Hesselbacher Sean, Subramanian Shyam, Allen Jerry, Surani Sara, Surani Salim
Department of Medicine, Section of Pulmonary, Critical Care, and Sleep Medicine, Baylor College of Medicine, Houston, TX, USA.
Open Respir Med J. 2012;6:20-7. doi: 10.2174/1874306401206010020. Epub 2012 May 9.
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
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.
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%.
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.
Epworth嗜睡量表（ESS）常用于阻塞性睡眠呼吸暂停（OSA）的评估，不过关于性别、种族和身体形态测量对该问卷回答的影响仍存在疑问。本研究的目的是检查接受多导睡眠图检查的不同人口统计学组患者的ESS评分差异，以及这些评分与睡眠呼吸紊乱的关系。
1900名连续接受多导睡眠图检查以诊断OSA的患者完成了问卷，包括人口统计学数据和ESS。通过多导睡眠图根据呼吸紊乱指数（RDI）≥15确定OSA。
在这个OSA高风险人群中，ESS为10.7±5.6。肥胖男性的ESS评分最高；非肥胖女性和非肥胖白人男性评分最低。ESS与RDI弱相关（r = 0.17，P < 0.0001）。ESS诊断OSA的敏感性为54%，特异性为57%。阳性预测值（PPV）和阴性预测值（NPV）分别为64%和47%。在肥胖受试者中，敏感性和特异性分别为55%和53%，而非肥胖受试者中分别为47%和63%。在肥胖的西班牙裔男性中，敏感性、特异性和PPV分别为59%、54%和84%。在非肥胖的白人女性中，敏感性、特异性和NPV分别为43%、59%和72%。
ESS似乎受多种因素影响，包括性别、种族和身体形态测量。尽管与OSA严重程度有显著相关性，但ESS预测OSA的能力一般。当应用于特定人群，尤其是有OSA风险的人群时，该测试特征有显著改善。
