Clinical Reproducibility of the Epworth Sleepiness Scale for Patients With Suspected Sleep Apnea
Open accessAbstract
Study objectives To determine the reproducibility of the Epworth Sleepiness Scale (ESS) score in a clinical population referred for diagnostic testing with suspected obstructive sleep apnea.Methods A retrospective audit of patients referred for a diagnostic sleep study with suspected sleep apnea was undertaken. Data collection was two 3-month time periods from January to March in 2012 and 2014. To evaluate reproducibility, the ESS score at primary care referral was compared to the ESS score at first specialist assessment/sleep assessment. The proportion of scores changing by more than 2, 3, 5, or 7 points was determined. Data were analyzed using Bland-Altman plots and paired t tests.Results A total of 154 patients (68% male) with a mean ± standard deviation age of 51 ± 13 years, body mass index 36 ± 10 kg/m 2, and apnea-hypopnea index 43 ± 40 events/h were included. The average ESS score change was -0.2 with a standard deviation of 3.9 reflecting a wide scatter. A difference between the sequential ESS scores of 5 or more was seen in 21% of subjects.Conclusions In a clinical obstructive sleep apnea referral population, the ESS score was variable when administered sequentially. Given this variability the ESS should not be used as the sole tool to prioritize patients for obstructive sleep apnea assessment.Commentary A commentary on this article appears in this issue on page 711.
The claims and statistics of this paper haven’t been checked yet.
Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.
Integrity signals
Registry
Cites
Statistics
Claims the paper makes
The claims and statistics of this paper haven’t been checked yet.
Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.
Self-check
Percentages, sums and reported differences re-computed from the paper’s own numbers.
The self-check needs the paper’s full text.
Cites
STATISTICAL METHODS FOR ASSESSING AGREEMENT BETWEEN TWO METHODS OF CLINICAL MEASUREMENT
Martin Bland, J., & Altman, D. (1986) · The Lancet · doi:10.1016/s0140-6736(86)90837-8 · Cited by 47,965 · see citing works
A New Method for Measuring Daytime Sleepiness: The Epworth Sleepiness Scale
Johns, M. W. (1991) · Sleep · doi:10.1093/sleep/14.6.540 · Cited by 17,364 · see citing works
Reliability and factor analysis of the Epworth Sleepiness Scale.
Johns, M. (1992) · Sleep · doi:10.1093/sleep/15.4.376 · Cited by 2,193 · see citing works
Sleep Apnea as an Independent Risk Factor for All-Cause Mortality: The Busselton Health Study
(2008) · Sleep · doi:10.5665/sleep/31.8.1079 · Cited by 889 · see citing works
Jenkinson, C., Davies, R. J., Mullins, R., & Stradling, J. R. (1999) · The Lancet · doi:10.1016/s0140-6736(98)10532-9 · Cited by 826 · see citing works
Sleepiness, Sleep-disordered Breathing, and Accident Risk Factors in Commercial Vehicle Drivers
Howard, M. E., Desai, A. V., Grunstein, R. R., Hukins, C., Armstrong, J. G., Joffe, D., Swann, P., Campbell, D. A., & Pierce, R. J. (2004) · American Journal of Respiratory and Critical Care Medicine · doi:10.1164/rccm.200312-1782oc · Cited by 467 · see citing works
Sleepiness in patients with moderate to severe sleep-disordered breathing
Kapur, V. K., Baldwin, C. M., Resnick, H. E., Gottlieb, D. J., & Nieto, F. J. (2005) · SLEEP · doi:10.1093/sleep/28.4.472 · Cited by 338 · see citing works
Evaluation of the measurement properties of the Epworth sleepiness scale: A systematic review
Kendzerska, T. B., Smith, P. M., Brignardello-Petersen, R., Leung, R. S., & Tomlinson, G. A. (2014) · Sleep Medicine Reviews · doi:10.1016/j.smrv.2013.08.002 · Cited by 334 · see citing works
Chung, K. (2000) · Journal of Psychosomatic Research · doi:10.1016/s0022-3999(00)00186-0 · Cited by 138 · see citing works
Clinical Reproducibility of the Epworth Sleepiness Scale
Nguyen, A. T. D., Baltzan, M., Small, D., Wolkove, N., Guillon, S., & Palayew, M. (2006) · Journal of Clinical Sleep Medicine · doi:10.5664/jcsm.26512 · Cited by 114 · see citing works
Obstructive Sleep Apnea in New Zealand Adults: Prevalence and Risk Factors Among Māori and Non-Māori
Mihaere, K., Harris, R. B., Gander, P. H., Reid, P., Purdie, G., Robson, B., & Neill, A. M. (2009) · SLEEP · doi:10.1093/sleep/32.7.949 · Cited by 88 · see citing works
Self-citationGreenstone, M., & Hack, M. (2014) · BMJ · doi:10.1136/bmj.g3745 · Cited by 81 · see citing works
Sleep, sleepiness and motor vehicle accidents: a national survey
Gander, P. H., Marshall, N. S., Harris, R. B., et al. (2005) · Australian and New Zealand Journal of Public Health · doi:10.1111/j.1467-842x.2005.tb00742.x · Cited by 73 · see citing works
Assessment of predictive ability of Epworth scoring in screening of patients with sleep apnoea
Sil, A., & Barr, G. D. (2011) · The Journal of Laryngology & Otology · doi:10.1017/s0022215111003082 · Cited by 68 · see citing works
Bausmer, U., Gouveris, H. T., Selivanova, O., Göpel, B., & Mann, W. J. (2010) · European Archives of Oto-Rhino-Laryngology · doi:10.1007/s00405-010-1250-y · Cited by 55 · see citing works
Societal costs of obstructive sleep apnoea syndrome.
Gander, P. H., Scott, G., Mihaere, K., et al. (2010) · PubMed · Cited by 30 · see citing works
Development and outcomes of a primary care-based sleep assessment service in Canterbury, New Zealand
Epton, M., Kelly, P. T., Shand, B. I., Powell, S. V., Jones, J. N., McGeoch, G., & Hlavac, M. C. (2017) · npj Primary Care Respiratory Medicine · doi:10.1038/s41533-017-0030-1 · Cited by 22 · see citing works
Brown, H. H. (2013) · Independent Nurse · doi:10.12968/indn.2013.15.4.98043 · Cited by 6 · see citing works
Flagged first, then by citations
Research works printed but not linked: 1
- [6]6. Scott H, Scott W, Mihaere K, et al. Economic evaluation of the treatment of obstructive sleep apnoea syndrome in Aoteraroa/New Zealand. IRBRP. 2007;3(2):237-261.
Cited by
Sorted by citations
Patil, S. P., Ayappa, I. A., Caples, S. M., Kimoff, R. J., Patel, S. R., & Harrod, C. G. (2019) · Journal of Clinical Sleep Medicine · doi:10.5664/jcsm.7638 · Cited by 721 · see citing works
Clinical utility of the Epworth sleepiness scale
Walker, N. A., Sunderram, J., Zhang, P., Lu, S.-E., & Scharf, M. T. (2020) · Sleep and Breathing · doi:10.1007/s11325-020-02015-2 · Cited by 102 · see citing works
- Authors
- Campbell, A. J., Neill, A. M., & Scott, D. A. R.
- Affiliations
- University of Otago (NZ)
- Corresponding author
- Campbell, Angela J.
- Venue
- Journal of Clinical Sleep Medicine
- Published
- 2018-05-15
- Volume
- 14
- Issue
- 5
- Pages
- 791-795
- ISSN
- 1550-9389 (ISSN-L)
- 1550-9397
- PMC
- PMC5940430
- OpenAlex
- W2803719223
- Cited by
- 61
- References
- 18
- Citations by year
- 2026: 2 · 2025: 6 · 2024: 7 · 2023: 10 · 2022: 9 · 2021: 12 · 2020: 7 · 2019: 4 · 2018: 4
- FWCI
- 4.63
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Journal of Clinical Sleep Medicine (publishedVersion)
- Europe PMC (PubMed Central) (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Funders
- Maurice and Phyllis Paykel Trust
- Topics
- Health Sciences › Medicine › Physiology › Obstructive Sleep Apnea Research
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Sleep and related disorders
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Sleep and Work-Related Fatigue
- Keywords
- Epworth Sleepiness Scale, obstructive sleep apnea, daytime sleepiness, reproducibility, test-retest reliability, primary care referral
- MeSH terms
- Female, Humans, Male, Middle Aged, Surveys and Questionnaires, Retrospective Studies, Reproducibility of Results, Sleep Apnea, Obstructive
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
Are you an author, or do you see a problem with this page? Request a review
