The utility of patient-completed and partner-completed Epworth Sleepiness Scale scores in the evaluation of obstructive sleep apnea.
OBJECTIVE
Excessive daytime sleepiness in obstructive sleep apnea (OSA) is often rated differently by patients and their partners. This cross-sectional study compared the utility of patient-completed and partner-completed Epworth Sleepiness Scale (ESS) scores in the evaluation of suspected OSA.


METHODS
Eighty-five patient-partner pairs were enrolled, and 75 patients completed diagnostic sleep studies. The individual and combined utilities of patient-completed and partner-completed ESS scores in identifying OSA and predicting various sleep study-derived indicators of disease severity were determined.


RESULTS
Mean partner-completed ESS scores were higher than patient-completed ESS scores (12.3 ± 4.2 vs. 9.4 ± 4.8, p < 0.0001); Bland-Altman plot showed significant bias (partner-completed ESS scores 33.5 % higher, SD ±55.2 %). Partner-completed and combined (but not patient-completed) ESS scores correlated weakly with the apnea-hypopnea index (AHI; partner-completed ESS score rs= 0.25, p = 0.029; combined ESS score rs= 0.29, p = 0.013) and oxygen desaturation index (partner-completed ESS score rs= 0.26, p = 0.025; combined ESS score rs= 0.23, p = 0.047). None of the ESS scores correlated with body mass index, arousal index, or other parameters of nocturnal oxygen desaturation. In OSA (AHI > 15/h) detection, partner-completed ESS scores had greater sensitivity than patient-completed ESS scores (76.9 vs. 46.2 %) but poorer specificity (39.1 vs. 65.2 %); sensitivity was greatest (82.7 %) when either patient-completed or partner-completed ESS score was 10 or higher, and specificity was greatest (80.8 %) when both scores were 10 or higher.


CONCLUSIONS
Neither patient-completed nor partner-completed ESS scores by themselves have great utility in identifying OSA or predicting its severity. However, taking both scores into consideration together improves the sensitivity and specificity of the screening process.
JFK Neuroscience Institute/Seton Hall University, 65 James Street, Edison,, NJ, 08818, USA. sbhat2012@yahoo.com.
Sushanth
S
Bhat
JFK Neuroscience Institute/Seton Hall University, 65 James Street, Edison,, NJ, 08818, USA.
Hinesh
H
Upadhyay
Seton Hall University, 400 South Orange Avenue, South Orange, NJ, 07079, USA.
Vincent A
VA
DeBari
JFK Neuroscience Institute/Seton Hall University, 65 James Street, Edison,, NJ, 08818, USA.
Muhammad
M
Ahmad
JFK Neuroscience Institute/Seton Hall University, 65 James Street, Edison,, NJ, 08818, USA.
Peter G
PG
Polos
JFK Neuroscience Institute/Seton Hall University, 65 James Street, Edison,, NJ, 08818, USA.
Sudhansu
S
Chokroverty
D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D006970:Disorders of Excessive Somnolence / Q000175:diagnosis* / Q000453:epidemiology*; D005260:Female; D005858:Germany; D006801:Humans; D008297:Male; D008875:Middle Aged; D015588:Observer Variation; D011594:Psychometrics / Q000706:statistics & numerical data*; D012016:Reference Values; D015203:Reproducibility of Results; D012307:Risk Factors; D012737:Sex Factors; D020181:Sleep Apnea, Obstructive / Q000175:diagnosis* / Q000453:epidemiology*; D018454:Spouses; D011795:Surveys and Questionnaires; D055815:Young Adult
Epworth Sleepiness Scale; Obstructive sleep apnea; Partner-completed Epworth Sleepiness Scale; Patient-completed Epworth Sleepiness Scale; Spouse-completed Epworth Sleepiness Scale; Spouses and obstructive sleep apnea