The Epworth score in African American populations.

INTRODUCTION

African Americans have elevated scores on the Epworth Sleepiness Scale (ESS) compared to whites. The reason for this difference is not clear.

METHODS

Responses to the ESS were assessed in 687 patients (52.3% African American) referred to a hospital-based sleep clinic. Differences in total ESS score and the scores on individual Epworth questions were compared in African Americans and whites. Findings were validated in an independent sleep apnea research cohort of 712 subjects (57.3% African Americans).

RESULTS

African Americans in the clinic-based population had a higher mean ESS score than whites (11.4 +/- 0.3 vs. 9.8 +/- 0.3, p < 0.0001). This difference persisted after adjusting for sleepiness risk factors. In adjusted analyses including responses to the other ESS questions, African Americans scored significantly greater on 3 of the 8 ESS component questions: questions 2-"Watching TV," 6-"Sitting and talking to someone," and 7-"Sitting quietly after lunch without alcohol." In the validation cohort, African Americans also had a higher mean ESS score (9.1 +/- 0.3, vs. 8.2 +/- 0.3, p = 0.04). In addition they had significantly elevated scores on questions 6 and 7 (p = 0.0002, p = 0.012 respectively) even after adjusting for responses to the other Epworth questions.

CONCLUSIONS

African Americans have greater sleepiness than whites as assessed by the ESS; this is independent of sleepiness risk factors. The difference appears due primarily to differences in responses to questions 6 and 7 of the ESS questions suggesting a difference in the interpretation of these 2 questions.