Sensitivity of Epworth Sleepiness Scale in Detecting Obstructive Sleep Apnea in Pakistani Adults

Background: Self-reported measures of Excessive daytime Sleepiness, such as the Epworth Sleepiness Scale (ESS), have been widely used as a screening tool for OSA, but their accuracy in predicting OSA has been questioned. Objective: The main objective of this research is to re-evaluate the usage of ESS in predicting Obstructive Sleep Apnea (OSA) and to consider additional screening tools, such as polysomnography, to improve the accuracy of OSA diagnosis in the Pakistani population. Methods: It was a retrospective cross-sectional study design, conducted on 500 participants. Data was obtained from the hospital records at the Sleep Lab of Dow University Hospital from January 2021 to March 2023 who completed the Epworth Sleepiness Scale (ESS), received a clinical evaluation from a doctor, and underwent diagnostic polysomnography (PSG), polysomnography is a comprehensive sleep study that monitors various physiological parameters to diagnose sleep disorders. Results: Out of a total sample of 500 participants, 272 were males and 228 were females. The average age was 51 ± 12 years. The average body mass index (BMI) was 37.2 ± 8.1. The average Epworth Sleepiness Scale (ESS) score of the participants was 12.4 ± 4.2. The finding of our study shows Epworth sleepiness score is a good predictor of OSA (AUC 0.84, 95% CI 0.757-0.923). However, the optimal cutoff of ESS is 8.4 which shows sensitivity and specificity of 83.1% and 81.8% respectively. Conclusion: The results suggest that the Epworth Sleepiness Scale may be a useful tool for identifying individuals with OSA, although it also has a low false positive rate, there is a need for further research, and the importance of combining clinical assessment and diagnostic tests for accurate OSA diagnosis.