The Epworth Sleepiness Scale: Self-administration Versus Administration by the Physician, and Validation of a French Version

Background/objectives: The Epworth Sleepiness Scale (ESS) measures sleepiness and is used for, among others, patients with obstructive sleep apnea (OSA). The questionnaire is usually self-administered, but may be physician administered. The aim was to compare the two methods of administration and to validate a French version.

Methods: Consecutive patients presenting to the sleep clinic at a tertiary care centre completed a self-administered questionnaire containing the ESS. During the medical interview the same day, one of three pulmonologists who specialized in sleep medicine administered the ESS. Correlations with the apnea-hypopnea index and mean sleep latencies were used to assess construct validity, while results of previous self-administered ESS questionnnaires in untreated and recently treated OSA patients were used to test reproducibility and longitudinal construct validity, respectively.

Results: In OSA patients, the ESS weakly correlated with the apnea-hypopnea index (r=0.224; P=0.05; n=120) and negatively with mean sleep latency. For untreated patients (test-retest), the mean (+/- SD) average score was unchanged (10.3+/-6.0 to 10.8+/-6.5; P=0.35; n=56) after a median of seven months. With continuous positive airway pressure use, the mean score decreased from 12.4+/-6.8 to 7.6+/-5.0 after 40.2 months (P<0.0001; n=68). For all subjects, the ESS score obtained by the physician was less than that of the self-administered result (9.4+/-5.9 versus 8.5+/-5.8; P<0.0001 [paired t test]; n=188).

Conclusions: In a sleep clinic population, the French version of the ESS performed similarly to the English version. However, the systematic underscoring during physician administration may be important to consider in the research setting if questionnaire administration methods are not consistent.