|Description:||The Epworth Sleepiness Scale (ESS) is used to assess daytime sleepiness in adults.1 The prevalence of daytime sleepiness in people with depressive symptoms is high—ranging from about 40%-50%.2 Clinicians can consider using the ESS to measure daytime sleepiness in patients experiencing depressive episodes. The ESS has demonstrated a positive association with depressive scores (e.g., on the Beck Depression Inventory) in people with Major Depressive Disorder (MDD).3|
|Disease States:||Major depressive disorder|
|Time to administer:||Less than 5 minutes|
|Commonly used in:||Clinical Trials & Research, Clinical Practice|
|Detailed Description:||The ESS was developed to measure daytime sleepiness in adults. 5 Respondents are asked to rate on a 0-3 scale (0 = no chance of dozing, 1 = slight chance of dozing, 2 = moderate chance of dozing, 3 = high chance of dozing) their chances of falling asleep in 8 different situations (e.g., “sitting and talking to someone,” “in a car, while stopped for a few minutes in traffic”). 5 Each item response is totaled, with scores ranging from 0-24; higher scores indicate a greater level of daytime sleepiness.1 Scores higher than 10 are indicative of excessive daytime sleepiness.4|
|Scale Validity:||The ESS has good reliability, with a mean Cronbach’s alpha of 0.82,4 with good internal consistency and split-half reliability (correlations around 0.84). 4 Known-group construct validity is strong, as patients with sleep disorders have reported higher scores on the ESS compared to normal individuals. 1,4,6|
|Alternative Versions:||The original version of the ESS, published in 1990, was updated in 1997 with new instructions after it was found that some respondents were not answering all of the questions, which invalidated their scores. New instructions added to the 1997 version resolved this issue and it is now the standard version. 6
The ESS has been translated into more than 50 languages, including Arabic, Croatian, Finnish, German, Hebrew, Polish, and Swedish. 7
|Cited Limitations:||The ESS may be prone to bias because answers are based on subjective self-report. It cannot make accurate predictions about a person’s future level of drowsiness. For this reason, the ESS cannot be used for adjudicating legal decisions, such as whether someone is fit to hold a driver’s license.6 The ESS should not be used in people with significant cognitive impairment.6
The ESS is not diagnostic and cannot be used to clinically diagnose a sleep disorder. It also does not offer information about other aspects of a person’s sleep that might be dysregulated. 6
Finally, additional research is needed to better explore the factor structure of the ESS as well as to analyze the way its cut-off scores are determined and implemented for clinical use. 4
Supporting references for the filters are as follows: Disease States: Daytime sleepienss;1 Validated Uses: Assessment;2 Administration Method: Self-report;3 Time to Administer: Less than 5 minutes;4 Commonly Used In: Clinical practice and research1
- Kendzerska TB, et al. Sleep Med Rev. 2014;18(4):321-31.
- Zhang D, et al. Front. Psychiatry. 2021;12:710435
- Lundt L. General Hospital Psychiatry 2005;27:146–148
- Fabbri M, et al. Int J Environ Res Pub Health. 2021;18:1082.
- Johns MW. Sleep. 1991;14(6):540-545.
- Epworth Sleepiness Scale. https://epworthsleepinessscale.com/. (n.d.) Accessed February 22, 2022.
- eProvide. Epworth Sleepiness Scale (ESS). https://eprovide.mapi-trust.org/instruments/epworth-sleepiness-scale. February 2022. Accessed February 22, 2022.