A visual analog scale for the assessment of mild sleepiness in patients with obstructive sleep apnea and healthy participants.

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From: Annals of Thoracic Medicine(Vol. 16, Issue 2)
Publisher: Medknow Publications and Media Pvt. Ltd.
Document Type: Article
Length: 3,911 words
Lexile Measure: 1510L

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Byline: Yousef. Alqurashi, Aleksander. Dawidziuk, Abdullah. Alqarni, Julia. Kelly, James. Moss, Michael. Polkey, Mary. Morrell

MOTIVATION: Studies have shown poor clinical effectiveness of the Epworth Sleepiness Scale (ESS) due to its ambiguity of items and cultural applicability. This study aimed to investigate the efficacy of a Visual Analog Scale (VAS) to assess sleepiness, compared to ESS. METHODS: Thirty-two obstructive sleep apnea (OSA) patients and 32 healthy participants completed two visits, 1 month apart, during which they completed both ESS and VAS. Patients diagnosed with OSA were treated with Continuous positive airway pressure (CPAP) between visits. The agreement between the ESS and VAS scores in both patients with OSA and healthy participants was investigated using Pearson correlation and Area Under the receiver operating characteristics. RESULTS: The (mean [+ or -] standard deviation) Oxygen Desaturation Index for patients with OSA was 18.5 [+ or -] 5.7 events/hour and 1.7 [+ or -] 1.0 events/hour in the healthy participants. A reduction in sleepiness, following CPAP treatment occurred in patients with OSA, using the ESS (11.2 [+ or -] 5.5-4.7 [+ or -] 5.0 points, P < 0.001) and the VAS (50.2 [+ or -] 3.0-21.9 [+ or -] 26.5 mm, P < 0.001). There was no significant change in sleepiness, in healthy participants using the ESS (3.91 [+ or -] 3.14-3.34 [+ or -] 3.27 points (P < 0.48) or the VAS (15.58 [+ or -] 21.21-12.05 [+ or -] 14.75 mm, (P < 0.44). A Likert scale showed that the VAS was easier to use compared to ESS in visit 1 (VAS: 8.7 [+ or -] 1.9 points, ESS: 7.7 [+ or -] 2.6 points, (P < 0.001), and visit 2 (VAS: 9.5 [+ or -] 1.4 points, ESS: 8.6 [+ or -] 1.5 points, P < 0.001). CONCLUSION: These preliminary results suggest that the VAS can detect a change in sleepiness after CPAP treatment in patients with OSA and that the VAS was also easier to use compared to ESS.


Obstructive sleep apnea (OSA) is a common disease. A recent study estimated that the global prevalence of OSA was approximately 1 billion people worldwide,[1] though 60% of those patients have mild OSA (Apnoea-hypopnea index: AHI >5 to <15 events/hour). One of the most common daytime symptoms of OSA is excessive daytime sleepiness (EDS); approximately 42% of patients with OSA report symptoms of EDS.[2] It has long been accepted that continuous positive airway pressure (CPAP) is an effective treatment for patients with moderate-to-severe OSA and symptoms of EDS.[3] Recently, our group has reported that 3 months of CPAP treatment improved the quality of life in patients with mild OSA and daytime symptoms.[4] Furthermore, following the outcome of the Sleep Apnea Cardiovascular Endpoints (SAVE) trial, which did not show cardiovascular risk reduction, sleepiness is the principle indication for starting CPAP in the majority of OSA patients; therefore, its assessment is of clinical importance.[5]

The Epworth Sleepiness Scale (ESS) is the most frequently used questionnaire to measure subjective EDS.[6] However, clinical studies have...

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Gale Document Number: GALE|A660154799