Snooze and Slumber: The Sleep Apnea Apnea-Hypopnea Index (AHI) VS the Epworth Sleepiness Scale (ESS)
PURPOSE: Obstructive sleep apnea (OSA) has a prevalence of approximately one billion people worldwide and is characterized by hypopneas, apneas and repetitive upper airway collapse during sleep. Several risk factors have been associated with this diagnosis including obesity, older age, male gender as well as upper airway and anatomical abnormalities. While the STOPBANG score is available to determine the pretest probability of OSA, there is little data available comparing a patient’s subjective degree of sleepiness to his OSA classification. METHODS: To better determine if there is any identifiable relation between the symptoms reported by a patient to the likelihood of actually having sleep apnea and to what degree, a retrospective analysis was done looking at 1443 patients seen in the Pulmonary and Sleep Clinic at Beaumont Hospital between the years 2014-2019. The Apnea-Hypopnea Index (AHI) was then compared to the Epworth Sleepiness Scale (ESS) score and evaluated using a Pearson correlation. RESULTS: The data was statistically significant and revealed there is no relation between a patient’s objective AHI versus subjective ESS (Pearson correlation= 0.106, p-value= 0.000). This information was further classified into employed versus unemployed and there was again no correlation indicating a higher ESS equates to more severe OSA, irrespective of employment status (employed AHI average = 25.5, employed ESS average = 10.0, unemployed average AHI = 27, unemployed average ESS = 9.97). CONCLUSIONS: Daytime sleepiness, snoring, nocturnal gasping and unrefreshing sleep are all indicators of possible sleep apnea yet based on this study, symptom severity as measured by the ESS does not correlate to actual sleep apnea or help classify the degree (mild, moderate, or severe) of OSA. Furthermore, whether the patient is employed versus unemployed does not lend itself to any correlation when evaluating the aforementioned scores. CLINICAL IMPLICATIONS: Therefore, it is imperative that physicians never underestimate the possibility of a patient having obstructive sleep apnea if he or she has any of the cardinal symptoms, irrespective of symptomatology severity.
Salimnia T, Frahm P, Patel VK. Snooze and slumber: the sleep apnea Apnea-Hypopnea Index (AHI) vs the Epworth Sleepiness Scale (ESS). Chest. 2022 Oct;162(4 Suppl):A2519. doi:10.1016/j.chest.2022.08.2065.