 60 % of subjects and CRs were not able to answer at least one question on the ESS. Despite the fact that all subjects complained of EDS, only 24 % of them had an abnormal ESS score (>10). Subjects rated their sleepiness lower (7.10 ± 4.31) than their CR proxy did (9.70 ± 5.14) (p < 0.0001). In multivariate analysis, an increase in age and a decrease in cognitive status of the subjects appeared related to the difference in ESS between subject and CR.
  
  
  CONCLUSIONS
  The majority of older adults were not able to answer all of the ESS items. The ESS may underestimate sleepiness severity in older subjects. Despite EDS complaints in all subjects, only one quarter of them had a pathological ESS score.
authors.affiliation: CHU Hôpital Bichat Claude Bernard, APHP, Paris, France. fannie.onen@bch.aphp.fr
authors.forename: Fannie
authors.initials: F
authors.lastname: Onen
authors.forename: Thierry
authors.initials: T
authors.lastname: Moreau
authors.forename: Nalaka S
authors.initials: NS
authors.lastname: Gooneratne
authors.forename: Clémence
authors.initials: C
authors.lastname: Petit
authors.forename: Bruno
authors.initials: B
authors.lastname: Falissard
authors.forename: S Hakki
authors.initials: SH
authors.lastname: Onen
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D017028:Caregivers / Q000523:psychology; D003430:Cross-Sectional Studies; D006970:Disorders of Excessive Somnolence / Q000175:diagnosis* / Q000453:epidemiology*; D005260:Female; D005602:France; D006801:Humans; D057187:Independent Living / Q000145:classification; D008297:Male; D008609:Mental Status Schedule / Q000706:statistics & numerical data; D011594:Psychometrics / Q000706:statistics & numerical data; D015203:Reproducibility of Results; D020181:Sleep Apnea, Obstructive / Q000175:diagnosis* / Q000453:epidemiology*; D011795:Surveys and Questionnaires