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Epworth sleepiness scale ratings – What does “in recent times” mean?

Introduction: In patients with obstructive sleep apnoea (OSA), daytime sleepiness is routinely assessed with the Epworth sleepiness scale (ESS). It requires the estimation of the likelihood to fall asleep in eight daily life situations. The wording “This refers to your usual way of life in recent times” keeps the time scale for this assessment vague. We were interested in the actual time frame used by untreated OSA patients and patients treated with continuous positive airway pressure (CPAP) to estimate their sleepiness.

Methods: A time scale with a range from “one day” to “30 years or more” was printed on the backside of the ESS. Patients were asked to rate what “in recent times” meant to them. In addition, ESS scores and type of visit (diagnosis (D), treatment check (T)) were evaluated.

Results: 94 diagnostic and 73 CPAP patients participated. Diagnostic patients based their sleepiness assessment on a median time frame of 24 months (1st quartile (Q1) 12, 3rd quartile (Q3) 60 months). CPAP patients administered a significantly (p<0.001) shorter time scale of six months (Q1 3 months, Q3 24 months). For both groups, the time scale was independent from sleepiness severity (D r=0.039, p=0.708, T r= -0.044, p=0.701). As expected, diagnostic patients were sleepier than controls (median ESS score D 9 (Q1 6, Q3 13), T 6 (Q1 4, Q3 9), p<0.001).

Conclusion: Patients with untreated OSA use a surprisingly long time frame of 2 years to estimate their habitual sleepiness while CPAP-treated patients apply a much shorter time scale of 6 months. This indicates an adjustment of the subjective time scale due to treatment related changes and should be taken into account when the ESS is used to document changes in sleepiness.