Occupational Medicine 2007 57(3):232; doi:10.1093/occmed/kqm009
© The Author 2007. Published by Oxford University Press on behalf of the Society of Occupational Medicine. All rights reserved. For Permissions, please email: journals.permissions@oxfordjournals.org
The Epworth Sleepiness Scale
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A brief history
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The Epworth Sleepiness Scale (ESS) was created by Murray Johns
[
1] while working at the Epworth Sleep Centre, Richmond, Victoria,
Australia.
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Description
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This is a simple, self-administered questionnaire which provides
a measurement of the subject's general level of daytime sleepiness.
The individual is asked on a scale of 0–3 to score the
likelihood of falling asleep in eight various situations.
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Items
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Use the following scale for each situation
- 0 = no chance of dozing
- 1 = slight chance of dozing
- 2 = moderate chance of dozing
- 3 = high chance of dozing
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Validity
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Although the ESS has advantages of being brief and simple to
carry out, subjects can over- or underscore. The score is subjective
and subjects may convey symptoms of fatigue rather than purely
excessive daytime sleepiness (EDS). Arbitrarily, a score of
>10 has been suggested as being an indicator of EDS, but
on an individual basis, the ESS cannot be used as a diagnostic
tool for obstructive sleep apnoea (OSA) in isolation. Detailed
history and formal multichannel respiratory monitoring during
sleep is recommended. Whether an ESS score can predict health
outcomes is not clear. However, the ESS remains a popular questionnaire
due to its simplicity and brevity.
The ESS has been translated into other languages such as Spanish and Greek with successful validation of the questionnaire.
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Key research
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In a group of >1000 healthy individuals, the mean ESS score
was 5.2 [
1].
There are some data suggesting that the ESS may correlate with severity of sleep-disordered breathing. In a group of over 
1800 subjects investigated for sleep-disordered breathing, the mean score was 7.2 in those without OSA increasing to a mean of 9.3 in those with severe OSA [2]. However, the scores had a wide range in all groups. Treating OSA using continuous positive airway pressure has shown improvements in ESS scores by a mean of 3.8 units (95% CI 3.1–4.6 units) [3].
Dev Banerjee
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References
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- Johns MW. (1991) A new method for measuring daytime sleepiness: the Epworth Sleepiness Scale. Sleep 14:540–545.[Web of Science][Medline]
- Gottlieb DJ, Whitney CW, Bonekat WH, et al. (1999) Relation of sleepiness to respiratory disturbance index: the Sleep Heart Health Study. Am J Respir Crit Care Med 159:502–507.[Abstract/Free Full Text]
- Giles TL, Lasserson TJ, Smith BH, White J, Wright J, Cates CJ. (2006) Continuous positive airways pressure for obstructive sleep apnoea in adults. Cochrane Database Syst Rev 3:CD001106.[Medline]
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A brief history
Description