In the majority of cases, the ESS questionnaire is self administered by the patient. An ESS score of 10 or higher is considered to be a predictor of obstructive sleep apnea (OSA). Lauren B. Bonzelaar, MD, of Rush University Medical Center in Chicago, posed the following question: Should the ESS questionnaire really be self administered? For example, she noted that the questionnaire includes questions such as, “How likely are you to doze in the following situations?” The research team hypothesized that patients may be in denial about their daytime sleepiness levels. If this is the case, then the accuracy of the ESS could be improved by having a close friend or family member who is aware of the patient’s daytime sleepiness fill out a second ESS questionnaire.
Explore this issue:August 2016
Dr. Bonzelaar and her colleagues hypothesized that ESS scores might differ if the questionnaire were filled out by a partner or friend of the patient rather than the patient. Their retrospective chart review of 100 patients compared the ESS score
obtained from a patient with the ESS score obtained from the patient’s friend or partner. The patients were suspected of having OSA, and the questionnaires were completed as part of standard practice upon completion for sleep apnea treatment in an otolaryngology clinic. On average, partners rated the patient higher than the patient rated himself. She concluded that the ESS questionnaire should be filled out with a partner or roommate in order to create a consensus of scoring.
Bottom line: The difference in mean ESS score obtained from the patient compared with the score obtained when a friend or partner fills out the form implies that this diagnostic form should be filled out by the patient in the presence of a partner/friend. A consensus by the patient and the friend may provide a more accurate score.
Improved Treatment of OSA
Respiratory stress from nighttime OSA causes concern for many reasons, one of which is that it leads to increased cardiovascular risk. Continuous positive airway pressure (CPAP) is an effective treatment for OSA only if the patient uses the device. Research has shown that nasal surgery can reduce the mean therapeutic CPAP pressure and increase compliance.
Taken together, these facts lead to the question, Is nasal surgery a cost-effective way to increase compliance?
Judith S. Kempfle, MD, postdoctoral fellow at Massachusetts Eye and Ear Infirmary in Boston and her colleagues performed a two-way sensitivity analysis to identify patients for whom septoplasty is cost-effective. They found that, across a range of plausible values in a clinically relevant decision model, nasal surgery is a cost-effective strategy for increasing CPAP compliance.