EPWORTH SLEEPINESS SCALE. The aim of this questionnaire is to get a measure of your sleepiness during the day. This helps distinguish between normal. Epworth Sleepiness Scale. Name: Date: Your age: (Yr). Your sex: Male Female. How likely are you to doze off or fall asleep in the situations described below. EPWORTH SLEEPINESS SCALE FORM. Instructions: Be as truthful as possible. Print the form. Read the situation in the first column; select your response from.

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Download professional therapy worksheets, handouts, and exercises. for measuring daytime sleepiness: the Epworth sleepiness scale. sleep, 14(6), Download free psychological assessments, symptom measures, and rating scales. measuring daytime sleepiness: the Epworth sleepiness scale. sleep, 14 (6). Epworth Sleepiness Scale Pittsburgh Sleep Quality Index Fatigue Severity Scale Download to read the full chapter text Observational study of sleep-related disorders in Italian patients with Parkinson's disease: . ISBN 0; Online ISBN ; eBook Packages Medicine.

Two investigations included the use of esophageal manom- etry13,28 as part of a PM array of bioparameters. However a pre- vious evidence review6 described only 3 studies, 2 in-laboratory NO and 1 at home, that could be used to provide support that this improves accuracy.

Despite its overwhelming face validity, the YES subsequent practice parameter requested further research be done PM or in-lab PSG before Type 2 monitors could be recommended. Although numer- ous studies using unattended home polysomnography to assess sleep disordered breathing have been published since the last evi- OSA diagnosed?

Therefore, the current committee only evaluated a PM if it did not include a measure of sleep stage. Figure 1Flow chart depicting recommended pathway of patients Our review also found that actigraphy28,29 was not a sufficiently considered for PM.

Patients appropriate for PM should have moder- accurate substitute measure of sleep time to recommend its rou- ate to high risk for OSA, have no comorbid medical conditions and tine use. Patients not considered appropriate for PM should have in-laboratory polysomnography. The sensor to detect apnea is an oronasal thermal sensor Certified Sleep Specialist or an individual who fulfills the eligibility and to detect hypopnea is a nasal pressure transducer.

Ideally, criteria for the sleep medicine certification examination PMs should use both sensor types. Both of these recommenda- spiratory effort and blood oxygenation.

The Task Force evaluated other sensor types in great detail. Previous literature review reveals that as a measure of airflow, Four studies in the current review14,29,31,43 evaluated a PM that uses nasal pressure is less accurate than pneumotachometer but more arterial tone, actigraphy, and oximetry.

The evidence for their use accurate than thermal sensors thermocouples and thermistors. Although nasal pressure 0. In 30 patients studied both in-laboratory and at devices may be superior to thermistors for detection of flow, they home31 and in a larger study of 98 individuals studied at home,43 are limited to only nasal flow assessment, leaving mouth flow similar degrees of accuracy were found in preselected populations undetected.

Therefore, this recommendation was types reflects these considerations. At the time of the earlier evi- based on consensus. Standards for patient evaluation and follow- dence review, nasal pressure monitors had not been tested in the up, requirements for policies and procedures, and recommen- unattended home setting,5 and the current literature review sheds dations for quality control are part of the AASM Standards for no further light on the relative performance of PM devices using Accreditation of Sleep Centers.

Ideally the sensor for identification of respiratory effort is PM for the diagnosis and management of OSA.

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For programs either calibrated or uncalibrated inductance plethysmography. It is important to recognize, in None of these techniques have been thor- ing and ongoing, systematic monitoring by senior scientists.

In oughly evaluated during PM. With the exception of respiratory the case of the SHHS, technologists were specifically trained and inductive plethysmography, these signals provide a qualitative certified for data acquisition and scoring. Technologists applied measure only. Therefore, previous guidelines for PSG have not all of the sensors following carefully designed protocols. Studies recommended their routine use during in-laboratory PSG. In or- were scored at a central facility using a detailed scoring manual.

Respiratory inductive plethysmography that is found to show good agreement. This does not mean that high quality tidal volume.

The sensor for the detection of blood oxygen is pulse oxim- 3. An experienced sleep technician, sleep technologist, or ap- etry with the appropriate signal averaging time and accommoda- propriately trained healthcare practitioner must perform the tion for motion artifact.

Fall-asleep crashes occur at two periods of day that coincide with circadian variation in sleepiness, in the early morning a.

Pack et al. The most common reasons behind fall-asleep crashes are working multiple jobs, night shift work, and sleep duration of less than 5 hours Connor et al. Sleep apnea accounts for a small, but measurable percentage of motor vehicle crashes, primarily in drivers above the age of 25 Sassani et al.

Individuals with sleep apnea are at twice the risk of having a traffic accident as unaffected individuals Teran-Santos et al. Sleepy drivers tend to display reduced vigilance, slow reaction times, and loss of steering control. Steering impairment in OSA, sleep deprivation, and alcohol intoxication was compared in a controlled clinical trial. Untreated OSA and sleep deprivation were similar in producing progressive steering deterioration throughout the drive, whereas alcohol-impaired individuals steered equally throughout the drive Hack et al.

Commercial truck drivers have attracted the most study because of the prevalence, severity, and public health impact of crashes involving commercial trucks.

There are an estimated , injuries and 5, fatalities each year in motor vehicle accidents involving commercial trucks CNTS, Although this figure is not universally accepted, the definition of fatigue by the NTSB is equivalent to the term sleepiness or sleep-related fatigue used by sleep experts i.

A congressionally mandated study of 80 long-haul truck drivers in the United States and Canada found that drivers had short sleep duration, averaging 5.

Sleep duration was verified electro-physiologically over the 5-day study. Further, commercial drivers have a high prevalence of sleep apnea Stoohs et al. Recent studies have found that sleep apnea affects 8 to 15 percent of commercial drivers in the United States and Australia Gurubhagavatula et al.

Work-Related Injuries Sleep-related fatigue is an independent risk factor in work-related injuries and fatalities, according to two large and well-designed studies Akerstedt et al.

T he current standard for clinical practice, established through

Swaen and coworkers prospectively studied a cohort of more than 7, workers in numerous industries in the Netherlands over a 1-year period before studying the occurrence of occupational accidents.

During the year they collected information about sleep patterns and other potential risk factors for work-related injuries.

The employees who reported being injured during the next year could be assessed for risk factors without recall bias affecting the results. The study found a dose-response relationship between two sleep-related fatigue measures and injuries.

For example, highly fatigued workers were 70 percent more likely to be involved in accidents than were workers reporting low fatigue levels, after adjustment for other risk factors. Workers with chronic insomnia were also far more likely than those who were good sleepers to report industrial accidents or injuries Leger et al.

Similarly, workers who report snoring and excessive daytime sleepiness, indications of sleep apnea, are twice as likely to be involved in workplace accidents, as verified by registry data and after adjusting for all potential confounders Lindberg et al. Falls in Older People Falls are a common and costly problem in older people 65 years and older , whether in the community or in long-term care facilities.

Each year, more than 30 percent of older people fall Hausdorff et al. Falls are the leading cause of death for this particular age group Murphy, Although most falls are not directly fatal, they are a leading cause of injuries and trauma-related hospital admissions Alexander et al.

Insomnia increases the risk of falling Brassington et al. One of the major questions raised by this finding is what is responsible for the increased risk of falls—the underlying insomnia or the use of medication to treat it?

Until recently, most of the studies addressing this question were not large enough to yield an answer.

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In , a large, prospective study of 34, nursing home residents across the state of Michigan ruled out use of hypnotic medications as a risk factor for falls Avidan et al. In fact, the study found that treated insomnia, and untreated insomnia, but not hypnotic medications, were predictors of falls. Although the results of this study did not find that insomnia increased the risk of hip fractures, other studies have found an association Fitzpatrick et al.

Preliminary data from the Study of Osteoporosis in Women also indicate an increased risk of falls associated with decreased sleep efficiency and sleep time as measured objectively using actigraphy in a large group of older women, with effects persisting after adjustment of health status and mood and other confounders Stone et al. Interventions There have been a few studies that have examined the effect of interventions on improving the outcomes associated with sleepiness.

A range of regulatory, technological, and therapeutic approaches are possible to ameliorate the problem of sleepiness among commercial drivers Walsh et al. However, there has been limited study of the benefit of these strategies. This analysis will help the establishment of much-needed future rules and regulations pertaining to sleep loss and fatigue. Preplanned naps have been successfully tested in crew members on transmeridian flights; the findings show that safe and feasible rotations occurred as crew members took brief, minute nap periods, and the naps improved alertness Graeber et al.

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Similarly, a study of Italian policemen who patrol highways found that prophylactic naps before a night shift can lower the risk of motor vehicle accidents during the shift, according to a combination of retrospective questionnaire, prospective analysis, and mathematical modeling Garbarino et al.

These studies also dispel any doubt of the causal relationship between sleep disorders and accidents. Preview Unable to display preview. Download preview PDF. References 1. J Neurol Neurosurg Psychiatry.

Google Scholar 2. Mov Disord. Google Scholar 3. Google Scholar 4. Google Scholar 5. Google Scholar 6. Neurol Sci ; Google Scholar 7. J Neurol Sci. Google Scholar 8.

Parkinsonism Relat Disord. Google Scholar 9.Sleep The cognitive deficits with sleep-disordered breathing are thought to be related to both sleep fragmentation and hypoxemia Weaver and George, Nor does it measure how often, or for how long, the respondent sleeps during the day.

Recent studies have found that sleep apnea affects 8 to 15 percent of commercial drivers in the United States and Australia Gurubhagavatula et al. PD mean duration was 6.

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