Identifying excessive sleepiness associated with OSA or SWD

It can be difficult to diagnose excessive sleepiness (ES) associated with obstructive sleep apnea (OSA) or shift work disorder (SWD).

Many patients may describe themselves as "tired," although there are a number of different diagnoses and potential treatments that could be appropriate. This section includes a variety of tools to help you find out more about what is affecting your patients.

Do you have a patient who may have ES associated with one of these disorders?

Patients can describe ES in different ways. For example, patients with ES associated with OSA often present with¹:

• Tiredness
• Fatigue
• Difficulty concentrating
• Lack of energy

Identifying ES associated with SWD

To identify patients who may have ES associated with SWD, ask 3 questions:

• Do you work shifts or a nontraditional work schedule?
• Do you struggle to stay awake when you should be awake?
• Is your work, home, or social life negatively affected?

The Epworth Sleepiness Scale (ESS) and treated OSA

When you suspect ES associated with treated OSA, consider having patients complete the ESS. The ESS can help you screen for ES. Patients are asked to rate the chances of dozing off or falling asleep during different routine situations.²

• A total score of 10 or more suggests the need for further evaluation. It is important to identify whether the patient has an underlying sleep disorder

Administering the ESS²

• The ESS is a self-rated questionnaire with 8 items that describe routine situations
• Subjects rate the likelihood of dozing off or falling asleep in each of these situations
• Each item is rated on a 4-point scale from 0 (would never doze) to 3 (high chance of dozing)
• The item scores are added to produce a total score ranging from 0 to 24
• Download the ESS tool

While NUVIGIL is indicated to treat ES associated with SWD, it is not indicated to treat SWD or its other associated symptoms or sequelae.

References: 1. Chervin RD. Sleepiness, fatigue, tiredness, and lack of energy in obstructive sleep apnea. Chest. 2000;118(2):372-379. 2. Johns MW. Reliability and factor analysis of the Epworth Sleepiness Scale. Sleep. 1992;15(4):376-381.