Introduction The pictorial Epworth Sleepiness Scale (ESS) (Ghiassi et al., Thorax 2011) has been developed and validated against the traditional ESS and allows subjects to intuitively answer the questions related to daytime sleepiness with pictorial items. Although non-specific, the ESS has been validated for sleep apnoea patients and it is widely used for screening patients. We hypothesised that the use of an online pictorial ESS can promote public awareness and help to screen for patients with undiagnosed sleep disorders.
Methods Between 2011 and 2012, we collected the pictorial ESS data of 24,272 subjects on the official webpage of the British Lung Foundation. Following a short explanation to the questionnaire, eight items are marked and given a score from `0` (not likely todoze) to `3` (very likely to doze) using pictorial items, the range of the total score for the pictorial ESS being `0` to `24`. The cut-off for excessive daytime sleepiness (EDS, more than 10 points) was chosen in line with the traditional ESS. In 3,265 questionnaires the subjects’ age and gender were also recorded (starting from 03/2012). Chi-square test was used to compare the proportion of different groups.
Results The total 24,272 subjects scored a mean of 9.3 (5.1) points on the pictorial ESS. Of those, 38.0% were excessively sleepy (14.6 (3.2) points) and 62.0% had normal levels of sleepiness (5.9 (2.7) points, p<0.001). In the 3,265 subjects with age and gender recorded, there was no significant difference in the prevalence of excessive daytime sleepiness between genders (42.8% vs 43.9%, p=0.68). When age was considered, females tended to be sleepier than males in their 3rd and 4th lifetime decade (p<0.02), whilst males scored significantly higher in the 7th decade (p<0.0001, Figure); there was a statistically significant trend with age (p-value for trend p<0.001)
Conclusion The online pictorial ESS identifies gender differences in EDS on a large scale and reveals more severe levels of sleepiness associated with higher age. The use of modern media facilitates reaching out to the general population to raise awareness of conditions associated with daytime sleepiness such as sleep apnoea.