The epworth sleepiness scale in service members with sleep disorders

Abstract

Introduction: Excessive daytime sleepiness affects an estimated 20% of the general population. Whilethe prevalence of sleepiness in the military is largely unknown, it is well established that short sleep duration isendemic. 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 themost widely used sleep questionnaire and provides a self-assessment of daytime sleepiness. To date the clinical utilityof this questionnaire in differentiating sleep disorders in military patients with sleep disorders has never been evaluated.Materials and Methods: The primary aim of this manuscript was to assess if Epworth Sleepiness Scale (ESS) scoresdiffered between military personnel with insomnia, obstructive sleep apnea (OSA), comorbid insomnia/obstructivesleep apnea (COMISA), and a group with neither insomnia nor obstructive sleep apnea (NISA). This study assessedthe clinical utility of the ESS in differentiating sleep disorders amongst a sample (N = 488) of U.S. military personnelwith insomnia (n = 92), OSA (n = 142), COMISA (n = 221), and a NISA group (n = 33) which served as the controlpopulation. Results: 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 OSAonly (11.5 ± 4.08; p < 0.001) and the NISA group (9.46 ± 4.84; p < 0.001). Also, ESS scores differed betweenpatients with insomnia only (13.0 ± 4.84) and the NISA group (p < 0.01). Conclusions: Overall, the ESS had poorability 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 arerequired to validate this questionnaire and determine an appropriate threshold value for abnormal sleepiness in the military population.