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Background: The Epsworth sleepiness score is a vital tool clinicians use to grade the severity of excessive daytime sleepiness and it is also given significant relevance by the third-party payers before approving Continuous Positive Airway Pressure (CPAP) treatment for patients with obstructive sleep apnea with apnea-hypopnea index between 5 to 15 events per hour. Many studies that explored if an elevated Epsworth sleepiness score can predict the presence of obstructive sleep apnea have had conflicting results. Whereas some show association between Epsworth sleepiness score and obstructive sleep apnea, others did not find any association. In this study, the association of Epsworth sleepiness score with obstructive sleep apnea was evaluated at a community-based practice with multiple locations all around central Florida. We also analyzed the association of apnea-hypopnea index with known risk factors for obstructive sleep apnea such as larger neck circumference, overweight and obesity.
Methods: In this cross-sectional study, we reviewed the charts of 529 consecutive subjects who presented for sleep evaluation at a community practice over a period of 6 months and underwent sleep studies. 186 (35%) of the patients were not included in our analysis because they have incomplete data. 343 patients were used for this data analysis and 252 (73.5%) were diagnosed with sleep apnea based on apnea-hypopnea index of ≥5 per hour on polysomnography. The following data were collected on each subject; body-mass-index, neck circumference, Epworth sleepiness score, the absence or presence of excessive daytime sleepiness, hypertension and diabetes. Epworth sleepiness score ≥10 was considered elevated while large neck circumference was set at ≥16 inches in females and ≥17 inches in males.
Results: 252 patients had sleep apnea, 94.8% of them were overweight or obese, 84.1% had large neck circumference, 82.1% presented with excessive daytime sleepiness, 63.1% had hypertension, 34.1% had diabetes and 57.5% had an elevated Epworth sleepiness score. Pearson’s tests between body-mass-index and apnea-hypopnea-index in the overweight and obese patients showed positive correlation (P<0.001, R=0.24, N=319). Furthermore, the relationship between neck circumference and apnea-hypopnea-index in males with neck circumference of ≥17 inches was significant with positive correlation (P=0.047, R=0.17, N=143) likewise, in females with neck circumference ≥16 inches, the relationship was also significant (P<0.001, N=128) with a stronger correlation (R=0.32) but the association between Epsworth sleepiness score and AHI was not significant (P=0.79, R=0.02, N=193). Interestingly, a significant positive correlation co-efficient (R=0.39, P=0.02) was seen between BMI and AHI in the population of males who were overweight, hypertensive and diabetic. The same relationship was not significant in females (P=0.1).
Conclusion: In this study, BMI in overweight patients and large neck circumference has positive correlation with apnea-hypopnea-index but no significant association was found between elevated Epsworth sleepiness score and apnea-hypopnea-index. The strength of this study is that it was done in a community-based setting with a realworld patient population. We believe our findings will be applicable to many community-based settings around the countryy.
Published Date: 2019-09-25; Received Date: 2019-08-18