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How is the Epworth Sleepiness Scale related with subjective sleep quality and polysomnographic features in patients with sleep-disordered breathing?

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Abstract

Purpose

To determine the relationship between the Epworth Sleepiness Scale (ESS) and the Subjective Sleep Quality (SSQ) or polysomnographic (PSG) features in patients with sleep-disordered breathing (SDB).

Methods

This is a retrospective study that included 646 untreated patients with a PSG diagnosis of primary snoring (PS) or obstructive sleep apnea syndrome. Patients with SDB were grouped into four categories according to ESS scores: no diurnal sleepiness (DS) = 0-6; mild DS = 7–12; moderate DS = 13–18, and severe DS = ≥19. Analyses of variance were performed to compare SSQ or PSG features among the four ESS severity categories.

Results

We found a significant increase in subjective sleep time in the group of patients with severe DS. With regard to PSG data, we also identified increases in total sleep time (TST) and rapid eye movement (REM) in the group of patients with severe DS.

Conclusion

Unexpectedly, DS severity was related with increases in TST and REM sleep. As has been described in SDB patients, a change in muscular tonus throughout sleep onset (and depth) is a causal factor of SDB features and DS impairment. Therefore, we propose that increases in TST and REM are worsening factors of SDB and consequently, also in DS.

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Abbreviations

DS:

Diurnal sleepiness

SDB:

Sleep-disordered breathing

BMI:

Body mass index

SA:

Sleep architecture

ESS:

Epworth Sleepiness Scale

SSQ:

Subjective sleep quality

PSG:

Polysomnography

PS:

Primary snoring

OSAS:

Obstructive sleep apnea syndrome

SST:

Subjective sleep time

TST:

Total sleep time

REM:

Rapid eye movement

SD:

Standard deviation

SSL:

Subjective sleep latency

LS:

Light sleep

MSLT:

Multiple sleep latency test.

References

  1. American Academy of Sleep Medicine (2005) International Classification of Sleep Disorders: diagnostic and coding manual, 2nd edn. Westchester, Illinois

    Google Scholar 

  2. Hoffstein V (2007) Review of oral appliances for treatment of sleep-disordered breathing. Sleep Breath 11:1–22

    Article  PubMed  Google Scholar 

  3. Atwood CW (2007) Obstructive sleep apnea clinical presentation. In: Pagel JF, Pandi-Perumal SR (eds) Primary care sleep medicine, 1st edn. Humana Press, Inc., Totowa, USA, pp 89–96

    Chapter  Google Scholar 

  4. Jones M, Morrell M (2008) Sleep and breathing disorders. In: Pandi-Perumal SR, Verster JC, Monti JM, Lader M, Langer SZ (eds) Sleep disorders diagnosis and therapeutics. Informa, UK, pp 526–535

    Google Scholar 

  5. Johns MW (1991) A new method for measuring daytime sleepiness: the Epworth Sleepiness Scale. Sleep 14:540–545

    PubMed  CAS  Google Scholar 

  6. Stepanski EJ (2002) Controversies in the measurement of daytime sleepiness. Sleep Med Rev 6:79–81

    Article  PubMed  Google Scholar 

  7. Leger D (1994) The cost of sleep related accidents: a report for the National Commission on Sleep Disorders Research. Sleep 17:84–93

    PubMed  CAS  Google Scholar 

  8. Rogers AE, Wang WT, Scott LD, Aiken LH, Dinges DF (2004) The working hours of hospital staff nurses and patient safety. Health Aff 23:202–212

    Article  Google Scholar 

  9. Matsumoto E, Tanaka E, Tabe H, Wakisaka N, Nakata Y, Ueda H, Hori T, Abe T, Tanne K (2007) Sleep architecture and the apnoea-hypopnoea index in children with obstructive-sleep apnoea syndrome. J Oral Rehabil 34:112–120

    Article  PubMed  CAS  Google Scholar 

  10. Lim LL, Tham KW, Fook-Chong SM (2008) Obstructive sleep apnoea in Singapore: polysomnography data from a tertiary sleep disorders unit. Ann Acad Med Singapore 37:629–636

    PubMed  Google Scholar 

  11. McArdle N, Douglas NJ (2001) Effect of continuous positive airway pressure on sleep architecture in the sleep apnea-hypopnea syndrome. Am J Respir Crit Care Med 164:1459–1463

    PubMed  CAS  Google Scholar 

  12. Jiménez-Correa U, Haro R, Poblano A, Arana-Lechuga Y, Terán-Pérez G, González-Robles R, Velázquez-Moctezuma J (2009) Mexican version of the Epworth Sleepiness Scale. Open Sleep J 2:6–10

    Google Scholar 

  13. Thorpy MJ (1990) ICSD (International Classification of Sleep Disorders). Diagnostic and coding manual. Diagnostic classification steering committee. American Sleep Disorders Association Rochester, Minnesota, USA

    Google Scholar 

  14. Rechtschaffen A, Kales A (1968) A manual of standardized terminology: techniques and scoring system of sleep stages of human subjects. UCLA Brain Information Service/Brain Research Institute, Los Angeles, USA

    Google Scholar 

  15. Kushida CA, Littner MR, Morgenthaler T, Alessi CA, Bailey D, Coleman J Jr, Friedman L, Hirshkowitz M, Kapen S, Kramer M, Lee-Chiong T, Loube DL, Owens J, Pancer JP, Wise M (2005) Practice parameters for the indications for polysomnography and related procedures: an update for 2005. Sleep 28:499–521

    PubMed  Google Scholar 

  16. Davies DP, Rodgers H, Walshaw D, James OFW, Gibson GJ (2003) Snoring, daytime sleepiness and stroke: a case-control study of first-ever stroke. J Sleep Res 12:313–318

    Article  PubMed  CAS  Google Scholar 

  17. Hossain JL, Ahmad P, Reinish LW, Kayumov L, Hossain NK, Shapiro CM (2005) Subjective fatigue and subjective sleepiness: two independent consequences of sleep disorders? J Sleep Res 14:245–253

    Article  PubMed  Google Scholar 

  18. Rosenthal L, Dolan C (2008) The Epworth Sleepiness Scale in the identification of obstructive sleep apnea. J Nerv Ment Dis 196:429–431

    Article  PubMed  Google Scholar 

  19. Chervin RD, Aldrich MS, Pickett R, Guilleminault C (1997) Comparison of the results of the Epworth sleepiness scale and the multiple sleep latency test. J Psychosom Res 42:145–155

    Article  PubMed  CAS  Google Scholar 

  20. Olson LG, Cole MF, Ambrogetti A (1998) Correlations among Epworth sleepiness scale scores, multiple sleep latency tests and psychological symptoms. J Sleep Res 7:248–253

    Article  PubMed  CAS  Google Scholar 

  21. O'Donnell D, Silva EJ, Münch M, Ronda JM, Wang W, Duffy JF (2009) Comparison of subjective and objective assessments of sleep in healthy older subjects without sleep complaints. J Sleep Res 18:254–263

    Article  PubMed  Google Scholar 

  22. Argyropoulos SV, Hicks JA, Nash JR, Bell CJ, Rich AS, Nutt DJ, Wilson SJ (2003) Correlation of subjective and objective sleep measurements at different stages of the treatment of depression. Psychiatry Res 120:179–190

    Article  PubMed  Google Scholar 

  23. Rosenthal L, Bishop C, Guido P, Syron ML, Helmus T, Rice FM, Roth T (1997) The sleep/wake habits of patients diagnosed as having obstructive sleep apnea. Chest 111:1494–1499

    Article  PubMed  CAS  Google Scholar 

  24. Manni R, Politini L, Ratti MT, Tartara A (1999) Sleepiness in obstructive sleep apnea syndrome and simple snoring evaluated by the Epworth sleepiness scale. J Sleep Res 8:319–820

    Article  PubMed  CAS  Google Scholar 

  25. Teodorescu M, Consens FB, Bria WF, Coffey MJ, McMorris MS, Weatherwax KJ, Durance A, Palmisano J, Senger CM, Chervin RD (2006) Correlates between daytime sleepiness in patients with asthma. Sleep Med 7:607–613

    Article  PubMed  Google Scholar 

  26. Violani C, Lucidi F, Robusto E, Devoto A, Zucconi M, Ferini Strambi L (2003) The assessment of daytime sleep propensity: comparison between the Epworth sleepiness scale and a newly development resistance to sleepiness scale. Clin Neurophysiol 114:1027–1033

    Article  PubMed  CAS  Google Scholar 

  27. Maldonado CC, Bentley AJ, Mitchell DA (2004) Pictorial sleepiness scale based on cartoon faces. Sleep 27:541–548

    PubMed  Google Scholar 

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Acknowledgments

The authors wish to thank Maggie Brunner, MA, for her expert review of the language of the manuscript, and Ariadna López, Mariana Arceo, and Marco Elías Gudiño-Zayas for their support in figure-making, and Alberto Labra and Adrián Poblano for his important comments.

Author information

Authors and Affiliations

  1. Clínica de Trastornos del Sueño, Facultad de Medicina, Universidad Nacional Autónoma de México (UNAM), Distrito Federal, México

    Ulises Jiménez-Correa & Reyes Haro

  2. Departamento de Matemáticas, División de Ciencias Básicas e Ingeniería, UAM-Iztapalapa, Distrito Federal, México

    Rosa Obdulia González-Robles

  3. Clínica de Sueño, División de Ciencias Biológicas y de la Salud, UAM-Iztapalapa, Distrito Federal, México

    Ulises Jiménez-Correa & Javier Velázquez-Moctezuma

  4. Clínica de Trastornos del Sueño, Unidad de Medicina Experimental, Hospital General de México, Dr. Balmis 148, Col. Doctores, Deleg. Cuauhtémoc, 06726, México, DF, México

    Ulises Jiménez-Correa

Authors
  1. Ulises Jiménez-Correa
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  2. Reyes Haro
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  3. Rosa Obdulia González-Robles
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  4. Javier Velázquez-Moctezuma
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Corresponding author

Correspondence to Ulises Jiménez-Correa.

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Disclosure Statement

This was not an industry-supported research. The authors have no financial conflict of interest. This research was part of the doctoral degree of Ulises Jiménez-Correa at the Universidad Autónoma Metropolitana Unidad Iztapalapa (UAM-Iztapalapa).

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Jiménez-Correa, U., Haro, R., González-Robles, R.O. et al. How is the Epworth Sleepiness Scale related with subjective sleep quality and polysomnographic features in patients with sleep-disordered breathing?. Sleep Breath 15, 513–518 (2011). https://doi.org/10.1007/s11325-010-0372-1

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  • DOI: https://doi.org/10.1007/s11325-010-0372-1

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