Hurlston April, Foster Shannon N, Creamer Jennifer, Brock Matthew S, Matsangas Panagiotis, Moore Brian A, Mysliwiec Vincent
Department of Sleep Medicine, Carl R. Darnall Army Medical Center, Fort Hood, TX.
Department of Sleep Medicine, San Antonio Uniformed Services Health Education Consortium, San Antonio, TX.
Mil Med. 2019 Dec 1;184(11-12):e701-e707. doi: 10.1093/milmed/usz066.
Excessive daytime sleepiness affects an estimated 20% of the general population. While the prevalence of sleepiness in the military is largely unknown, it is well established that short sleep duration is endemic. The reasons for this include: the demanding nature of their duties, shift work and 24-hour duty periods, deployments and exigencies of military service as well as sleep disorders. The Epworth Sleepiness Scale (ESS) is the most widely used sleep questionnaire and provides a self-assessment of daytime sleepiness. To date the clinical utility of this questionnaire in differentiating sleep disorders in military patients with sleep disorders has never been evaluated.
The primary aim of this manuscript was to assess if Epworth Sleepiness Scale (ESS) scores differed between military personnel with insomnia, obstructive sleep apnea (OSA), comorbid insomnia/obstructive sleep apnea (COMISA), and a group with neither insomnia nor obstructive sleep apnea (NISA). This study assessed the clinical utility of the ESS in differentiating sleep disorders amongst a sample (N = 488) of U.S. military personnel with insomnia (n = 92), OSA (n = 142), COMISA (n = 221), and a NISA group (n = 33) which served as the control population.
In the present sample, 68.4% of service members reported excessive daytime sleepiness (EDS) with an ESS > 10. ESS scores differed between military personnel with COMISA (13.5 ± 4.83) and those with OSA only (11.5 ± 4.08; p < 0.001) and the NISA group (9.46 ± 4.84; p < 0.001). Also, ESS scores differed between patients with insomnia only (13.0 ± 4.84) and the NISA group (p < 0.01).
Overall, the ESS had poor ability to differentiate sleep disorders. In military personnel, the ESS appears elevated in the most common sleep disorders, likely due to their insufficient sleep, and does not help to differentiate OSA from insomnia. Further studies are required to validate this questionnaire and determine an appropriate threshold value for abnormal sleepiness in the military population.
据估计，20%的普通人群受日间过度嗜睡影响。虽然军队中嗜睡的患病率很大程度上未知，但睡眠时长较短的情况很普遍，原因包括：职责要求苛刻、轮班工作和24小时值班制、部署以及军事任务的紧急情况，还有睡眠障碍。爱泼沃斯思睡量表（ESS）是使用最广泛的睡眠问卷，可对日间嗜睡进行自我评估。迄今为止，该问卷在区分患有睡眠障碍的军事患者的睡眠障碍方面的临床效用从未得到评估。
本论文的主要目的是评估爱泼沃斯思睡量表（ESS）得分在患有失眠、阻塞性睡眠呼吸暂停（OSA）、共病失眠/阻塞性睡眠呼吸暂停（COMISA）的军事人员与既无失眠也无阻塞性睡眠呼吸暂停的一组人员（NISA）之间是否存在差异。本研究评估了ESS在区分美国军事人员样本（N = 488）中的睡眠障碍方面的临床效用，该样本包括患有失眠的人员（n = 92）、OSA患者（n = 142）、COMISA患者（n = 221）以及作为对照人群的NISA组（n = 33）。
在当前样本中，68.4%的军人报告有日间过度嗜睡（EDS），ESS得分>10。COMISA军人（13.5±4.83）与仅患有OSA的军人（11.5±4.08；p<0.001）以及NISA组（9.46±4.84；p<0.001）之间的ESS得分存在差异。此外，仅患有失眠的患者（13.0±4.84）与NISA组之间的ESS得分也存在差异（p<0.01）。
总体而言，ESS区分睡眠障碍的能力较差。在军事人员中，ESS在最常见的睡眠障碍中似乎升高，可能是由于他们睡眠不足，且无助于区分OSA和失眠。需要进一步研究来验证该问卷，并确定军事人群中异常嗜睡的合适阈值。
