Type of publication:
*Ibrahim J.; *Ali A.; *Khan M.Z.; *Radzali M.; *Crawford E.; *Makan A.; *Ahmad N.; *Srinivasan K.; *Moudgil H.
American Journal of Respiratory and Critical Care Medicine; May 2019; vol. 199 (no. 9)
INTRODUCTION: With an increase in referrals to investigate sleep disordered breathing it is important to ensure appropriate targeted investigation. Our traditional use of the Epworth Sleepiness Scores (ESS) in screening and/or guiding treatment for obstructive sleep apnoea/hypopnoea syndrome (OSAHS) is at best based on equivocal and sometimes conflicting published evidence. In evaluating our practice, our objectives presently were (1) to profile our patients and nature of their disease, and (2) to assess the role of Epworth scores in investigating these patients. METHOD(S): Retrospective review of 200 successive adults referred to this department over an 18 month period to end December 2017. Data were extracted from medical records and analysed using SPSS statistics packages appropriately for normal and nonparametric distribution with statistically significant findings reported at p<0.05. RESULT(S): Mean (SD, range) age of patients was 53.2 (13.8, 22 to 84) years with 55% males. Comparing those diagnosed with (n=152) to those without OSAHS (n=48), patients with disease tended to be older at 54.7 (13.3, 24-85) versus 48.5 (14.7, 22-79) years, had higher BMI at 36.8 (8.7, 21.5- 69.4) versus 32.6(8.5, 19.5-51.9) kg/m2 with more positively diagnosed from the males investigated (92/111 versus 60/89). Markers of disease severity were as expected with higher levels among those diagnosed with disease: Apnoea Hypopnoea Index (AHI) 25 versus 2.3, Oxygen desaturation Index (ODI) (at 4%) 25.9 versus 2.3, and time spent with oxygen saturation below 90% at 25.9 versus 8.3%. The ESS (n=121) did not differ between groups, respectively 11.3 (5.9, 0-24) versus 12.4 (6.2, 0-24), p=0.395 (not significant). Findings were similar analysed by stepwise logistic regression. None of the markers of disease severity correlated with ESS (Spearman rho= -0.04, p=0.675, NS). CONCLUSION(S): The relatively high (76%) prevalence of disease in these patients investigated suggests appropriately targeted investigation; whereas findings related to increasing age, male gender, and increased BMI are as expected, the distribution of the ESS again does not show the ability to discriminate and conversely had found relatively over-reporting of symptoms among those without disease and under-reporting of those with disease but not at statistically significant levels.
Link to full-text [no password required]