title: Emerging applications: Screening OSA by Modified Pictorial Epworth Sleepiness Scale in Indian subjects.
abstract: BACKGROUND
  The Epworth Sleepiness Scale (ESS) is a widely used scoring to measure excessive daytime sleepiness. This scale was designed to be self-completed by the subjects, but unfortunately in a developing country with low literacy this had affected its outcome interpretation. The Traditional ESS has been translated into a Modified Pictorial version for easy comprehension by the patients.
  
  
  METHODS
  Subjects were evaluated for their competence to self-complete the ESS (Conventional and Pictorial) in Sleep Clinic at Respiratory Department of Santosh Medical College and Hospital, Ghaziabad. Modified Pictorial representations were designed along with 5 newer questions incorporated as sub-questions in 8 original domains prepared and labelled as Pictorial Scale. The Traditional (ESS) and Pictorial (Modified) representations were compared for agreement by receiver operating curve and the area under curve.
  
  
  RESULTS
  It was found that time taken to complete the Traditional ESS was significantly higher in comparison to Modified Pictorial Epworth Sleepiness Scale with reduced errors (Pictorial ESS 4.67min than Traditional ESS 14.43min).
  
  
  CONCLUSIONS
  Modified pictures scale showed statistically significant improvements over ESS and hence can be used as an alternative for subjects with low literacy level.
authors.affiliation: Santosh Medical College and Hospital, Ghaziabad, U.P., India.
authors.forename: Azmat
authors.initials: A
authors.lastname: Karim
authors.affiliation: Santosh Medical College and Hospital, Ghaziabad, U.P., India. Electronic address: vijaykumar1945@gmail.com.
authors.forename: V K
authors.initials: VK
authors.lastname: Arora
authors.affiliation: Santosh Medical College and Hospital, Ghaziabad, U.P., India.
authors.forename: M B
authors.initials: MB
authors.lastname: Gupta
mesh_terms: D000328:Adult; D005260:Female; D006801:Humans; D007194:India; D008297:Male; D008875:Middle Aged; D020181:Sleep Apnea, Obstructive / Q000175:diagnosis*; D011795:Surveys and Questionnaires; D055815:Young Adult
keywords: AHI (apnoea and hypopnoea index); Area under curve; ESS (Epworth Sleepiness Scale); OSA (obstructive sleep apnoea); Receiver operating curve; mPESS (Modified Pictorial Epworth Sleepiness Scale); pESS (Pictorial Epworth Sleepiness Scale)