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Epworth Sleepiness Scale (ESS)
Availability

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Epworth Sleepiness Scale.

Classification
Supplemental: Spinal Cord Injury (SCI), Sport-Related Concussion (SRC) Subacute (after 72 hours to 3 months), and Persistent/Chronic (3 months and greater post concussion)
 
Exploratory: Sport-Related Concussion (SRC) Acute (time of injury until 72 hours)
Short Description of Instrument
The Epworth Sleepiness Scale (ESS) was developed in 1991 and is the most widely used subjective scale of daytime somnolence.
 
As with all subjective scales, participants may not recognize sleepiness, particularly when chronic.
 
Translations are available in over 20 languages and the Scale can be completed in less than 5 minutes.
 
See Epworth Sleepiness Scale - Children and Adolescents Version (ESS-CHAD) for children and adolescents aged 5-18.
Scoring
Rated from 0-24, with high scores indicating worse sleepiness.
 
General interpretation is as follows
 
0-5 Lower Normal Daytime Sleepiness
 
6-10 Higher Normal Daytime Sleepiness
 
11-12 Mild Excessive Daytime Sleepiness
 
13-15 Moderate Excessive Daytime Sleepiness
 
16-24 Severe Excessive Daytime Sleepiness
Rationale/Justification
Strengths/Weaknesses: The ESS is indicated for studies requiring a subjective measure of 'sleep propensity' (i.e. sleepiness). It has been extensively used in the general population and many health conditions. The ESS has also been used quite extensively in SCI studies. More evidence supporting its psychometric properties in SCI is warranted.
References
Key references:
Johns MW. A new method for measuring daytime sleepiness: the Epworth sleepiness scale. Sleep. 1991;14(6):540-545.
 
Johns MW. A new perspective on sleepiness. Sleep Biol Rhythm, 2010; 8: 170-179.
 
SCI references:
 
Boswell-Ruys CL, Lewis CR, Gandevia SC, Butler JE. Respiratory muscle training may improve respiratory function and obstructive sleep apnoea in people with cervical spinal cord injury. Spinal Cord Ser Cases. 2015 Jul 9;1:15010. Erratum in: Spinal Cord Ser Cases.2016 Jul 21;2:16019.
 
Campbell AJ, Neill AM, Scott DAR. Clinical reproducibility of the Epworth Sleepiness Scale for patients with suspected sleep apnea. J Clin Sleep Med. 2018;14(5): 791-795.
 
McCormick ZL, Chu SK, Binler D, Neudorf D, Mathur SN, Lee J, Marciniak C. Intrathecal Versus Oral Baclofen: A Matched Cohort Study of Spasticity, Pain, Sleep, Fatigue, and Quality of Life. PM R. 2016 Jun;8(6):553-62.
 
Sankari A, Bascom A, Oomman S, Badr MS. Sleep disordered breathing in chronic spinal cord injury. J Clin Sleep Med. 2014 Jan 15;10(1):65-72.
 
Sankari A, Martin JL, Bascom AT, Mitchell MN, Badr MS. Identification and treatment of sleep-disordered breathing in chronic spinal cord injury. Spinal Cord. 2015 Feb;53(2):145-9.
 
ThØfner HultÉn VD, Biering-SØrensen F, JØrgensen NR, Jennum PJ. Melatonin and cortisol in individuals with spinal cord injury. Sleep Med. 2018 Nov;51:92-98.
 
Other references:
Joorabbaf Motlagh S, Shabany M, Sadeghniiat Haghighi K, Nikbakht Nasrabadi A, Emami Razavi SH. Relationship Between Sleep Quality, Obstructive Sleep Apnea and Sleepiness During Day With Related Factors in Professional Drivers. Acta Medran. 2017 Nov;55(11):690-695.
 
Mollayeva T, Shapiro CM, Cassidy JD, Mollayeva S, Colantonio A. Assessment of Concussion/Mild Traumatic Brain Injury-Related Fatigue, Alertness, and Daytime Sleepiness: A Diagnostic Modelling Study. Neuropsychiatry (London) 6.6 (2016): 525-543.