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Zirkadianer Rhythmus

Einfluss auf den Punktwert der Epworth-Schläfrigkeits-Skala

Circadian rhythm

Influence on Epworth Sleepiness Scale score

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Zusammenfassung

Hintergrund

Die Epworth-Schläfrigkeits-Skala (ESS) ist ein häufig benutztes Messinstrument, um das Ausmaß von Tagesschläfrigkeit bei Patienten mit schlafbezogenen Atmungsstörungen zu erfassen. Inwieweit die Tagesschläfrigkeit bedingt durch tageszeitabhängige Vigilanzschwankungen zum Zeitpunkt der Beantwortung der ESS-Fragen einen Einfluss auf den Summenwert der ESS hat, ist bisher noch nicht umfassend geklärt.

Ziel der Arbeit

Ziel der Studie war es, den Einfluss des tageszeitabhängigen Vigilanzniveaus auf die ESS zu evaluieren.

Material und Methoden

Im Rahmen einer monozentrischen, prospektiven, nichtinterventionellen Beobachtungsstudie bei Patienten (n = 97) mit Verdacht auf schlafbezogene Atmungsstörungen wurde in zeitlichem Zusammenhang zur Polysomnographieuntersuchung und Therapie die Tagesschläfrigkeit erfasst. Die Karolinska-Schläfrigkeits-Skala (KSS) und die Stanford-Schläfrigkeits-Skala (SSS) dienten als Referenzmethode zur Erfassung der momentanen Tagesschläfrigkeit über jeweils 3 Messzeitpunkte (morgens, nachmittags, abends) vor und nach einer Polysomnograpie(PSG)-Diagnostiknacht sowie nach einer CPAP-Titrierungsnacht („continuous positive airway pressure“, insgesamt 9 Messzeitpunkte). Gleichzeitig zu KSS und SSS wurde die ESS zur Beantwortung angeboten.

Ergebnisse

Die Skalenniveaus von KSS und SSS zeigen einen tageszeitabhängigen Verlauf mit einer erhöhten Tagesschläfrigkeit nachmittags und abends. Nach einer PSG-Diagnostiknacht war die Tagesschläfrigkeit im Vergleich zur Referenzmessung erhöht. Nach einer CPAP-Titrierung reduzierte sich die morgendliche Tagesschläfrigkeit wieder. KSS und SSS spiegeln somit Schwankungen des Vigilanzniveaus wider. Die Summenwerte der ESS waren von tageszeit- und tagesabhängigen Schwankungen des Vigilanzniveaus unbeeinflusst.

Schlussfolgerung

Die ESS scheint nach vorliegenden Daten – von tageszeitlichen Vigilanzschwankungen unbeeinflusst – die Tagesmüdigkeit retrospektiv über einen längeren Zeitraum zu erfassen.

Abstract

Background

The Epworth Sleepiness Scale (ESS) is frequently used to determine daytime sleepiness in patients with sleep-disordered breathing. It is still unclear whether different levels of alertness induced by the circadian rhythm influence ESS score.

Objective

The aim of this study is to investigate the influence of circadian rhythm-dependent alertness on ESS performance.

Materials and methods

In a monocentric prospective noninterventional observation study, 97 patients with suspected sleep-disordered breathing were investigated with respect to daytime sleepiness in temporal relationship to polysomnographic examination and treatment. The Karolinska Sleepiness Scale (KSS) and the Stanford Sleepiness Scale (SSS) served as references for the detection of present sleepiness at three different measurement times (morning, noon, evening), prior to and following a diagnostic polysomnography night as well as after a continuous positive airway pressure (CPAP) titration night (9 measurements in total). The KSS, SSS, and ESS were performed at these times in a randomized order.

Results

The KSS and SSS scores revealed a circadian rhythm-dependent curve with increased sleepiness at noon and in the evening. Following a diagnostic polysomnography night, the scores were increased compared to the measurements prior to the night. After the CPAP titration night, sleepiness in the morning was reduced. KSS and SSS reflect the changes in alertness induced by the circadian rhythm. The ESS score war neither altered by the intra-daily nor by the inter-daily changes in the level of alertness.

Conclusion

According to the present data, the ESS serves as a reliable instrument to detect the level of daytime sleepiness independently of the circadian rhythm-dependent level of alertness.

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Authors and Affiliations

  1. Klinik für Hals-Nasen-Ohrenheilkunde, Kopf- und Halschirurgie, Carl-Thiem-Klinikum GmbH, Thiemstr. 111, 03048, Cottbus, Deutschland

    M. Herzog

  2. Habersaathstraße 38e, 10115, Berlin, Deutschland

    A. Bedorf

  3. Klinik und Poliklinik für Hals-Nasen-Ohren-Heilkunde, Universitätsklinikum Regensburg, Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Deutschland

    C. Rohrmeier & T. Kühnel

  4. Institut für Medizinische Epidemiologie, Biometrie und Informatik, Martin-Luther-Universität Halle-Wittenberg, Magdeburger Straße 8, 06112, Halle (Saale), Deutschland

    B. Herzog

  5. Klinik und Poliklinik für Hals-, Nasen-, Ohrenkrankheiten, Kopf- und Halschirurgie, Universitätsmedizin Greifswald, Sauerbruchstrasse, 17475, Greifswald, Deutschland

    T. Bremert

  6. Klinik und Poliklinik für Hals-Nasen-Ohren-Heilkunde, Kopf- und Halschirurgie, Martin-Luther-Universität Halle-Wittenberg, Ernst-Grube-Straße 40, 01620, Halle (Saale), Deutschland

    M. Herzog, S. Plontke & S. Plößl

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Correspondence to M. Herzog.

Ethics declarations

Interessenkonflikt

M. Herzog gibt an, dass er zu Implantationskursen der Firmen Inspire und ImThera eingeladen wurde. A. Bedorf, C. Rohrmeier, T. Kühnel, B. Herzog, T. Bremert, S. Plontke und S. Plößl geben an, dass kein Interessenkonflikt besteht.

Alle beschriebenen Untersuchungen am Menschen wurden mit Zustimmung der zuständigen Ethik-Kommission, im Einklang mit nationalem Recht sowie gemäß der Deklaration von Helsinki von 1975 (in der aktuellen, überarbeiteten Fassung) durchgeführt. Von allen Patienten liegt eine Einverständniserklärung vor.

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W. Baumgartner, Wien

P. K. Plinkert, Heidelberg

M. Ptok, Hannover

C. Sittel, Stuttgart

N. Stasche, Kaiserslautern

B. Wollenberg, Lübeck

Gewidmet Prof. Dr. Wolfgang Pirsig, als Pionier der deutschen HNO-ärztlichen Schlafmedizin.

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Herzog, M., Bedorf, A., Rohrmeier, C. et al. Zirkadianer Rhythmus. HNO 65, 154–162 (2017). https://doi.org/10.1007/s00106-016-0270-3

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