What is the role of the Epworth Sleepiness Scale (ESS) in the evaluation of obstructive sleep apnea (OSA)?

Updated: Sep 15, 2020
  • Author: Himanshu Wickramasinghe, MD, MBBS; Chief Editor: Zab Mosenifar, MD, FACP, FCCP  more...
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EDS is most frequently assessed by a sleep physician using the Epworth Sleepiness Scale (ESS). This questionnaire is used to help determine how frequently the patient is likely to doze off in 8 frequently encountered situations.

Although patients do not always accurately describe their sleepiness on this scale compared with objective measures, an ESS score greater than 10 is generally considered sleepy. However, a 2003 study showed that an ESS score of 12 is associated with a greater propensity to fall asleep on the Multiple Sleep Latency Test (MSLT), suggesting that 12 would be a better cutoff. [75]

The ESS score does not correlate well with the primary objective measurement of sleepiness, the MSLT, [76, 77] in that a higher ESS score does not mean shorter latencies on the MSLT. However, a higher ESS score does mean a greater likelihood of falling asleep on the MSLT. [75, 78] The ESS is useful for evaluating responses to treatment; the ESS score should decrease with effective treatment.

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