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Comparison of Epworth Sleepiness Scale and OSA-18 Scores With Polysomnography in Children
Beatrice R Bacon1, Amanda B Hassinger2, Gaayathri Varavenkataraman3
1Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, USA.
Insights
The Modified Epworth Sleepiness Scale (M-ESS) and OSA-18 scores show a weak correlation with obstructive sleep apnea (OSA) severity in children. New screening tools are needed for pediatric OSA diagnosis.
Area of Science:
- Pediatric Sleep Medicine
- Otolaryngology
- Respiratory Medicine
Background:
- Obstructive sleep apnea (OSA) is a prevalent condition in children, impacting their health and development.
- Accurate diagnosis and severity assessment are crucial for effective management.
- Current screening tools, such as the Modified Epworth Sleepiness Scale (M-ESS) and OSA-18, are widely used but their correlation with objective polysomnography (PSG) outcomes in pediatric populations requires further investigation.
Purpose of the Study:
- To evaluate the correlation between M-ESS scores, OSA-18 scores, and polysomnography (PSG) findings in children.
- To determine the clinical utility of these subjective scales in assessing OSA severity in pediatric patients.
Main Methods:
- A retrospective chart review was conducted on consecutive children presenting to a pediatric otolaryngology clinic between July 2021 and July 2023.
- Data collected included demographics, BMI, M-ESS scores, OSA-18 scores, and PSG results (including apnea-hypopnea index [AHI] and oxygen saturation nadir).
- Statistical analyses, including one-way ANOVA and Pearson/Spearman correlation coefficients, were performed to assess relationships between variables.
Main Results:
- The study included 367 children (mean age 7.8 years).
- M-ESS scores showed a weak correlation with AHI (r=0.19, P<.001), and OSA-18 scores correlated weakly with oxygen saturation nadir (r=-0.16, P=.002).
- After adjusting for age and BMI, neither M-ESS nor OSA-18 scores were independently associated with AHI, indicating limited predictive value for OSA severity.
Conclusions:
- The Modified Epworth Sleepiness Scale (M-ESS) and OSA-18 scores demonstrate a weak correlation with obstructive sleep apnea severity in children.
- These findings suggest that current subjective screening tools may not be sufficiently reliable for accurately assessing OSA severity in pediatric populations.
- There is a need for the development and validation of more accurate and age-appropriate screening tools for pediatric sleep apnea.
Objective:
Our goal is to determine if there is a correlation between Modified Epworth Sleepiness Scale (M-ESS) scores, obstructive sleep apnea (OSA)-18 scores, and polysomnography (PSG) outcomes in children.
Study Design:
Retrospective chart review.
Setting:
Pediatric otolaryngology clinic.
Methods:
Charts of consecutive children presenting from July 2021 to July 2023 were reviewed. Demographics, body mass index (BMI), BMI Z score, M-ESS score, OSA-18 score, PSG results, and sleep apnea severity were included. One-way analysis of variance and Pearson/Spearman correlation coefficients were calculated.
Results:
Three hundred sixty-seven children were included, 162 (44.1%) girls and 205 (55.9%) boys. Mean patient age was 7.8 (95% confidence interval [CI]: 7.3-8.3) years. M-ESS score was 6.3 (n = 348, 95% CI: 5.8-6.8), mean OSA-18 score was 56.2 (n = 129, 95% CI: 53.0-59.4). Mean apnea-hypopnea index (AHI) was 10.1 (95% CI: 8.7-11.4) events/h, obstructive AHI 9.3 (95% CI: 8.0-12.7) events/h, respiratory distress index 14.6 (95% CI: 8.4-20.8) events/h, and oxygen saturation nadir 89.8% (95% CI: 89.1-90.4). Sixty-two children (17.2%) had mild, 192 (53.5%) moderate, and 105 (29.2%) severe sleep apnea. M-ESS score correlated weakly to AHI (r = .19, P = <.001), and OSA-18 score to oxygen saturation nadir (r = -.16, P = .002). After logistic regression adjusted for age and BMI, neither clinical scores were independently associated with AHI.
Conclusion:
M-ESS and OSA-18 scores have a weak correlation with OSA severity in children. More reliable, age-appropriate screening tools are needed in pediatric sleep apnea.
