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.

Prevalence and Characteristics of Central Compared to Obstructive Sleep Apnea: Analyses from the Sleep Heart Health Study Cohort.

Abstract: Study objectives Determine the prevalence of central sleep apnea (CSA) in a large community-based cohort using current definitions and contrast the clinical characteristics of subjects with CSA to those with obstructive sleep apnea (OSA) and no sleep apnea. Methods A cross sectional analysis of baseline data from 5,804 participants of the Sleep Heart Health study was performed. Subjects meeting contemporary diagnostic criteria for CSA and Cheyne Stokes respiration (CSR) were compared to those without sleep apnea and those with OSA. Demographic data, medical comorbidities, medication use, and sleep related symptoms were compared between the groups. Results The prevalences of CSA and Cheyne Stokes respiration (CSR) in this sample were 0.9 (95% confidence intervals [CI]: 0.7-1.2)% and 0.4 (95% CI: 0.3-0.6)%, respectively. Individuals with CSA were older, had lower body mass indexes (BMI), lower Epworth Sleepiness Scale scores, and were more likely to be male than individuals with obstructive sleep apnea OSA. Among those with self-reported heart failure (HF), OSA was much more common at 55.1% (95% CI: 45.6-64.6) than CSA 4.1% (95% CI: 0.3-7.9). Conclusions This is the largest community-based study of the prevalence and characteristics of CSA to date and demonstrates a prevalence of CSA that is intermediate to those previously noted. Contrary to prior data from clinic based samples, individuals with heart failure were much more likely to have OSA than CSA.

Components of sleep quality and sleep fragmentation in rheumatoid arthritis and osteoarthritis.

Abstract: Objectives Poor sleep is increasingly recognized as contributing to a decreased quality of life, increased morbidity/mortality and heightened pain perception. The purpose of the present study was to assess components of sleep quality and self-identified contributors to sleep fragmentation in rheumatoid arthritis (RA) and osteoarthritis (OA) patient populations. Methods Consecutive RA and OA clinic patients were invited to participate in a self-administered questionnaire study which included the validated multi-domain Pittsburgh Sleep Quality Index (PSQI), visual analogue scales for pain, fatigue, global functioning, modified Health Assessment Questionnaire (mHAQ), stress scores, the Centre for Epidemiologic Studies–Depression (CES–D) score, the 36-item short form (SF-36) quality of life measure, the Rheumatoid Arthritis Disease Activity Index (RADAI), the Epworth Sleepiness Scale (ESS), Berlin score for obstructive sleep apnoea (OSA) risk and the International Restless Legs Syndrome Study Group (IRLSSG) diagnostic criteria. Results The study population included 145 RA and 78 OA patients. PSQI global scores were >5 in 62% of RA and 67% of OA patients. Multivariate analysis identified global functioning and the CES–D to be independent predictors for higher global PSQI scores in RA patients, whereas in OA patients predictors were the mHAQ and SF-36 mental component summary. Abnormalities in subjective sleep assessment, sleep latency, sleep duration, sleep efficiency, daytime dysfunction and increased sleep-aid medication use were observed in both populations. The most common abnormality reported by both RA and OA patients was increased sleep fragmentation. The most frequent self-identified cause for sleep disturbance was ‘need to use the washroom’ by 51% of RA and 49% of OA patients, and, second most common, ‘pain’ was identified as a cause for awakening by 33% of RA and 45% of OA patients. Conclusions A high prevalence of abnormal sleep quality in both RA and OA patient populations was observed. The most common abnormality was sleep fragmentation, with an increased sleep disturbance score. ‘Need to use the washroom’ and ‘pain’ were the most common self-identified reasons for awakening from sleep. A review of sleep hygiene, optimization of urological status, and rheumatological disease symptomatic control may prove beneficial in terms of sleep health. Copyright © 2011 John Wiley & Sons, Ltd.

Measures of sleep in rheumatologic diseases: Epworth Sleepiness Scale (ESS), Functional Outcome of Sleep Questionnaire (FOSQ), Insomnia Severity Index (ISI), and Pittsburgh Sleep Quality Index (PSQI)

Abstract: Fatigue is a major symptom associated with rheumatologic diseases such as systemic lupus erythematosis and rheumatoid arthritis and may be a direct manifestation of disease activity, but such fatigue may also be related to sleep disturbances (1, 2). Indeed, sleep disturbances are common in a variety of rheumatologic diseases (3–5). Such disturbed sleep may be due to pain, depression, lack of exercise, or corticosteroid usage (6–8). Sleep quality may also be impaired by comorbid sleep disorders, such as obstructive sleep apnea or restless leg syndrome, the prevalences of which are reported to be high in rheumatologic populations (9–12). Sleep disturbances may, in turn, impact functional disability, lower pain thresholds, or impair immune function and thus contribute to rheumatologic-associated morbidities (13–15). Sleep disturbances in fibromyalgia and rheumatoid arthritis have received relatively more attention than in other rheumatologic diseases, but even in fibromyalgia and rheumatoid arthritis, there are many unanswered questions related to the causes and outcomes of sleep disturbances (3). The study of sleep disturbances can be onerous because gold standard direct tests, such as polysomnography and multiple sleep latency testing, are both expensive and require considerable commitment of time from research subjects. Laboratory-based sleep studies may present an additional challenge in rheumatologic populations in whom mobility restriction and pain may significantly increase subject burden. Thus, there is strong impetus for utilizing patient-reported measures in assessing sleep and sleep-related outcomes in rheumatologic diseases. Four patient-reported measures are discussed in this section, each of which captures a different sleep-related domain and has been extensively utilized in a variety of populations: [1] the Epworth Sleepiness Scale, which assesses daytime sleepiness, [2] the Functional Outcome of Sleep Questionnaire, which assesses sleep-related quality of life, [3] the Insomnia Severity Index, which measures the subjective symptoms and consequences of difficulties initiating and maintaining sleep, and [4] the Pittsburgh Sleep Quality Index, which assesses perceived sleep quality more generally. Please note that the Medical Outcomes Study Sleep Scale, a global measure of sleep quality and sleep-related outcomes, is discussed separately in this issue of Arthritis Care & Research, within the section on fibromyalgia. None of the scales reviewed here was developed specifically for rheumatologic or musculoskeletal conditions and, indeed, each has relied heavily for validation on populations with primary sleep disorders. To varying extents, as discussed below, each of these measures has been used in rheumatologic populations. Nonetheless, clinicians and researchers must carefully consider their objectives and the appropriateness of their populations in selecting a sleep questionnaire to meet their needs.

Sleepiness, quality of life, and sleep maintenance in REM versus non-REM sleep-disordered breathing.

Abstract: Rationale:TheimpactofREM-predominantsleep-disorderedbreathing(SDB)onsleepiness,qualityoflife(QOL),andsleepmaintenance is uncertain. Objective: To evaluate the association of SDB during REM sleep with daytime sleepiness, health-related QOL, and difficulty maintaining sleep, in comparison to their association with SDB during non-REM sleep in a community-based cohort. Methods: Cross-sectional analysis of 5,649 Sleep Heart Health Study participants (mean age 62.5 [SD 5 10.9], 52.6% women, 22.6% ethnic minorities). SDB during REM and non-REM sleep was quantifiedusingpolysomnographicallyderivedapnea-hypopneaindexin REM (AHIREM) and non-REM (AHINREM) sleep. Sleepiness, sleep maintenance, and QOL were respectively quantified using the Epworth Sleepiness Scale (ESS), the Sleep Heart Health Study Sleep Habit Questionnaire, and the physical and mental compositesscales of the Medical Outcomes Study Short Form (SF)-36. Measurements and Main Results: AHIREM was not associated with the ESS scores or the physical and mental components scales scores of the SF-36 after adjusting for demographics, body mass index, and AHINREM. AHIREM was not associated with frequent difficulty maintainingsleeporearlyawakeningfromsleep.AHINREMwasassociated with the ESS score (b 5 0.25; 95% confidence interval [CI], 0.16 to 0.34) and the physical (b 52 0.12; 95% CI, 20.42 to 20.01) and