The Epworth Sleepiness Scale in Service Members with Sleep Disorders

Author:

Hurlston April1,Foster Shannon N2,Creamer Jennifer3,Brock Matthew S2,Matsangas Panagiotis4,Moore Brian A56,Mysliwiec Vincent2

Affiliation:

1. Department of Sleep Medicine, Carl R. Darnall Army Medical Center, Fort Hood, TX

2. Department of Sleep Medicine, San Antonio Uniformed Services Health Education Consortium, San Antonio, TX

3. Sleep Medicine Center, Martin Army Community Hospital, Fort Benning, GA

4. Operations Research Department, Naval Postgraduate School, Monterey, CA

5. University of Texas Health Science Center at San Antonio, San Antonio, TX

6. University of Texas at San Antonio, San Antonio, TX

Abstract

ABSTRACTIntroductionExcessive 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.Materials and MethodsThe 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.ResultsIn 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).ConclusionsOverall, 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.

Publisher

Oxford University Press (OUP)

Subject

Public Health, Environmental and Occupational Health,General Medicine

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4. Prevalence and impact of short sleep duration in redeployed OIF soldiers;Luxton;Sleep,2011

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