Background: The Epworth Sleepiness Scale (ESS) is a questionnaire widely used in English speaking countries for assessment of subjective daytime sleepiness. Objective: Our purpose was to translate and validate the ESS for use in German-speaking countries. Methods: A German translation of the ESS was administered to 159 healthy German-speaking Swiss and to 174 patients with various sleep disorders. Results: The mean ± SD of ESS scores in normals was 5.7 ± 3.0, in patients it was 13.0 ± 5.1 (p < 0.001). Scores were not correlated with age or gender but with the percentage of time spent at an oxygen saturation <90% (R = 0.35, p < 0.001), and the respiratory disturbance index (R = 0.26, p < 0.001) in primary snorers and sleep apnea patients. Item analysis confirmed internal consistency of the scale (Cronbach α = 0.60 in normals, and 0.83 in patients). Follow-up scores in 25 sleep apnea patients on treatment showed a reduction by 7 ± 5 points (p < 0.05). Conclusions: Our data validate the ESS for application in German-speaking populations. The simplicity, reliability and the apparent lack of relevant influences of language and cultural background on performance of the ESS makes it a valuable tool for clinical management and research.

Young T, Palta M, Dempsey J, Skatrud J, Weber S, Badr S: The occurrence of sleep-disordered breathing among middle-aged adults. N Engl J Med 1993;328:1230–1235.
Ohayon MM, Guilleminault C, Priest RG, Caulet M: Snoring and breathing pauses during sleep: Telephone interview survey of a United Kingdom population sample. BMJ 1997;314:860–863.
Johns MW: A new method for measuring daytime sleepiness: The Epworth Sleepiness Scale. Sleep 1991;14:540–554.
Johns MW: Daytime sleepiness, snoring and obstructive sleep apnea. The Epworth Sleepiness Scale. Chest 1993;103:30–36.
Johns MW: Reliability and factor analysis of the Epworth Sleepiness Scale. Sleep 1992;15:376–381.
Johns MW: Sleepiness in different situations measured by the Epworth Sleepiness Scale. Sleep 1994;17:703–710.
Johns MW, Hocking B: Daytime sleepiness and sleep habits of Australian Workers. Sleep 1997;20:844–849.
Hardinge FM, Pitson DJ, Stradling JR: Use of the Epworth Sleepiness Scale to demonstrate response to treatment with nasal continuous positive airway pressure in patients with obstructive sleep apnea. Respir Med 1995;89:617–620.
Chen SY, Clift SJ, Dahlitz MJ, Dunn G, Parkes JD: Treatment in the narcoleptic syndrome: Self assessment of the action of dexamphetamine and clomipramine. J Sleep Res 1995;4:113–118.
Pouliot Z, Peters M, Neufeld H, Kryger MH: Using self-reported questionnaire data to prioritize OSA for polysomnography. Sleep 1997;20:232–236.
Maycock G: Sleepiness and driving: The experience of UK car drivers. J Sleep Res 1996;5:229–237.
Izquierdo-Vicario Y, Ramos-Platón M, Conesa-Peralejy D, Lozano-Parra AB, Espinar-Sierra J: Epworth Sleepiness Scale in a sample of the Spanish population (letter). Sleep 1997;20:676–677.
Spieweg I, Volk S, Mayer G, Bes FW: Schlafstörungsspezifische Selbstbeurteilungsverfahren, Schlaffragebögen; in Kompendium Schlafmedizin für Ausbildung, Klinik und Praxis. Landsberg/Lech, Deutsche Gesellschaft für Schlafforschung und Schlafmedizin, 1997, III-2.3.0–III-2.3.8.
Standards of Practice Committee of the American Sleep Disorders Association: Practice parameters for the use of portable recording in the assessment of obstructive sleep apnea. Sleep 1994;17:372–377.
Bloch KE, Li Y, Sackner MA, Russi EW: Breathing patterns during nonapneic snoring. Eur Respir J 1997;10:576–586.
American Sleep Disorders Association Standards of Practice Committee: Practice parameters for the indications for polysomnography and related procedures. Sleep 1997;20:406–422.
Diagnostic Classification Steering Committee (Thorpy MJ, Chairman): International Classification of Sleep Disorders: Diagnostic and Coding Manual. Rochester, American Sleep Disorders Association, 1990.
Cronbach LJ: Coefficient alpha and the internal structure of test. Psychometrika 1951;16:297–334.
Bland MJ, Altman DG: Statistical methods for assessing agreement between two methods of clinical measurement. Lancet 1986;i:307–310.
Hanley JA, McNeil BJ: The meaning and use of the area under a receiver operating characteristic curve. Radiology 1982;143:29–36.
Carskadon MA, Dement WC, Mitler MM, Roth T, Westbrook PR, Keenan S: Guidelines for the multiple sleep latency test (MSLT): A standard measure of sleepiness. Sleep 1986;9:519–524.
Mitler MM, Guijavarty KS, Browman CP: Maintenance of wakefulness test: A polysomnographic technique for evaluating treatment in patients with excessive somnolence. Electroencephalogr Clin Neurophysiol 1982;53:658–661.
Douglass AB, Bornstein R, Nino-Murcia G, Keenan S, Miles L, Zarcone VP, Guilleminault C, Dement WC: The sleep disorders questionnaire. I. Creation and multivariate structure of SDQ. Sleep 1994;17:160–167.
Kump K, Whalen C, Thishler PV, Browner I, Ferrette V, Strohl KP, Rosenberg C, Redline S: Assessment of the validity and utility of a sleep-symptom questionnaire. Am J Respir Crit Care Med 1994;150:735–741.
Hoddes E, Zarcone V, Smythe H, Phillips R, Dement WC: Quantification of sleepiness: A new approach. Psychophysiology 1973;10:431–436.
Copyright / Drug Dosage / Disclaimer
Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.
You do not currently have access to this content.