What is the clinical evidence from this study?

Study design: Cohort. Population: Suspected Obstructive Sleep Apnea Syndrome (OSAS) (n=238). Intervention: Epworth Sleepiness Scale (ESS) and Body Mass Index (BMI) assessment. Primary outcome: Association between Epworth Sleepiness Scale (ESS) and Apnea-Hypopnea Index (AHI) (p=0.152).

June 30, 2015Open Access

Association of Excessive Daytime Sleepiness and Obesity with Apnea-Hypopnea Index in Adult Patients Suspected of Obstructive Sleep Apnea Syndrome

Key Result

The Epworth Sleepiness Scale showed no significant association with the Apnea-Hypopnea Index, but obese patients were twice as likely to have excessive daytime sleepiness (OR 2.07).

Study Design

Type

Cohort (n=238)

Multicenter

Structured PICO

Is excessive daytime sleepiness or obesity associated with Apnea-Hypopnea Index in adult patients suspected of obstructive sleep apnea syndrome?

Population

238 adult patients (aged 19 and above) suspected to have sleep disorders and referred for polysomnography (PSG) at a tertiary private hospital.

Intervention

Assessment of excessive daytime sleepiness (EDS) via Epworth Sleepiness Scale (ESS) and obesity via Body Mass Index (BMI)

Outcome

Correlation of ESS with BMI and Apnea-Hypopnea Index (AHI), and association of BMI with AHIsurrogate

The Epworth Sleepiness Scale alone is insufficient to predict OSAS severity (AHI), whereas BMI is significantly associated with both daytime sleepiness and OSAS severity.

Main Result

p-value: p=0.152

Limitations

Subjective nature of the self-administered ESS questionnaire which depends on personality traits and emotional factors
Sample population was taken from a sleep laboratory rather than a general community population, introducing potential selection bias
Patients may underestimate their sleepiness or be in denial of their symptoms
Retrospective study design

Abstract

Objective: To determine whether excessive daytime sleepiness (EDS) as assessed by the Epworth Sleepiness Scale (ESS) is significantly correlated with body mass index (BMI) and Apnea-Hypopnea Index (AHI) in patients suspected of OSAS and whether obesity as assessed by BMI is associated with AHI. Methods: Study Design: Non-Concurrent Cohort Study Setting: Tertiary Private Hospital Population: The charts of 389 patients suspected to have sleep disorders and referred for polysomnography (PSG) at the Center for Snoring and Sleep Disorders in year 2009 were reviewed. Inclusion criteria were patients aged 19 and above with complete data. A total of 238 patient charts were included in the study. Results:The study included a total of 238 patient charts. Results showed no significant association between ESS and AHI (p-value >0.05), even when correlated with the different severities of OSAS (p-value>0.05). Sensitivity and specificity of ESS was found to be 54% and 57%, respectively, indicating that ESS is not a sensitive and specific tool to predict the presence of OSAS. These findings suggest that ESS may not be able to significantly identify patients with OSAS. However, BMI showed a significant association with ESS (p-value<0.05), representing more patients with EDS belonging to the obese category. Conversely, obese patients were twice more likely to have EDS, represented by ESS scores of ³10. BMI wasalso significantly associated with AHI using one-way Anova test. Conclusion: This report concludes that the ESS alone is insufficient to identify patients with OSAS. Nevertheless, questionnaires like the ESS supplement relevant history to help diagnose patients with sleep disorders, particularly OSAS. On the other hand, the ESS showed a significant association with BMI, representing more obese patients had excessive daytime sleepiness. The likelihood ratio of having excessive daytime sleepiness is 2 times more for obese patients. BMI was also significantly associated with AHI, which confirms the well established relationship of obesity with OSAS, and shows that obese patients are at higher risk for severe OSAS. Keywords:obstructive sleep apnea syndrome, daytime sleepiness, Epworth sleepiness scale, polysomnography, apnea-hypopnea index, body-mass index.

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