The Epworth Sleepiness Scale may not reflect objective measures of sleepiness or sleep apnea

Neurology. 1999 Jan 1;52(1):125-31. doi: 10.1212/wnl.52.1.125.


Objective: To assess the validity of the Epworth Sleepiness Scale score (ES) as a measure of sleepiness among patients suspected or confirmed to have obstructive sleep apnea syndrome.

Background: The ES is used with increasing frequency as a measure of excessive daytime sleepiness in part because several studies suggested that the ES correlates with mean sleep latency (MSL) on the Multiple Sleep Latency Test and with severity of sleep apnea among patients with that disorder. However, associations identified between the ES and other measures were not strong or consistent.

Methods: The authors used regression models and retrospective data from a relatively large series of 237 patients to restudy how ES relates to MSL, to a simple self-rating of problem sleepiness (available for 141 patients), and to two polysomnographic measures of sleep apnea severity: the number of apneas or hypopneas per hour of sleep and the minimum recorded oxygen saturation.

Results: The ES had a statistically significant association with self-rated problem sleepiness but not with MSL or measures of sleep apnea severity. Male gender, adjusted for potential confounding variables, had considerably more influence on the ES than did MSL or measures of sleep apnea severity.

Conclusions: Our data suggest that the subjectively derived ES cannot be used as a surrogate for the objectively determined MSL.

Publication types

  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Adult
  • Female
  • Humans
  • Logistic Models
  • Male
  • Middle Aged
  • Oximetry
  • Polysomnography / standards*
  • Reproducibility of Results
  • Retrospective Studies
  • Self-Examination
  • Sleep Apnea Syndromes / diagnosis*
  • Sleep Apnea Syndromes / physiopathology*
  • Sleep Stages / physiology*