Epworth Sleepiness Scale

About: Epworth Sleepiness Scale is a research topic. Over the lifetime, 4742 publications have been published within this topic receiving 155088 citations.

Residual sleepiness in sleep apnea patients treated by continuous positive airway pressure

Abstract: Hypoxic brain damage might explain persistent sleepiness in some continuous positive airway pressure-compliant obstructive sleep apnea called residual excessive sleepiness. Although continuous positive airway pressure may not be fully efficient in treating this symptom, wake-promoting drug prescription in residual excessive sleepiness is no longer allowed by the European Medicines Agency. The aim of this study is to describe residual excessive sleepiness phenotypes in a large prospective sample of patients with obstructive sleep apnea. Residual excessive sleepiness was defined by an Epworth Sleepiness Scale score ≥ 11. Eligible patients from the French National Sleep Registry attending follow-up continuous positive airway pressure visits numbered 1047. Patients using continuous positive airway pressure 15 h⁻¹ (n = 31) or with major depression were excluded (n = 150). Residual excessive sleepiness prevalence in continuous positive airway pressure-treated obstructive sleep apnea was 13% (18% for those with an initial Epworth Sleepiness Scale score > 11), and significantly decreased with continuous positive airway pressure use (9% in ≥ 6 h night⁻¹ continuous positive airway pressure users, P 30 h⁻¹ versus 18% when AHI 15-30, P < 0.005). There was no relationship between residual excessive sleepiness and body mass index, cardiovascular co-morbidities or diabetes. Continuous positive airway pressure improved symptoms in the whole population, but to a lower extent in patients with residual excessive sleepiness (fatigue scale: -5.2 versus -2.7 in residual excessive sleepiness- and residual excessive sleepiness+ patients, respectively, P < 0.001). Residual excessive sleepiness prevalence decreased with continuous positive airway pressure compliance. Hypoxic insult is unlikely to explain residual excessive sleepiness as obstructive sleep apnea severity does not seem to be critical. Residual symptoms are not limited to sleepiness, suggesting a true 'continuous positive airway pressure-resistant syndrome', which may justify treatment by wake-promoting drugs.

Cognitive Function and Sleep Related Breathing Disorders in a Healthy Elderly Population: the Synapse Study

Abstract: Study Objectives: Sleep related breathing disorders (SRBD) are risk factors for cognitive dysfunction in middle-aged subjects, but this association has not been observed in the elderly. We assess the impact of SRBD on cognitive performance in a large cohort of healthy elderly subjects. Design: Cross-sectional study examining the association between subjective memory test, neuropsychological battery testing and SRBD in the elderly. Setting: Community-based sample in home and research clinical settings. Participants: 827 subjects, 58.5% women, aged 68 y at study entry, participated in the study. All were free of previously diagnosed SRBD, coronary heart disease, and neurological disorders, including stroke and dementia. Clinical interview, neurological assessment, polygraphy, and extensive cognitive testing were conducted for all participants. Intervention: N/A Measurement and Results: SRBD (apnea-hypopnea index (AHI) > 15 events/h) was diagnosed in 445 (53%) subjects, 167 (37%) of them with AHI > 30. Minimal daytime sleepiness was found in the group; 9.2% of the population had an Epworth Sleepiness Scale score > 10. No significant association was found between AHI, nocturnal hypoxemia, and cognitive scores. Comparison of mild vs severe cases showed a trend toward lower cognitive scores with AHI > 30, affecting delayed recall and Stroop test. Conclusions: The impact of undiagnosed SRBD on cognitive function appeared quite limited in a generally older healthy population, and only slightly affected severe cases. The implication of undiagnosed SRBD on the cognitive impairment in elderly subjects remains hypothetical and needs to be prospectively studied. Clinical Trial Information: Autonomic Nervous System Activity, Aging and Sleep Apnea/Hypopnea (SYNAPSE); Registration #NCT 00766584 (This study is ongoing, but not recruiting participants.); URL - http://clinicaltrials.gov/ct2/show/NCT00766584?term=NCT+00766584&rank=1

Sleep disordered breathing and hypertension: does self-reported sleepiness modify the association?

Abstract: EPIDEMIOLOGICAL STUDIES INDICATE THAT PEOPLE WITH SIGNIFICANT LEVELS OF SLEEP DISORDERED BREATHING (SDB) ARE AT INCREASED RISK FOR developing hypertension and may have increased risk for other cardiovascular events.1–3 In contrast to patients referred for clinical evaluation of SDB, however, only a small proportion of participants in these epidemiologic studies who had an elevated apnea-hypopnea index (AHI) complained of significant sleepiness.4 Among Sleep Heart Health Study (SHHS) participants with moderate to severe SDB (AHI ≥ 15), only 46% reported an elevated score on the Epworth Sleepiness Scale (ESS) or frequent feelings of sleepiness or feeling unrested.5 Several epidemiologic studies have shown a relation between self-reported sleepiness and cardiovascular disease, though these studies have not used polysomnography to measure SDB. In the Cardiovascular Health Study, daytime sleepiness was the only sleep disturbance symptom associated with incident myocardial infarction, heart failure, overall cardiovascular morbidity and mortality, and all-cause mortality.6 The risk of stroke was independently associated with taking frequent daytime naps in the first National Health and Nutrition Survey.7 In the Caerphilly cohort, a population-based study of older men, daytime sleepiness was found to be associated with increased ischemic heart disease events.8 A prospective study of 157 healthy older adults found significant relationships between an elevated Epworth Sleepiness Scale score (ESS ≥ 10) and blood pressure, as well as incident diagnosed hypertension.9 Studies in clinical patient samples in which polysomnography was performed also point to a relation between self-reported sleepiness and cardiovascular disease. Higher ESS was related to lower stroke volume index and cardiac index in middle-aged obstructive sleep apnea patients after controlling for polysomnographic measures of sleep apnea severity.10 A review of randomized trials evaluating the effect of continuous positive airway pressure (CPAP) on blood pressure in persons with SDB found that studies with less sleepy participants show a smaller decrease in blood pressure on CPAP therapy.11–13 These findings suggest that the symptom of excessive self-reported sleepiness may identify a subset of individuals with SDB at greatest risk of cardiovascular sequelae, including hypertension. If so, this would have important implications for the clinical management of the large proportion of individuals with polysomnographic evidence of SDB who report no significant daytime sleepiness. We use cross-sectional data from the Sleep Heart Health Study (SHHS) to explore whether self-reported sleepiness modifies the relationship between SDB and prevalent hypertension.

Treatment of excessive daytime sleepiness in patients with Parkinson's disease with modafinil.

Abstract: Excessive daytime sleepiness (EDS) may limit the symptomatic treatment of Parkinson's disease and can alter the patient's lifestyle significantly Ten consecutive patients with Parkinson's disease on various dopaminergic drugs and EDS were recruited to a 4-week open-label trial of modafinil Patients were evaluated using the Epworth Sleepiness Scale and Unified Parkinson's Disease Rating Scale part III All but three patients, with previous history of intolerability of a dopamine agonist caused by EDS, remained on their baseline medications Modafinil was titrated as needed to a maximum of 400 mg/day The mean Epworth Sleepiness Scale score at baseline of patients completing the study (n = 9) was 1422 (+/- 303) After completing the study on an average dose of 172 mg/day, the Epworth Sleepiness Scale score was 60 (+/- 487) Unified Parkinson's Disease Rating Scale scores were not affected by this medication Side effects encountered were headache, generalized paresthesias, and hallucinations (n = 1 each, the patient developing hallucinations dropped out of the trial before completing 4 weeks of the study drug) The three patients who did not tolerate any increments of dopamine agonist before modafinil were able to tolerate further upward titration of the dopamine agonist Modafinil may be effective in reducing EDS in patients with Parkinson's disease treated with dopaminergic drugs It does not seem to worsen parkinsonian symptoms and may allow further increase in dopaminergic therapy in patients previously unable to tolerate this because of EDS

Periodic leg movements and sleepiness in patients evaluated for sleep-disordered breathing.

Abstract: Most polysomnograms are performed because sleep-disordered breathing (SDB) is suspected, but periodic leg movements during sleep (PLMS) are frequent incidental findings, and their significance is not well understood. In a clinical series of 1,124 adult patients with suspected or confirmed SDB, we tested for an association between the rate of periodic leg movements and one important outcome, the severity of daytime sleepiness. Objective sleepiness was assessed by the Multiple Sleep Latency Test in all subjects, problem sleepiness by self-rating in 873, and subjective sleep propensity by the Epworth Sleepiness Scale in 201. Increased leg movements were associated with decreased objective sleepiness (p = 0.03) but explained less than 1% of the variance. When nocturnal arousals were scored (n = 321 subjects), rates of leg movements associated with arousals predicted less objective sleepiness (p = 0.008); rates of leg movements without arousals predicted nothing. The rates of leg movements showed no association with subjective problem sleepiness or sleep propensity. We conclude that incidental periodic leg movements during sleep are not associated with excessive daytime sleepiness, and therefore appear unlikely to contribute to this problem. Increased sleepiness may reduce the likelihood of arousal with each leg movement.