Modified Epworth Sleepiness Scale in Chinese children with obstructive sleep apnea: a retrospective study
Eric Y T Chan1, Daniel K Ng, Chung-hong Chan
1Department of Pediatrics, Kwong Wah Hospital, Hong Kong, China.
Insights
Chinese children with high apnea-hypopnea index (AHI) are significantly sleepier. A modified Epworth Sleepiness Scale (ESS) score over 8 effectively identifies children with high AHI, aiding in obstructive sleep apnea syndrome diagnosis.
Area of Science:
- Pediatric Sleep Medicine
- Respiratory Medicine
- Clinical Diagnostics
Background:
- Obstructive Sleep Apnea Syndrome (OSAS) is a growing concern in children.
- Assessing excessive daytime sleepiness (EDS) is crucial for diagnosing OSAS.
- The apnea-hypopnea index (AHI) quantifies sleep apnea severity.
Purpose of the Study:
- To determine if Chinese children with a high AHI experience increased sleepiness.
- To evaluate the efficacy of a modified Epworth Sleepiness Scale (ESS) in identifying sleepiness in this population.
Main Methods:
- Retrospective review of 192 Chinese children (3-12 years old) undergoing polysomnography.
- Utilized a modified ESS to measure excessive daytime sleepiness (EDS).
- Analyzed correlation between AHI severity and modified ESS scores.
Main Results:
- Children with high AHI (>5.0) were significantly sleepier than those with lower AHI.
- Modified ESS scores strongly correlated with AHI (rho = 0.124).
- A modified ESS cutoff of >8 demonstrated high specificity (0.91) for identifying high AHI, with an odds ratio of 4.295.
Conclusions:
- Increased sleepiness is a key indicator in Chinese children with high AHI.
- A modified ESS score >8 is a valuable screening tool for suspected OSAS in children.
- Screening for EDS in snoring children can help prioritize management for those with high AHI.
Background And Objective:
The purpose of this study is to assess whether Chinese children with high apnea-hypopnea index (AHI) are sleepier by a modified Epworth Sleepiness Scale (ESS).
Materials And Methods:
Records were retrospectively reviewed. We included children who were between 3 and 12 years old, admitted for overnight polysomnogram because of suspected obstructive sleep apnea syndrome (OSAS). A modified ESS was used to assess excessive daytime sleepiness (EDS) of the children.
Results:
One hundred ninety-two Chinese children were included. Children with high AHI, defined as AHI > 5.0, were sleepier than children with AHI less than or equal to 5. After adjustment by age, gender, and obesity, children with high AHI remained significantly sleepier. Modified ESS was significantly correlated with AHI (rho = 0.124, 95% CI = 0.004-0.281). Modified ESS score of >8 was the best cutoff point with the sensitivity and specificity of 0.29 and 0.91, respectively. The odds ratio of children with modified ESS > 10 having high AHI was 4.231 (95%CI = 1.248 to 14.338) and children with modified ESS > 8 had the highest odds ratio, 4.295(95%CI = 1.66 to 11.1), of having high AHI.
Conclusion:
Chinese children with high AHI appear to be sleepier than children with low AHI. Children with suspected OSAS and high modified ESS, i.e., ESS > 8, had significantly higher odds ratio of having high AHI. Increased sleepiness is a specific but not a sensitive symptom in snoring children with high AHI. Screening for EDS in snoring children may help us identify those with high AHI and prioritize the management of those children.
