Introduction Excessive daytime sleepiness is generally less prevalent in insomnia when compared with other sleep disorders.1 As a result of this, the Epworth Sleepiness Scale (ESS)2 is currently used by our service to triage patients referred by their GP with symptoms of insomnia for assessment. Patients with an ESS 0-3 are triaged straight to assessment in a joint sleep medicine and clinical psychology clinic. Patients with an ESS 4+ are first triaged for further investigation, using actigraphy, oximetry and full overnight polysomnography to look for other elements of sleep disturbance apart from insomnia. This audit aimed to evaluate the effectiveness of the current triaging process and review patient treatment pathways arising from this.
Methods Data was analysed for 131 patients, 86 females (age 16–87, mean 49.6), and 45 males (age 19–84, mean 52.98), from the joint insomnia clinic between February 2018 and March 2019. ESS of 0–3, 4–10, and 11+, were analysed separately to look for associations between the ESS and diagnoses, in order to evaluate the utility of the current triaging process.
Results Figures 1 and 2 show diagnoses/treatment pathways.
As shown as the ESS increased, there was a shift from psychological to physiological sleep pathology. This is also reflected in the change from psychological to medical intervention, with the exception of drug therapy for delayed sleep in ESS 0–3. Those with an Epworth of 4–10 had more of a diverse and comorbid presentation, while ESS 11+ was mostly physiological pathology.
Discussion This audit demonstrated our current triaging process using Epworth scores is effective in directing patients to the most appropriate care pathway. The vast majority of those with the lowest Epworth scores accessed psychological treatment in the form of CBT-I, whilst the utility of further objective investigation in those with ESS 4+ was also demonstrated.
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Johns MW. A new method for measuring daytime sleepiness: the Epworth sleepiness scale. sleep 1991;14(6):540–545.
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