Showing papers on "Epworth Sleepiness Scale published in 1997"

Daytime Sleepiness and Sleep Habits of Australian Workers

Abstract: Excessive daytime sleepiness in the general community is a newly recognized problem about which there is little standardized information. Our aim was to measure the levels of daytime sleepiness and the prevalence of excessive daytime sleepiness in a sample of Australian workers and to relate that to their self-reported sleep habits at night and to their age, sex, and obesity. Sixty-five percent of all 507 employees working during the day for a branch of an Australian corporation answered a sleep questionnaire and the Epworth sleepiness scale (ESS) anonymously. Normal sleepers, without any evidence of a sleep disorder, had ESS scores between 0 and 10, with a mean of 4.6 +/- 2.8 (standard deviation). They were clearly separated from the "sleepy" patients suffering from narcolepsy or idiopathic hypersomnia whose ESS scores were in the range 12-24, as described previously. ESS scores > 10 were taken to represent excessive daytime sleepiness, the prevalence of which was 10.9%. This was not related significantly to age (22-59 years), sex, obesity, or the use of hypnotic drugs but was related significantly but weakly to sleep-disordered breathing (frequency of snoring and apneas), the presence of insomnia, and reduced time spent in bed (insufficient sleep).

Randomized, double-blind, placebo-controlled crossover trial of modafinil in the treatment of excessive daytime sleepiness in narcolepsy

Abstract: Seventy-five patients meeting international diagnostic criteria for narcolepsy enrolled in a 6-week, three-period, randomized, crossover, placebo-controlled trial. Patients received placebo, modafinil 200 mg, or modafinil 400 mg in divided doses (morning and noon). Evaluations occurred at baseline and at the end of each 2-week period. Compared with placebo, modafinil 200 and 400 mg significantly increased the mean sleep latency on the Maintenance of Wakefulness Test by 40% and 54%, with no significant difference between the two doses. Modafinil, 200 and 400 mg, also reduced the combined number of daytime sleep episodes and periods of severe sleepiness noted in sleep logs. The likelihood of falling asleep as measured by the Epworth Sleepiness Scale was equally reduced by both modafinil dose levels. There were no effects on nocturnal sleep initiation, maintenance, or architecture, nor were there any effects on sleep apnea or periodic leg movements. Neither dose interfered with the patients' ability to nap voluntarily during the day nor with their quantity or quality of nocturnal sleep. Modafinil produced no changes in blood pressure or heart rate in either normotensive or hypertensive patients. The only significant adverse effects were seen at the 400-mg dose, which was associated with more nausea and more nervousness than either placebo or the 200-mg dose. As little as a 200-mg daily dose of modafinil is therefore an effective and well-tolerated treatment of excessive daytime somnolence in narcoleptic persons.

Neuropsychological Function in Mild Sleep-Disordered Breathing

Abstract: Although a broad range of neuropsychological deficits has been reported in patients with severe sleep disordered breathing (SDB), little is known about the impact of mild SDB on neuropsychological performance. In this study, we compared neuropsychological test performance in two groups of carefully screened volunteers who differed clearly according to the respiratory disturbance index (RDI). Controls (n = 20) were identified on the basis of an RDI < 5; cases (n = 32) had an RDI in the range of 10-30. Cases and controls were well matched with regard to IQ, age, and sex. Cases had significantly more self-reported snorting and apneas and a higher body mass index than controls but did not differ according to sleepiness as measured by either the multiple sleep latency test or the Epworth sleepiness scale. An extensive battery of neuropsychological and performance tests was administered after an overnight sleep study. Cases performed significantly more poorly on a visual vigilance task (perceptual sensitivity, d': 2.24 +/- 0.64 vs. 2.70 +/- 0.53, p = 0.01, for cases and controls, respectively) and a test of working memory, the Wechsler adult intelligence scale-revised digits backwards test (6.12 +/- 2.20 vs. 7.55 +/- 2.22, p = 0.02), than controls. The groups did not differ in their performance on other tests of memory, information processing, and executive functioning. In summary, subjects with mild SDB may manifest a vigilance deficit in the absence of substantial sleepiness. Subjects with a mildly elevated RDI (10-30) without sleepiness do not appear to suffer appreciable deficits in more complex neuropsychological processes (e.g. executive functions).

Quality of life consequences of sleep-disordered breathing

Abstract: Sleep-disordered breathing occurs in approximately 2% to 4% of the adult population and includes conditions in which patients stop breathing completely (apnea) or have marked reductions in airflow (hypopnea) during sleep. Typical symptoms of sleep apnea include snoring, restless sleep, excessive daytime somnolence, nocturnal enuresis, irritability, depression, memory deficits, inability to concentrate, and decreased alertness. The clinically relevant outcomes of these symptoms include impairment in work efficiency, increased automobile accident rates, and decrements in quality of life. Treatment of sleep apnea, primarily with continuous positive airway pressure, reduces sleepiness and improves mood disturbances, neurocognition, and performance. Traditional measurements of sleep apnea severity do not correlate well with current tests and scales that are used to quantify alterations in alertness, performance, quality of life, or sleepiness. A disease-specific quality of life scale has been developed following patient and physician interviews and literature reviews. The Calgary Sleep Apnea Quality of Life Index is expected to capture aspects of quality of life important to sleep apnea patients, such as cognitive function, performance, and mood, that could be improved with appropriate treatment of sleep-disordered breathing.

Predictors of sleepiness in epilepsy patients.

Abstract: Sleepiness, a common complaint of epilepsy patients, is frequently attributed to antiepileptic medications. To determine predictors of subjective sleepiness in epilepsy patients, we gave self-administered, validated surveys of sleepiness [Epworth sleepiness scale (our major outcome measure)] and sleep apnea [sleep apnea scale of the sleep disorders questionnaire (SA/SDQ)] to 158 epilepsy patients and 68 neurology patients without epilepsy (controls). An elevated Epworth score (>10) was more likely in epilepsy patients compared to controls after controlling for age and gender (p 0.10) of elevated Epworth score. Before attributing sleepiness in epilepsy patients to antiepileptic medications or uncontrolled seizures, clinicians should consider the possibility of a coexisting sleep disorder.

Sleepiness and driving: the experience of heavy goods vehicle drivers in the UK

Abstract: An interview survey of 996 heavy goods vehicle (HGV) drivers was undertaken. It was designed to investigate the relationship between HGV drivers' accidents, daytime sleepiness (measured using the Epworth Sleepiness Scale) and other relevant physical characteristics. The drivers were sampled randomly at motorway service areas. The average age was 41.4 y (SD 10.5), they drove an average of 69700 miles annually (SD 36120), and their average score on the Epworth daytime sleepiness scale was 5.65 (SD 3.31). They reported an average accident liability of 0.26 accidents in a 3-y recall period. Drivers who reported snoring regularly whilst sleeping at night or who were obese or who had a noticeably large collar size had higher accident liabilities than those not exhibiting these characteristics. Accident liability increased with increasing scores on the Epworth daytime sleepiness scale. These findings suggest that further investigation of the mechanisms behind the higher accident rates of some categories of HGV drivers would be justified in the interests of road safety.

Effect of Breathe Right nasal strip on snoring

Abstract: Snoring is a significant problem both for the patient and for the bedpartner It is well known that nasal stuffiness can contribute to snoring, and sleep quality may deteriorate because of the snoring Nasal dilation can reduce snoring and improve sleep Thirty-five habitual snorers (18 female, 17 male) and their bedpartners participated in an open label study The patients were diagnosed as heavy snorers after they underwent overnight polysomnography showing that their apnoea indexes were below 5, thus sleep apnoea patients were not included in the study The participants and their partners filled out evaluations concerning snoring intensity, mouth dryness and Epworth Sleepiness Scale prior to and after using Breath Right nasal strips for 14 consecutive nights The Breathe Right external nasal dilator is a simple, nonpharmaceutical method to decrease nasal airway resistance and thus potentially reduce or eliminate snoring After using the strips there were statistically significant decreases in snoring (p < 0001) as graded by the bed partner, and in mouth dryness (p = 0025) and in the Epworth Sleepiness Scale scores (p = 0001), as graded by the patient The results of this study indicate that Breathe Right nasal strips may be used to reduce snoring, mouth dryness and sleepiness in patients presenting with symptoms of snoring

Epworth Sleepiness Scale outcome in 616 brazilian medical students

Abstract: The Epworth Sleepiness Scale (ESS) measures daytime sleepiness in adults. This paper reports the following data in 616 medical students: 1-ESS scores, 2-its correlation with the declared night sleep time, 3-comparison with ESS values obtained from Australia, 4-comparison of ESS values in a sub-population of 111 students tested early and late 1995. There were 387 males, 185 females and 4 not specified. Age = 20.16 +/- 2.23 (SD), ESS score = 10.00 +/- 3.69 (SD), declared sleep time = 7.04 +/- 1.03 (SD). ESS scores did not statistically correlate with sleep time. Average ESS score was statistically higher than in the Australian sample. Retesting of the medical students showed an increase in ESS values from March to November 1995. Sleep time difference was non-significant. Higher ESS scores in this sample seem to be related to shorter sleep time, but fatigue effects can not be ruled out.

Comparison of the results of the epworth sleepiness scale and the multiple sleep

Abstract: The Epworth Sleepiness Scale (ESS), which asks patients to estimate the likelihood that they would doze off or fall asleep in sedentary situations, has been proposed to be a quick, inexpensive way to assess sleepiness. We analyzed relations among ESS scores, mean sleep latencies on the Multiple Sleep Latency Test (MSLT), and subjective assessments of severity of sleepiness in 60 patients (34 women) with suspected excessive daytime sleepiness. Mean scores were 14.2 --_ 5.9 on the ESS and 8.3_+ 5.2 minutes on the MSLT. ESS scores correlated negatively, but not strongly, with MSLT scores (rho = -0.37, p = 0.0042) and ESS scores of 14 and above predicted a low mean sleep latency on the MSLT. The ESS score correlated with the degree to which patients complained of sleepiness and may be useful as an otherwise elusive link between patients' complaints and their objective findings on MSLT. Copy- right © 1997 Elsevier Science Inc.

Fatigue in multiple sclerosis is not due to sleep apnoea.

Abstract: Fatigue is a frequent and disabling phenomenon among patients with multiple sclerosis (MS). Daytime sleepiness is a typical symptom of the sleep apnoea/hypopnoea syndrome due to nocturnal hypoxia and recurrent arousals causing sleep fragmentation. Since MS plaques are often found in the midbrain, brain stem and upper cervical cord on magnetic resonance imaging (MRI) we hypothesized that fatigue in MS patients might be caused by a central respiratory dysfunction. We investigated 10 patients with definite MS by oligography, two questionnaires assessing fatigue (Fatigue Severity Scale, FSS) and daytime sleepiness (Epworth Sleepiness Scale, ESS), MRI and pulmonary function tests. A total of six patients had either an elevated FSS and/or an elevated ESS. None of the six patients with an elevated FSS and/or ESS has an apnoea index > 5/hour. CT90 was normal in nine patients. We conclude that fatigue and daytime sleepiness in MS cannot be explained by nocturnal apnoeas or oxygen desaturations. The Fatigue Severity Scale should be integrated to the extended Barthel index, which is a new instrument for disability assessment in MS patients.

The Upper Airway Resistance Syndrome (UARS)

Abstract: Pickwickian Syndrome (Burwell et al., 1956; Gastaut, Tassinari and Duron, 1965), Obstructive Sleep Apnea Syndrome (Guilleminault, Eldrige, and Dement, 1976), and the Sleep Hypopnea Syndrome (Gould et al., 1988) are well known and described breathing disorders during sleep. Often these sleep disorders are associated with clinical features of hypersomnia. These syndromes share diagnostic markers allowing identification by procedures used in the assessment of breathing disorders during sleep. This assessment is based on polysomnographic findings using direct or indirect monitoring of respiratory activity and states of alertness.

Sleep disordered breathing in primary care medicine.

Abstract: Primary care medicine plays a key role in the delivery of health care. Sleep disorders medicine is a new specialty and standard medical school curricula do not contain any or only very little training in sleep medicine. Unrecognized and therefore untreated sleep disorders account for a large loss of human life and socio-economic damage. Recognition of sleep disorders, in particular sleep-disordered breathing at the primary care level is thus a major element in health care delivery. The objective of this study was to assess the occurrence of the risk of sleep-disordered breathing (SDB) in a large primary care population. 852 primary care patients received a validated questionnaire which contained items based on signs and symptoms of SDB, periodic limb movement disorder (PLMD), and insomnia. A polygraphically validated algorithm was used to identify patients with a high suspicion of having sleep disordered breathing. Based on this algorithm 20% of the study participants had a high risk for SDB, 18.5% of PLMD and 25% of insomnia.Most commonly daytime sleepiness and fatigue was associated in patients with a positive likelihood of SDB, PLMD, and insomnia. Fifty percent of all primary care patients reported to snore while 31% of snorers reported to snore every night. SDB was twice as common in men than in women and associated with a significantly higher body mass index. A popular validated scale to assess the degree of daytime sleepiness, the Epworth sleepiness scale, was not always useful to document the degree of daytime sleepiness.We conclude that SDB, PLMD, and insomnia are very frequent sleep disorders in primary care patients yielding the need to include assessment of these sleep disorders in the medical history of primary care physicians.

[The effect of long-term therapy of obstructive sleep apnea syndrome with CPAP for symptoms of daytime sleepiness]

Abstract: The study was undertaken to investigate whether a long-term CPAP therapy improves the symptoms of daytime sleepiness in patients with the obstructive sleep apnoea syndrome. Seventy six patients (72 men and 4 women) with AHI = 53(+/- SE = 3), BMI 35 (+/- SE = 0.8), mean age 46.3 (+/- SE = 11.4) have undergone CPAP therapy for at least one year (mean: 2.48 +/- SE = 0.33). The aggravation of alterations of the daytime sleepiness was estimated using the questionnaire from Sleep Laboratory at the Marburg University and the Epworth Sleepiness Scale (ESS). After the CPAP therapy, we have observed the decrease of the symptoms of the excessive daytime sleepiness (p < 0.001). Negative correlation between CPAP compliance and ESS outcome was observed (r = 0.4; p < 0.001). There was not correlation between the term of using CPAP and the degree of the complaints decrease.

[Changes in the time spent awake in obstructive sleep apnea and snoring--results of a pilot study]

Abstract: Continuous positive airway pressure (CPAP) therapy reduces sleeping time per day and daytime sleepiness in obstructive sleep apnoea (OSA) and heavy snoring. Due to sleep fragmentation the OSA and heavy snoring are associated with a daytime sleepiness and increased necessity of sleep. In this pilot study the effect of CPAP-therapy on daytime sleepiness and sleep time during 24 hours were assessed in patients with OSA or heavy snoring (daytime sleepiness, none or slight apnoea with AHI 10/h, ESS-Score > 8) and heavy snoring (AHI 8) who were treated with nCPAP. Before and 2 months after initiation the CPAP-therapy all patients completed diary cards recording the sleeping time/day for 1 month; additionally they scored sleepiness using the Epworth sleepiness scale (ESS-score ranged from 0 to 24, the higher the score the worse the sleepiness) before and 2 months after initiation the CPAP-therapy. In the whole study population nCPAP-therapy reduced the sleeping time significantly by a mean period of 46 minutes per 24 hours (from 8.3 +/- 1.3 to 7.5 +/- 1.2 hours, p < 0.001) and improved the ESS score from 13.7 +/- 4.6 to 6.1 +/- 3.6 (p < 0.0001). In respect of the change of sleeping time/day and of the sleepiness score there was no significant difference between the OSA and heavy snoring group. With CPAP the AHI in OSA patients was reduced from 34.5 +/- 23.6/h to 3.2 +/- 3.2/h. Due to the improvement of sleep-related breathing disorders CPAP therapy reduced the mean sleeping time/day by approximately 10% and the daytime sleepiness score both in patients with OSA and heavy snoring compared to the pretreatment period.

Descriptive Epidemiology of Excessive Daytime Sleepiness

Abstract: Daytime sleepiness is the common experience of the tendency to sleep during the daytime. When this phenomenon is not invalidating, is justified by lifestyle and is sporadic, it may be considered a normal expression of our needs. If, however, the tendency to fall asleep during the day becomes excessive, undesired, inappropriate, disturbing and persistent, it becomes pathologic and may be referred to as excessive daytime sleepiness (EDS) [1–3]. EDS is being studied with increasing interest, since it is indicative of several diseases and has major familial and social effects.