0506 FALLING ASLEEP VERSUS FEELING SLEEPY IN SLEEP APNEA SCREENING

The symptom of sleepiness can be assessed by different methods such as the multiple sleep latency test, the maintenance of wakefulness test and the Epworth sleepiness scale (ESS), each one contemplating different dimensions of sleepiness. ESS, for instance, assesses the propensity to falling asleep in soporific situations. The ESS correlates weakly with the apnea-hypopnea index (AHI) and is a poor predictor of obstructive sleep apnea (OSA). We performed a retrospective cross-sectional study to test whether a single question on perceiving oneself as sleepy can replace the ESS to detect different levels of AHI. From a sleep laboratory database we selected records of adults that underwent baseline in-laboratory full-night polysomnography performed with standard equipment and scored using AASM criteria. All subjects replied to the following question: “Do you consider yourself sleepier than other people?” and answered the ESS. Exactly 3785 patients were included; 63% were men, the mean (±SD) age was 44 ± 13 years, body mass index (BMI), 29.6 ± 5.9kg/m2, and AHI, 22.4 ± 23.7 events/hour. ESS>10 was observed in 1381 (36.5%) patients; 1887 (49.9%) considered themselves sleepier than other people (Sleepier). Factor analysis indicates that this question remains in the same component as the eight ESS items. Sleepier and ESS>10 patients were significantly different in terms of anthropometric, polysomnographic, and perceived-sleep variables. The Sleepier group had AHI>5 in 72.9% of the cases; the ESS>10 group had AHI>5 in 72.3% of the cases. Those in the Sleepier group had AHI>30 in 32.3% of the cases; those in the ESS>10 group had AHI>30 in 23.7% of the cases. To detect AHI>30, being in the Sleepier group had a sensitivity of 73%, specificity of 46%, accuracy of 54%; having an ESS>10 had a sensitivity of 58%, specificity of 58%, accuracy of 58%. Sleepiness is knowingly a poor predictor of OSA. In case of time limitation to obtain the ESS score, one question on self-perceived sleepiness will perform only slightly inferiorly to the ESS, in OSA screening. Feeling sleepy reproduces the same dimension of the sleepiness symptom as falling asleep in soporific situations and can replace the ESS when necessary. -