Under reporting of sleepiness and driving impairment in patients with sleep apnoea/hypopnoea syndrome

J Sleep Res. 1997 Dec;6(4):272-5. doi: 10.1111/j.1365-2869.1997.00272.x.


Under reporting of symptoms by patients with sleep apnoea/hypopnoea syndrome (SAHS) has been reported anecdotally, but investigation of the prevalence or determinants of this is limited. To assess this, repeated ratings in 99 patients with sleep apnoea/hypopnoea syndrome of pre-treatment Epworth sleepiness score, unintended napping, driving impairment and mood were obtained, first at presentation and then after treatment with continuous positive airway pressure (CPAP) therapy of median 22 (range 2-70) weeks duration. Median Epworth score for pre-treatment sleepiness rose from 12 (range 0-24) initially to 14 (range 5-24) retrospectively (P<0.0001). More patients initially under-rated Epworth score (67%) than over-rated (29%; P<0.001). 'False negative' cases with an initially 'normal' (< or = 10) and retrospectively 'sleepy' (> or = 11) Epworth score comprised 24% of all patients and 62% of initially 'normal' scorers. Unintended napping behaviour also was rated as significantly more severe on retrospective assessment (P<0.001). Driving impairment due to sleepiness was initially reported by 23% of all drivers and retrospectively by 37% (P=0.01), with 25% of initial deniers retrospectively admitting compromised driving ability before continuous positive airway pressure. No polysomnographic predictors of symptom under reporting were found (P>0.1). These results suggest a high prevalence of symptom minimization before treatment in patients with sleep apnoea/hypopnoea syndrome.

Publication types

  • Comparative Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Affect
  • Aged
  • Automobile Driving*
  • Disorders of Excessive Somnolence / diagnosis*
  • Disorders of Excessive Somnolence / etiology*
  • Female
  • Humans
  • Male
  • Middle Aged
  • Positive-Pressure Respiration / methods
  • Retrospective Studies
  • Severity of Illness Index
  • Sleep Apnea Syndromes / complications*
  • Sleep Apnea Syndromes / therapy
  • Surveys and Questionnaires