Revisiting the Epworth sleepiness scale : Is excessive daytime sleepiness still a valid screening tool for obstructive sleep apnea in a population at risk?

IF 1.9 4区 医学 Q2 MEDICINE, GENERAL & INTERNAL
Wiener Klinische Wochenschrift Pub Date : 2024-07-01 Epub Date: 2023-06-05 DOI:10.1007/s00508-023-02213-4
Hrvoje Puretić, Marijana Bosnar Puretić, Gordana Pavliša, Marko Jakopović
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引用次数: 0

Abstract

Objective: Obstructive sleep apnea (OSA) is a common medical problem with numerous comorbidities and high costs. Since the introduction of the Epworth sleepiness scale (ESS), excessive daytime sleepiness (EDS) has been considered the most common and prominent symptom of OSA. Aim of this study was to re-evaluate the ESS for detection of OSA in a population at risk compared to the gold standard overnight polysomnography (PSG).

Methods: A total of 266 patients (mean age 57.9 ± 11.6 years; 189 men and 77 women), referred to our sleep laboratory for probable OSA, were given ESS followed by an overnight PSG. The ESS values were compared to PSG apnea hypopnea index (AHI) with sensitivity (SE), specificity (SP), positive predictive value (PPV), negative predictive value (NPV) and diagnostic accuracy (DA) calculated for ESS. The positive cut-off value for ESS was ≥ 10 and for AHI ≥ 5.

Results: Only 92 (34.6%) subjects had a positive ESS. An OSA was diagnosed by PSG in 213 (80.1%) subjects: 46 having mild, 37 moderate and 130 severe apnea. Most subjects with positive ESS (88.0%) were found to have OSA but most subjects with a negative ESS (75.9%) were also positive for OSA (42% with AHI ≥ 30). The area under the receiver operating characteristic (ROC) curve for ESS was 0.60 (95% confidence interval, CI 0.54-0.66; p = 0.020) with SE 38.0%, SP 79.3%, PPV 88.0%, NPV 24.1% and DA 46.2%.

Conclusion: It was found that excessive daytime sleepiness, measured by ESS, is not a valuable screening tool for OSA, especially when the test is negative. Other screening tests that involve additional parameters, beside daytime sleepiness alone, should be considered.

重新审视埃普沃思嗜睡量表:在高风险人群中,白天过度嗜睡仍然是阻塞性睡眠呼吸暂停的有效筛查工具吗?
目的:阻塞性睡眠呼吸暂停(OSA)是一种常见的医疗问题,合并症多,费用高。自埃普沃思嗜睡量表(ESS)问世以来,白天过度嗜睡(ESS)一直被认为是 OSA 最常见、最突出的症状。本研究的目的是重新评估ESS与黄金标准的夜间多导睡眠图(PSG)相比,在高危人群中检测 OSA 的效果:共有 266 名患者(平均年龄为 57.9 ± 11.6 岁;189 名男性和 77 名女性)因可能患有 OSA 而被转诊到我们的睡眠实验室,他们在接受ESS 检查后又接受了一夜多导睡眠图检查。将ESS值与PSG呼吸暂停低通气指数(AHI)进行比较,计算ESS的敏感性(SE)、特异性(SP)、阳性预测值(PPV)、阴性预测值(NPV)和诊断准确性(DA)。ESS的阳性临界值≥10,AHI≥5:只有 92 名受试者(34.6%)的ESS 值为阳性。213名受试者(80.1%)通过 PSG 诊断出患有 OSA:其中 46 人患有轻度呼吸暂停,37 人患有中度呼吸暂停,130 人患有重度呼吸暂停。大多数 ESS 呈阳性的受试者(88.0%)被发现患有 OSA,但大多数 ESS 呈阴性的受试者(75.9%)也被发现患有 OSA(AHI ≥ 30 的受试者占 42%)。ESS的接收器操作特征曲线下面积为0.60(95%置信区间,CI 0.54-0.66;P = 0.020),SE为38.0%,SP为79.3%,PPV为88.0%,NPV为24.1%,DA为46.2%:研究发现,通过ESS测量的白天过度嗜睡并不是一种有价值的 OSA 筛查工具,尤其是在测试结果呈阴性的情况下。除了单纯的白天嗜睡之外,还应该考虑其他涉及额外参数的筛查测试。
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来源期刊
Wiener Klinische Wochenschrift
Wiener Klinische Wochenschrift 医学-医学:内科
CiteScore
4.70
自引率
3.80%
发文量
110
审稿时长
4-8 weeks
期刊介绍: The Wiener klinische Wochenschrift - The Central European Journal of Medicine - is an international scientific medical journal covering the entire spectrum of clinical medicine and related areas such as ethics in medicine, public health and the history of medicine. In addition to original articles, the Journal features editorials and leading articles on newly emerging topics, review articles, case reports and a broad range of special articles. Experimental material will be considered for publication if it is directly relevant to clinical medicine. The number of international contributions has been steadily increasing. Consequently, the international reputation of the journal has grown in the past several years. Founded in 1888, the Wiener klinische Wochenschrift - The Central European Journal of Medicine - is certainly one of the most prestigious medical journals in the world and takes pride in having been the first publisher of landmarks in medicine.
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