Healthcare and Medicine Reference
In-Depth Information
Table 57-1 The Epworth Sleepiness Scale
Name: _____________________________________________________________________________________________________________________
Today's date: ______________________________________________ Your age (years): ______________________________________________
Your sex (male = M; female = F): _____________________________________________________________________________________________
How likely are you to doze off or fall asleep in the following situations, in contrast to feeling just tired? This refers to your
usual way of life in recent times. Even if you have not done some of these things recently, try to work out how they
would have affected you. Use the following scale to choose the most appropriate number for each situation:
0 = would never doze
1 = slight chance of dozing
2 = moderate chance of dozing
3 = high chance of dozing
SITUATION *
CHANCE OF DOZING
Sitting and reading
________
Watching TV
________
Sitting, inactive in a public place (e.g., a theater or a meeting)
________
As a passenger in a car for an hour without a break
________
Lying down to rest in the afternoon when circumstances permit
________
Sitting and talking to someone
________
Sitting quietly after a lunch without alcohol
________
In a car, while stopped for a few minutes in traffic
________
Thank you for your cooperation.
*The numbers for the eight situations are added together to give a global score between 0 and 24.
From Johns MW. A new method for measuring daytime sleepiness: the Epworth Sleepiness Scale. Sleep 1991;14:540-545.
Table 57-2 Scores for Various Conditions: Ages and Epworth Sleepiness Scale Scores of Experimental Subjects
EPWORTH
SLEEPINESS SCALE
SCORES (MEAN ± SD)
TOTAL NUMBER
OF SUBJECTS (M/F)
AGE IN YEARS
(MEAN ± SD)
SUBJECTS/DIAGNOSES
RANGE
Healthy control subjects
30 (14/16)
36.4 ± 9.9
5.9 ± 2.2
2-10
Primary snoring
32 (29/3)
45.7 ± 10.7
6.5 ± 3.0
0-11
Obstructive sleep apnea syndrome
55 (53/2)
48.4 ± 10.7
11.7 ± 4.6
4-23
Narcolepsy
13 (8/5)
46.6 ± 12.0
17.5 ± 3.5
13-23
Idiopathic hypersomnia
14 (8/6)
41.4 ± 14.0
17.9 ± 3.1
12-24
Insomnia
16 (6/12)
40.3 ± 14.6
2.2 ± 2.0
0-6
Periodic limb movement disorder
18 (16/2)
52.5 ± 10.3
9.2 ± 4.0
2-16
SD, standard deviation.
From Johns MW. A new method for measuring daytime sleepiness: the Epworth Sleepiness Scale. Sleep 1991;14:540-545.
knowledge or recognition of their snoring habits, and
accounts from bed partners may be more helpful for the
clinician.
Snoring is usually worse in the supine position, after
sleep deprivation or alcohol ingestion. Loud snoring may
not disturb sound sleepers, but some patients may report
complaints from family members and even neighbors.
Snoring may continue for decades. Persistent loud snoring
is a classic symptom of obstructive sleep apnea syndrome,
but the absence of snoring does not exclude the diagnosis
of apnea. Some patients have airway dynamics that are not
conducive to production of snoring. This is especially true
in patients who have had upper airway surgical procedures
that eliminated flaccid tissue that can vibrate. Other indi-
viduals, such as those with neuromuscular disorders, may
not generate enough force to produce turbulent airflow.
Snoring, for many people, produces little disruption in
their lives, but snoring may have implications on overall
health. Individuals who snore have a greater risk of vascu-
lar disease. Witnesses may be able to account for snoring
occurring in bursts or associated with snorts, gasps,
choking, body jerks, and movements. Patients may recall
being awoken by their own gasps and relay symptoms of
gastroesophageal reflux. These associated symptoms raise
the suspicion of obstructive sleep apnea.
SLEEP APNEA
Apnea is the absence of ventilation. In the sleep laboratory,
apneas are defined by the cessation of breathing for more
than 10 seconds and are usually associated with oxygen
desaturation and arousal. 8 Patients' bed partners note that
 
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