Change in Epworth Sleepiness Scale after surgical treatment of obstructive sleep apnea

Abstract

Objectives/hypothesis: To evaluate the effect of surgical intervention for obstructive sleep apnea (OSA) on patients' level of excessive daytime sleepiness as determined by the Epworth Sleepiness Scale (ESS). The ESS questionnaire is a validated measure of subjective daytime sleepiness. There have been several studies that have shown that continuous positive airway pressure (CPAP) improves excessive daytime sleepiness in OSA patients as measured by the ESS.

Study design: Retrospective case series.

Methods: This is a study of patients who had uvulopalatopharyngoplasty (UPPP); UPPP and tonsillectomy; or UPPP, tonsillectomy, and radiofrequency ablation of the base of the tongue for OSA between January 2007 and December 2009. Forty patients were identified who met the criteria of having had an ESS evaluation and polysomnography prior to surgery for OSA.

Results: Across all of the patients there was a mean reduction of their ESS by 5.6 ± 4.1; t = 8.82, P < .001. Only three of the patients did not improve in their ESS scores after surgical treatment for OSA.

Conclusions: Surgical intervention for OSA significantly improves sleepiness in OSA patients as measured by the ESS. Two meta-analyses of multiple, randomized, controlled studies showed patients with mild to moderate OSA treated with CPAP demonstrated an improvement in the ESS score of 1.2 points (95% confidence interval, 0.05-1.9, P = .001) and 2.94 points for patients with mild to severe OSA treated with CPAP. The results of this study show an improvement in ESS after surgery that is substantially higher than previously reported with CPAP for all categories of OSA.