Article Text

Download PDFPDF

Sleep: clinical studies
P23 500 consecutive referrals to a DGH sleep service: how useful is the Epworth?
  1. L H White,
  2. S Backway,
  3. A Kerry,
  4. A Stanton,
  5. M Juniper
  1. Great Western Hospital, Swindon, UK


Introduction and Objectives Our sleep service offers assessment and treatment of sleep-disordered breathing (SDB). Our commissioners suggested that patients with an Epworth Sleepiness Score (ESS) = 9 did not require assessment. We assessed the characteristics of patients referred and usefulness of baseline ESS. All patients referred for assessment of SDB were entered onto a database prospectively from October 2009 to June 2011. Baseline data recorded was: referral source, demographics, ESS, sleep study type, oxygen desaturation index >4% (ODI), study interpretation, treatment decision.

Results 500 patients were referred, most commonly by GP (n=349), endocrinology (n=50), respiratory (n=34) and ENT (n=29). 365 patients were male, mean age (±SD) 51.3±13.5 years. 476 patients (95.2%) underwent respiratory polygraphy (377 inpatient, 99 at home) and 24 (4.8%) overnight oximetry. Initial mean ESS (±SD) was 13.3±6.0 and was positive (=10) in 354 patients (70.8%). SDB was demonstrated in 309 patients (61.8%) and periodic limb movements in 8. Positivity rates varied with referral source (GP–64.8%, diabetes–55.2%, respiratory–67.6%, ENT – 55.2%) and sleep study type (inpatient polygraphy-60.2%, home polygraphy-76.8%, oximetry-58.3%). Diagnosis was obstructive sleep apnoea (OSA) (n=246, 15 with coexistent hypoventilation), upper airways resistance (n=56), obesity hypoventilation (n=4), central sleep apnoea (n=2) and COPD-related nocturnal hypoxia (n=1). Median ODI for all studies was 9 (range 0–150). OSA was mild in 72 patients (29.3%), moderate in 65 (26.4%) and severe in 106 (43.1%). ODI was <5 in 3 patients (1.2%) but the study deemed positive. Following clinical assessment, 269 patients (53.8%) commenced CPAP, of whom 36 (13.4%) had an initial ESS=9. In these patients, severity of SDB did not relate to baseline ESS (mean ODI 32.0 (ESS=9) vs 30.5 ESS=10)). Of the 106/500 patients with ESS=9, 54.3% had a positive study and 33.3% were commenced on CPAP, as compared to 65.5% and 58.8% respectively of patients with ESS=10.

Conclusion We identified a reasonable percentage of patients referred with suspected SDB. A significant number of such patients had a normal ESS, which may underestimate symptoms warranting CPAP. A negative ESS should not preclude sleep referral and should be used with caution when designing referral criteria.

Statistics from

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.