Assessment of daytime sleepiness and reliability test of Epworth sleepiness scale in young individuals

Debalina Sahoo; Harshida Gosai; Ujjwal Sahoo; Pratik Akhani; Arvind Kanchan; Jaman Mohan Harsoda

doi:10.4103/1110-1415.137814

Users Online: 184

ORIGINAL ARTICLE

Year : 2014 | Volume : 42 | Issue : 2 | Page : 79-82

Assessment of daytime sleepiness and reliability test of Epworth sleepiness scale in young individuals

Debalina Sahoo¹, Harshida Gosai¹, Ujjwal Sahoo², Pratik Akhani¹, Arvind Kanchan¹, Jaman Mohan Harsoda¹
¹ Department of Physiology, Sumandeep Vidyapeeth University, Vadodara, Gujarat, India
² Department of Pharmacy, Sumandeep Vidyapeeth University, Vadodara, Gujarat, India

Date of Submission	29-Mar-2014
Date of Acceptance	25-May-2014
Date of Web Publication	31-Jul-2014

Correspondence Address:
Debalina Sahoo
Department of Physiology, Sumandeep Vidyapeeth University, Vadodara 391760, Gujarat
India

Check

DOI: 10.4103/1110-1415.137814

Abstract

Background
The Epworth Sleepiness Scale (ESS) is a brief, self-administered questionnaire to measure the daytime sleepiness (DS) in young individuals. It measures an individual's usual level of DS or average sleep propensity in daily life. The scale also estimates whether someone is experiencing excessive sleepiness, which possibly requires medical attention.
Aim
The aim of the study was to assess the level of DS as well as to assess the reliability of ESS in young individuals.
Settings and design
The study was designed as a cross-sectional questionnaire-based study.
Participants and methods
A total of 120 apparently healthy participants belonging to both sexes were evaluated at baseline and after 6 months. The anthropometric measurements included BMI and neck width, ESS scores, DS by the mean levels of chance of dozing, O ₂ saturation, and pulse rate.
Statistical analysis
The reliability of ESS scores and its correlations with various parameters were assessed using paired T-test.
Results
The mean levels of chance of dozing and ESS scores were significantly lower during daytime in female individuals. ESS scores were significantly correlated with BMI, neck width, and pulse rate; however, there was no correlation between ESS scores and O ₂ saturation. The ESS scores as well as the above-mentioned results did not change significantly even after 6 months, indicating good reliability.
Conclusion
The ESS is appropriate for measuring DS in young individuals, and it also enables characterization of individuals with sleep-related disorders.

Keywords: chance of dozing, daytime sleepiness, Epworth Sleepiness Scale, O ₂ saturation, reliability

How to cite this article:
Sahoo D, Gosai H, Sahoo U, Akhani P, Kanchan A, Harsoda JM. Assessment of daytime sleepiness and reliability test of Epworth sleepiness scale in young individuals. Tanta Med J 2014;42:79-82

How to cite this URL:
Sahoo D, Gosai H, Sahoo U, Akhani P, Kanchan A, Harsoda JM. Assessment of daytime sleepiness and reliability test of Epworth sleepiness scale in young individuals. Tanta Med J [serial online] 2014 [cited 2018 Apr 27];42:79-82. Available from: http://www.tdj.eg.net/text.asp?2014/42/2/79/137814

Introduction

Daytime sleepiness (DS) is a complicated clinical problem, often indicating a serious underlying physiological abnormality [1,2]. DS is associated with higher mortality [3,4], an increased risk for motor vehicle crashes [5] and work-related accidents, and a higher prevalence of comorbid conditions such as diabetes, myocardial infarction, and stroke [6-8]. DS is defined as a tendency to sleep, despite the intention to stay awake [9]. DS is one of the main symptoms of sleep disorders. The obstructive sleep apnea syndrome is characterized by repetitive reduction or cessation of airflow due to partial or complete airway obstruction [10,11]. This disease is usually associated with hypoxemia, bradycardia, arousals, and fragmented sleep [12]. The major behavioral symptoms include excessive daytime sleepiness (EDS), neurocognitive deficits such as impairments in concentration and memory, and psychological problems such as depression or personality changes [13]. It is very important to identify DS, given that it is a symptom related with an increased risk for accidents at home, at work, and on the streets. In addition, there is also a great risk for DS-related accidents in the country. Sleep propensity has been measured only within the context of the individual's situation and activity, both physical and mental, at the time. An individual's usual sleep propensity in the same situation can be called his situational sleep propensity - for example, when sitting and watching TV. This is situation-specific for each individual. The multiple sleep latency test is widely used to measure DS, in the sense of the propensity to fall asleep when encouraged to perform in a nonstimulating environment. The Stanford Sleepiness Scale measures feelings of sleepiness or tiredness at a particular time. However, the Stanford Sleepiness Scale has been found to be quite unsatisfactory when assessing sleep propensity as measured by the multiple sleep latency test [14].

Participants and methods

The present study was carried out at the Department of Physiology, SBKS Medical Institute and Research Centre, Vadodara. In the initial stage of this study, a total of 120 healthy individuals were taken for eight questionnaires. They answered the Epworth Sleepiness Scale (ESS) at the same time, without any discussion. There were 60 male and 60 female individuals.

In the second stage of the study, the same individuals were retested after 6 months. The ESS has been proposed significantly as a simple method to measure DS level. The ESS is a self-administered questionnaire that asks the individuals to rate their usual chances of dozing off in eight specific situations that are commonly met in daily life (0 = would never doze; 3 = high chance of dozing). The total score is based on a scale of 0-24 [14-17]. In addition to ESS, we also measured their neck width. Oxyhemoglobin saturation and pulse rate were measured by the Neclife fingertip pulse oxymeter (NL-50D, Chandigarh, India).

Because of its noninvasive nature and simplicity, pulse oximetry is widely used in many medicine areas to determine patient's blood oxygen saturation (SaO ₂ ) and pulse rate [18]. The readings were obtained by putting the sensor on the index finger of the individual's favored hand and were noted down until pulse reached a regular rhythm; then the value that was the most stable for a minimum of 30 s was noted. The students were seated comfortably and they breathed naturally at rest [19].

All statistical parameters were carried out with the help of Microsoft Excel. Data were analyzed using frequencies and percentages for categorical variables and central tendency and dispersion measures (SD) for quantitative variables. The differences in the values of various parameters at baseline and after 6 months were assessed by paired T-test. The correlations between various parameters were determined by Pearson's moment correlation. P-value less than 0.05 was considered statistically significant.

Results

The means for height, weight, BMI, and neck width were significantly greater in male individuals than in female individuals [Table 1]. The mean O ₂ saturation in male individuals was 97.63 ± 1, and in female individuals O ₂ saturation was 95.91 ± 1.96 [Figure 1]. In male individuals, many had bradycardia and their mean pulse rate was 69.79 ± 2.97, and in female individuals few had bradycardia and the others had tachycardia with mean pulse rate of 94.07 ± 4.96 [Figure 1]. The mean with SD for chance of dozing was highly significantly different between male and female individuals (12.16 ± 2.38 vs. 9.0± 1.5, P < 0.01) [Figure 2]. The mean level of chance of dozing was significantly lower during daytime in female individuals than in male individuals. However, the sleep duration was greater in female individuals than in male individuals. The mean with SD for sleep duration between male and female was 7.2 ± 1.32 vs. 9.23 ± 1.98 [Figure 1]. Among 120 participants, 80% male individuals were suffering from DS.

Figure 1: Comparison of pulse, O2 saturation, and sleep duration in male and female individuals.

Click here to view

Figure 2: Chance of dozing off in male and female individuals.

Click here to view

Table 1 Description of different characteristics of sample (n = 120)

Click here to view

Among 120 individuals, 8.33% male and 65% female had less than 10 chance of dozing, which means that they were most likely getting enough sleep; 35% female had 10-16 chance of dozing, which means that they might be suffering from EDS; and 11.6% had more than 16 chance of dozing, which means that they were dangerously sleepy [Table 2].

Table 2 Chance of dozing off in Epworth Sleepiness Scale (%)

Click here to view

Discussion

ESS was highly correlated when tested and retested 6 months later. The DS was expected to remain constant in students. The high ESS scores of EDS were the clinical features of sleep apnea. In this study, the ESS was correlated with pulse rate. The mean pulse was more in female individuals than in male individuals. Hence, in female individuals with tachycardia, the chance of dozing was less, and in male individuals with bradycardia the chance of dozing was more. In our study, bradycardia has been seen due to increased vagal tone because many of them went to gym regularly. Some of them played cricket, football, or volleyball 2-3 h regularly. We have not found any correlation between ESS and O ₂ saturation. Some healthy adults fell asleep in less than 6 min. In the second stage of the study, slight changes came from the previous study. Apart from sleeping about 1-2 h less per day by waking up earlier in the morning in summer than in winter, most aspects of the sleep habits of such students do not change significantly over a year [14]. The availability of a simple, self-reported measure of sleepiness across different times of the day should help define these characteristics in a variety of populations [20]. A few students have taken medication at that time. The findings by the other authors revealed that EDS was more prevalent in women than in men and that destitute nocturnal sleep, an irregular sleep-wake schedule, and depression were the risk factors of EDS for both sexes, and being married works as a protective factor against EDS for men alone [21]. It could also lead to inaccurate inferences with consequential outcomes. High scores on sleepiness in inappropriate situations could be an indication of further complication during pregnancy. Sleepiness in pregnant women can be related to preterm labor [22] and gestational diabetes mellitus [23]. Conversely, the relationships between these clinical characteristics and the factors of ESS are still to be explored [24].

Reliability

Comparisons between the ESS of the initial stage study and of the second stage of study determined the reliability of the questionnaire. In the initial stage, their mean ESS score was 12.16 ± 2.38 versus 9.0 ± 1.5 in male and female individuals, respectively. In the second stage of study, the mean with SD for chance of dozing off was highly significantly different between male and female individuals (12.06 ± 2.29 vs. 8.98 ± 1.38, P < 0.01).

Conclusion

The ESS is appropriate to measure DS. This study is required in the area of test-retest reliability. In addition, it provides information on sleepiness at multiple times across the day. In summary, the ESS requires high chance of dozing quality to assess its measurement properties. High scores on sleepiness in inappropriate situations indicate complications in future.

Acknowledgements

The authors are thankful to the authority of Sumandeep Vidyapeeth University and SBKSMIRC, Department of Physiology, for providing necessary facilities.

References

1.	Kendzerska TB, Smith PM, Brignardello-Petersen R, Leung RS, Tomlinson GA. Evaluation of the measurement properties of the Epworth Sleepiness Scale: a systematic review. Sleep Med Rev 2013; pii:1-11.
2.	Ruggles K, Hausman N. Evaluation of excessive daytime sleepiness. WMJ 2003; 102:21-24. [PUBMED]
3.	Hays JC, Blazer DG, Foley DJ. Risk of napping: excessive daytime sleepiness and mortality in an older community population. J Am Geriatr Soc 1996; 44:693-698.
4.	Newman AB, Spiekerman CF, Enright P, Lefkowitz D, Manolio T, Reynolds CF, et al. Daytime sleepiness predicts mortality and cardiovascular disease in older adults. The Cardiovascular Health Study Research Group. J Am Geriatr Soc 2000; 48:115-123.
5.	MacLean AW, Davies DR, Thiele K. The hazards and prevention of driving while sleepy. Sleep Med Rev 2003; 7:507-521.
6.	Chasens ER, Sereika SM, Burke LE. Daytime sleepiness and functional outcomes in older adults with diabetes. Diabetes Educ 2009; 35:455-464.
7.	Koutsourelakis I, Perraki E, Economou NT, Dimitrokalli P, Vagiakis E, Roussos C, et al. Predictors of residual sleepiness in adequately treated obstructive sleep apnoea patients. Eur Respir J 2009; 34:687-693.
8.	Stroe AF, Roth T, Jefferson C, Hudgel DW, Roehrs T, Moss K, et al. Comparative levels of excessive daytime sleepiness in common medical disorders. Sleep Med 2010; 11:890-896.
9.	Jimenez-Correa U, Haro R, Poblano A, Arana-Lechuga Y, Teran-Perez G, Rosa Gonzalez-Robles O, et al. Mexican version of the Epworth Sleepiness Scale. Open Sleep J 2009; 2:6-10.
10.	Alvarez D, Hornero R, Garcia M, Campo FD, Zamarron C. Improving diagnostic ability of blood oxygen saturation from overnight pulse oximetry in obstructive sleep apnea detection by means of central tendency measure. Artif Intell Med 2007; 41:13-24.
11.	Guilleminault C, Tilkian A, Dement WC. The sleep apnea syndromes. Annu Rev Med 1976; 27:465-484. [PUBMED]
12.	Guilleminault C, Van Den Hoed J, Mitler MM. In: Gilleminault C, Dement WC, editors. Clinical overview of the sleep apnea syndromes. Sleep apnea syndromes. New York: Alan R Liss; 1978.
13.	Day R, Gerhardstein R, Lumley A, Roth T, Rosenthal L. The behavioral morbidity of obstructive sleep apnea. Prog Cardiovasc Dis 1999; 41:341-354.
14.	Johns MW. Reliability and factor analysis of the Epworth Sleepiness Scale. Sleep 1992; 15:376-381. [PUBMED]
15.	Johns MW. A new method for measuring daytime sleepiness: the Epworth Sleepiness Scale. Sleep 1991; 14:540-545. [PUBMED]
16.	Johns MW, Gay TJ, Goodyear MD, Masterton JP. Sleep habits of healthy young adults: use of a sleep questionnaire. Br J Prev Soc Med 1971; 25:236-241. [PUBMED]
17.	Zwyghuizen-Doorenbos A, Roehrs T, Schaefer M, Roth T. Test-retest reliability of the MSLT. Sleep 1988; 11:562-565.
18.	Epstein LJ, Dorlac GR. Cost-effectiveness analysis of nocturnal oximetry as a method of screening for sleep apnea-hypopnea syndrome. Chest 1998; 113:97-103.
19.	Giner J, Casan P. Lung cancer pulse oximetry and capnography in lung function laboratories. Arch Bronconeumol 2004; 40:311-314.
20.	Dolan DC, Taylor DJ, Okonkwo R, Becker PM, Jamieson AO, Schmidt-Nowara W, et al. The Time of Day Sleepiness Scale to assess differential levels of sleepiness across the day. J Psychosom Res 2009; 67:127-133.
21.	Doi Y, Minowa M. Gender differences in excessive daytime sleepiness among Japanese workers. Soc Sci Med 2003; 56:883-894.
22.	Okun ML, Schetter CD, Glynn LM. Poor sleep quality is associated with preterm birth. Sleep 2011; 34:1493-1498.
23.	Reutrakul S, Zaidi N, Wroblewski K, Kay HH, Ismail M, Ehrmann DA, et al. Sleep disturbances and their relationship to glucose tolerance in pregnancy. Diabetes Care 2011; 34:2454-2457.
24.	Baumgartel KL, Terhorst L, Conley YP, Roberts JM. Psychometric evaluation of the Epworth Sleepiness Scale in an obstetric population. Sleep Med 2013; 14:116-121.