Beninati and Shepard used SEI in the spousal arousal syndrome, which reported that after treatment with nasal continuous positive airway pressure, sleep efficiency increased. SEI has also been used by Yamadera to assess sleep in psychological studies. Hertz et al reported its use in sleep with Prader-Willi syndrome patients. Pharmacologic sleep-related trials have used this variable as an outcome measurement. However, it is recognized that as an outcome measurement of efficacy, the impact of a possible placebo effect cannot be completely calculated. This is acknowledged, and regardless of this confound, this variable has been extensively used previously in the medical and surgical sleep-related literature, and we have presented these data in a similar fashion. canadian helth& care mall
Questionnaires were used extensively in this investigation in an attempt to gather data on the subjective variables of sleepiness, pain, speech, swallowing, and snoring. The ESS was chosen to evaluate daytime sleepiness. Johns’ reported the ESS to be significantly correlated with sleep latency measured by multiple sleep latency testing and polysomnography. In OSAS, ESS scores were significantly correlated with RDI and nadir Sa02; also, ESS scores of simple snorers were the same as the scores of control subjects. Based on these reports, the ESS was adopted as a previously validated measurement of daytime sleepiness. The ESS improved in our study from a pretreatment mean of 8.5±4.5, to a posttreatment ESS mean of 5.2±3.3 (p<0.0001). These scores are compared with the reported mean ESS scores of Johns for normal control subjects of 5.9±2.2, primary snoring of 6.5±3.0, and OSAS of 11.7±4.6. In those with mild OSAS, he reported a mean RDI of 8.8±2.3 with a mean ESS score of 9.5±3.3. The pretreatment mean ESS scores in our study are consistent with a low level but present sleepiness, and they do decline after treatment to a level below the normal control subjects reported by Johns. It is recognized that there are conflicting reports concerning the correlation between ESS and RDI. Redline et al reported on a series of control subjects (RDI <5) and subjects with mild SDB (RDI, 10 to 30) who underwent ESS and multiple sleep latency testing. Their data suggested that RDI did not correlate in this study with objective or subjective sleepiness. We have reported in our study a nonsignificant change in RDI after RFe treatment (p=0.548), and due to this finding, we did not attempt to correlate RDI with ESS as an outcomes measure.