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. 2022 Sep 1;18(9):2273-2279.
doi: 10.5664/jcsm.10048.

Sex differences in Epworth Sleepiness Scale normalization with continuous positive airway pressure

Matthew T Scharf  1   2 , Peng Zhang  3 , Nathan A Walker  4 , Mariam Mirza  5 , Aesha M Jobanputra  2 , R Nisha Aurora  2 , Jag Sunderram  2 , Shou-En Lu  3
Affiliations

Sex differences in Epworth Sleepiness Scale normalization with continuous positive airway pressure

Matthew T Scharf et al. J Clin Sleep Med. .

Abstract

Study objectives: Continuous positive airway pressure (CPAP) improves sleepiness in patients with obstructive sleep apnea, but some patients remain sleepy. The objective of this study was to identify determinants that are associated with improvements in self-reported sleepiness in patients with obstructive sleep apnea on CPAP therapy.

Methods: A retrospective cohort study was performed in a clinic-based population to determine which variables contributed to the improvement in the Epworth Sleepiness Scale (ESS) in patients on CPAP therapy for OSA, stratified by baseline ESS score (< 11 or ≥ 11). Variables associated with ESS scores normalizing with CPAP were also assessed.

Results: Patients with a baseline high ESS score showed greater improvements in the ESS with CPAP. When looking at interactions between baseline ESS classification and changes in ESS, we found that a higher apnea-hypopnea index was only associated with improvement in the ESS among patients with a high baseline ESS. Other assessed factors or covariates were not significantly different. When looking at ESS normalization, we found that female sex and lower body mass index were associated with a lower likelihood of ESS normalization. The difference in the rate of ESS normalization between females and males was higher with more days on CPAP.

Conclusions: Of all the assessed factors and covariates, only the apnea-hypopnea index was associated with the change in the ESS differently in patients with a high or normal baseline ESS score. ESS normalization rates were lower in females than in males, and this disparity was amplified by more days on CPAP.

Citation: Scharf MT, Zhang P, Walker NA, et al. Sex differences in Epworth Sleepiness Scale normalization with continuous positive airway pressure. J Clin Sleep Med. 2022;18(9):2273-2279.

Keywords: CPAP; Epworth Sleepiness Scale; OSA; sex.

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Conflict of interest statement

All authors have seen and approved the manuscript. The authors report no conflicts of interest.

Figures

Figure 1
Figure 1. Baseline ESS was a determinant of the change in the ESS with increasing AHI.
There was a greater decrease in the ESS with a higher baseline AHI only in patients with a high baseline ESS score. AHI = apnea-hypopnea index, ESS = Epworth Sleepiness Scale.
Figure 2
Figure 2. ESS normalization rates with greater duration of CPAP use.
ESS normalization rates were higher in males with longer duration of CPAP use. CPAP = continuous positive airway pressure, ESS = Epworth Sleepiness Scale.
See this image and copyright information in PMC

References

    1. Senaratna CV , Perret JL , Lodge CJ , et al. . Prevalence of obstructive sleep apnea in the general population: a systematic review . Sleep Med Rev. 2017. ; 34 : 70 – 81 . - PubMed
    1. Johns MW . A new method for measuring daytime sleepiness: the Epworth Sleepiness Scale . Sleep. 1991. ; 14 ( 6 ): 540 – 545 . - PubMed
    1. Weaver TE , Maislin G , Dinges DF , et al. . Relationship between hours of CPAP use and achieving normal levels of sleepiness and daily functioning . Sleep. 2007. ; 30 ( 6 ): 711 – 719 . - PMC - PubMed
    1. Antic NA , Catcheside P , Buchan C , et al. . The effect of CPAP in normalizing daytime sleepiness, quality of life, and neurocognitive function in patients with moderate to severe OSA . Sleep. 2011. ; 34 ( 1 ): 111 – 119 . - PMC - PubMed
    1. Budhiraja R , Kushida CA , Nichols DA , et al. . Predictors of sleepiness in obstructive sleep apnoea at baseline and after 6 months of continuous positive airway pressure therapy . Eur Respir J. 2017. ; 50 ( 5 ): 1700348 . - PMC - PubMed