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Epworth Sleepiness Scale (ESS) - Adult Version
Epworth Sleepiness Scale (ESS) - Adult Version
Please visit this website for more information about the instrument: Epworth Sleepiness Scale
Supplemental - Highly Recommended: Parkinson's Disease (PD)
Recommendations for use: Indicated for studies evaluating subjective sleepiness where the individuals rate their level of daytime sleepiness.
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.
Translations are available in over 20 languages and the Scale can be completed in less than 5 minutes.
The ESS was developed as a trait to measure the tendency to fall asleep in eight specific situations (sitting and reading, watching TV, sitting inactive in a public place, being a passenger in a car for an hour, lying down in the afternoon, sitting and talking to someone, sitting quietly after lunch, stopping for a few minutes in traffic while driving).
It is a subjective tool of how sleepiness interferes with individuals' common daily activities. It consists of a simple self-administered questionnaire asking patients to rate the likelihood (from 0 to 3) of dozing or falling asleep in those eight situations. For each situation, patients estimate the likelihood of their falling asleep in a four-point scale (0= never doze to 3= high probability). Scores from each of the eight situations yield a total scoring ranging from 0 to 24. The higher the ESS score, the greater the sleepiness. The upper limit of normality is generally accepted as 10-12 points.
See Epworth Sleepiness Scale - Children and Adolescents Version (ESS-CHAD) for children and adolescents aged 5-18.
The ESS does not evaluate the occurrence of sudden sleep onset episodes which is well-known in PD. Thus, new scales were developed to capture hypersomnolence in active situations like eating and driving (Hobson et al., 2002).
|Scoring and Psychometric Properties||
Scoring: Rated from 0-24, with high scores indicating worse sleepiness.
0-10: No Sleepiness
11-14: Mild sleepiness
15-17: Moderate sleepiness
18 or higher: Severe sleepiness
Psychometric Properties: The scale shows acceptable test-retest reliability. Studies have shown little to no correlation between ESS scores and the multiple sleep latency results, suggesting that the two tests measure different aspects of sleepiness, which remain to be elucidated.
Strengths: 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 such as Parkinson disease. The ESS has also been used quite extensively in SCI studies. It is simple and self-administered that can be completed in less than 5 minutes.
Weaknesses: More evidence supporting its psychometric properties in SCI is warranted. It asks subjects picture themselves in situations which they may experience rarely or never (e.g., driving, going to the theater). Semantic issues may also lead to confusion. Circadian variations in alertness are not captured with this scale. The eight situations are equally weighted, despite obvious differences in significance (e.g., driving versus going to the theater). There may be individual variation scores over time.
Generally, the ESS is more reliable when scores are abnormally high or very low. Many sleepy PD subjects may score in the normal range because they do not actually fall asleep, despite being drowsy, either because of effective compensatory measures or lack of opportunity. It does not evaluate the occurrence of sleep attacks, that is a situation commonly experienced by PD patients.
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Document last updated August 2022