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Body mass index, gender, and ethnic variations alter the clinical implications of the epworth sleepiness scale in patients with suspected obstructive sleep apnea.

Hesselbacher S, Subramanian S, Allen J, Surani S, Surani S - Open Respir Med J (2012)

Bottom Line: In obese subjects, the sensitivity and specificity were 55% and 53%, compared with 47% and 63% in non-obese subjects.The ability of the ESS to predict OSA is modest, despite a significant correlation with the severity of OSA.The test characteristics improve significantly when applied to select populations, especially those at risk for OSA.

View Article: PubMed Central - PubMed

Affiliation: Department of Medicine, Section of Pulmonary, Critical Care, and Sleep Medicine, Baylor College of Medicine, Houston, TX, USA.

ABSTRACT

Introduction: The Epworth Sleepiness Scale (ESS) is often used in the evaluation of obstructive sleep apnea (OSA), though questions remain about the influence gender, ethnicity, and body morphometry have in the responses to this questionnaire. The aim of this study was to examine differences in ESS scores between various demographic groups of patients referred for polysomnography, and the relationship of these score to sleep-disordered breathing

Methods: Nineteen hundred consecutive patients referred for polysomnographic diagnosis of OSA completed questionnaires, including demographic data and ESS. OSA was determined based on a respiratory disturbance index (RDI) ≥15 by polysomnography.

Results: In this high risk population for OSA, the ESS was 10.7 ± 5.6. The highest ESS scores were seen in obese males; non-obese females and non-obese Caucasian males scored the lowest. ESS was weakly correlated with RDI (r = 0.17, P < 0.0001). The sensitivity of ESS for the diagnosis of OSA was 54% and the specificity was 57%. The positive (PPV) and negative (NPV) predictive values were 64% and 47%, respectively. In obese subjects, the sensitivity and specificity were 55% and 53%, compared with 47% and 63% in non-obese subjects. In obese, Hispanic males, the sensitivity, specificity, and PPV were 59%, 54%, and 84%, respectively. In non-obese, Caucasian females, the sensitivity, specificity, and NPV were 43%, 59%, and 72%.

Conclusions: The ESS appears to be affected by many factors, including gender, ethnicity, and body morphometry. The ability of the ESS to predict OSA is modest, despite a significant correlation with the severity of OSA. The test characteristics improve significantly when applied to select populations, especially those at risk for OSA.

No MeSH data available.


Related in: MedlinePlus

Test characteristics of the Epworth Sleepiness Scale (ESS) in the diagnosis of obstructive sleep apnea (OSA), related togender, ethnicity, and body mass index. (A) The sensitivity and specificity of the ESS for the diagnosis of OSA are plotted for the overallstudy population (N = 1900), males (N = 1092), females (N = 805), Caucasians (N = 998), Hispanics (N = 856), other races (N = 46), obese(N = 1370), and non-obese (N = 529). (B) The sensitivity and specificity of the ESS for the diagnosis of OSA are plotted for obese Caucasianmales (OCM, N = 397), non-obese Caucasian males (NCM, N = 198), obese Hispanic males (OHM, N = 364), non-obese Hispanic males(NHM, N = 104), obese Caucasian females (OCF, N = 269), non-obese Caucasian females (NCF, N = 130), obese Hispanic females (OHF, N= 303), and non-obese Hispanic females (NHF, N = 82).
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Figure 2: Test characteristics of the Epworth Sleepiness Scale (ESS) in the diagnosis of obstructive sleep apnea (OSA), related togender, ethnicity, and body mass index. (A) The sensitivity and specificity of the ESS for the diagnosis of OSA are plotted for the overallstudy population (N = 1900), males (N = 1092), females (N = 805), Caucasians (N = 998), Hispanics (N = 856), other races (N = 46), obese(N = 1370), and non-obese (N = 529). (B) The sensitivity and specificity of the ESS for the diagnosis of OSA are plotted for obese Caucasianmales (OCM, N = 397), non-obese Caucasian males (NCM, N = 198), obese Hispanic males (OHM, N = 364), non-obese Hispanic males(NHM, N = 104), obese Caucasian females (OCF, N = 269), non-obese Caucasian females (NCF, N = 130), obese Hispanic females (OHF, N= 303), and non-obese Hispanic females (NHF, N = 82).

Mentions: In all participants, the sensitivity of ESS for predicting OSA was 54% and specificity was 57%. The positive predictive value (PPV) was 64% and negative predictive value (NPV) was 47. In males, the sensitivity was 56%, specificity was 58%, PPV was 74%, and NPV was 38%; in females, sensitivity was 49%, specificity was 56%, PPV was 48%, and NPV was 57%. Among the self-reported ethnicity groups, the ESS displayed the best sensitivity in Hispanics (56%) and best specificity in Caucasians (57%). The PPV was substantially better in Hispanics (69%) than either Caucasian (59%) or other races (50%), while the NPV was <50% for all 3 ethnicity groups. In obese subjects, sensitivity was 55%, specificity was 53%, PPV was 68%, and NPV was 40%, compared with sensitivity of 47%, specificity of 63%, PPV of 49%, and NPV of 61% for non-obese subjects. Sensitivities and specificities for each group are shown in Fig. (2A).


Body mass index, gender, and ethnic variations alter the clinical implications of the epworth sleepiness scale in patients with suspected obstructive sleep apnea.

Hesselbacher S, Subramanian S, Allen J, Surani S, Surani S - Open Respir Med J (2012)

Test characteristics of the Epworth Sleepiness Scale (ESS) in the diagnosis of obstructive sleep apnea (OSA), related togender, ethnicity, and body mass index. (A) The sensitivity and specificity of the ESS for the diagnosis of OSA are plotted for the overallstudy population (N = 1900), males (N = 1092), females (N = 805), Caucasians (N = 998), Hispanics (N = 856), other races (N = 46), obese(N = 1370), and non-obese (N = 529). (B) The sensitivity and specificity of the ESS for the diagnosis of OSA are plotted for obese Caucasianmales (OCM, N = 397), non-obese Caucasian males (NCM, N = 198), obese Hispanic males (OHM, N = 364), non-obese Hispanic males(NHM, N = 104), obese Caucasian females (OCF, N = 269), non-obese Caucasian females (NCF, N = 130), obese Hispanic females (OHF, N= 303), and non-obese Hispanic females (NHF, N = 82).
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3367266&req=5

Figure 2: Test characteristics of the Epworth Sleepiness Scale (ESS) in the diagnosis of obstructive sleep apnea (OSA), related togender, ethnicity, and body mass index. (A) The sensitivity and specificity of the ESS for the diagnosis of OSA are plotted for the overallstudy population (N = 1900), males (N = 1092), females (N = 805), Caucasians (N = 998), Hispanics (N = 856), other races (N = 46), obese(N = 1370), and non-obese (N = 529). (B) The sensitivity and specificity of the ESS for the diagnosis of OSA are plotted for obese Caucasianmales (OCM, N = 397), non-obese Caucasian males (NCM, N = 198), obese Hispanic males (OHM, N = 364), non-obese Hispanic males(NHM, N = 104), obese Caucasian females (OCF, N = 269), non-obese Caucasian females (NCF, N = 130), obese Hispanic females (OHF, N= 303), and non-obese Hispanic females (NHF, N = 82).
Mentions: In all participants, the sensitivity of ESS for predicting OSA was 54% and specificity was 57%. The positive predictive value (PPV) was 64% and negative predictive value (NPV) was 47. In males, the sensitivity was 56%, specificity was 58%, PPV was 74%, and NPV was 38%; in females, sensitivity was 49%, specificity was 56%, PPV was 48%, and NPV was 57%. Among the self-reported ethnicity groups, the ESS displayed the best sensitivity in Hispanics (56%) and best specificity in Caucasians (57%). The PPV was substantially better in Hispanics (69%) than either Caucasian (59%) or other races (50%), while the NPV was <50% for all 3 ethnicity groups. In obese subjects, sensitivity was 55%, specificity was 53%, PPV was 68%, and NPV was 40%, compared with sensitivity of 47%, specificity of 63%, PPV of 49%, and NPV of 61% for non-obese subjects. Sensitivities and specificities for each group are shown in Fig. (2A).

Bottom Line: In obese subjects, the sensitivity and specificity were 55% and 53%, compared with 47% and 63% in non-obese subjects.The ability of the ESS to predict OSA is modest, despite a significant correlation with the severity of OSA.The test characteristics improve significantly when applied to select populations, especially those at risk for OSA.

View Article: PubMed Central - PubMed

Affiliation: Department of Medicine, Section of Pulmonary, Critical Care, and Sleep Medicine, Baylor College of Medicine, Houston, TX, USA.

ABSTRACT

Introduction: The Epworth Sleepiness Scale (ESS) is often used in the evaluation of obstructive sleep apnea (OSA), though questions remain about the influence gender, ethnicity, and body morphometry have in the responses to this questionnaire. The aim of this study was to examine differences in ESS scores between various demographic groups of patients referred for polysomnography, and the relationship of these score to sleep-disordered breathing

Methods: Nineteen hundred consecutive patients referred for polysomnographic diagnosis of OSA completed questionnaires, including demographic data and ESS. OSA was determined based on a respiratory disturbance index (RDI) ≥15 by polysomnography.

Results: In this high risk population for OSA, the ESS was 10.7 ± 5.6. The highest ESS scores were seen in obese males; non-obese females and non-obese Caucasian males scored the lowest. ESS was weakly correlated with RDI (r = 0.17, P < 0.0001). The sensitivity of ESS for the diagnosis of OSA was 54% and the specificity was 57%. The positive (PPV) and negative (NPV) predictive values were 64% and 47%, respectively. In obese subjects, the sensitivity and specificity were 55% and 53%, compared with 47% and 63% in non-obese subjects. In obese, Hispanic males, the sensitivity, specificity, and PPV were 59%, 54%, and 84%, respectively. In non-obese, Caucasian females, the sensitivity, specificity, and NPV were 43%, 59%, and 72%.

Conclusions: The ESS appears to be affected by many factors, including gender, ethnicity, and body morphometry. The ability of the ESS to predict OSA is modest, despite a significant correlation with the severity of OSA. The test characteristics improve significantly when applied to select populations, especially those at risk for OSA.

No MeSH data available.


Related in: MedlinePlus