Value Of ESS In Diagnosing Obstructive Sleep Apnea Syndrome: A Systematic Review

Objective:To evaluate the diagnostic accuracy of Epworth sleepiness scale forObstructive sleep apnea syndrome.Methods:We searched MEDLINE, EMBASE, TheCochrane Library, CBM, WanFang,CNKI to identify all diagnostic tests which evaluatedthe diagnostic value of ESS in patients with OSAS. QUADAS items were used to evaluatethe quality of the included studies. Pooled sensitivity, specificity, positive likelihoodratio,negative likelihood ratio,diagnostic odds ratio, summary receiver operatingcharacteristic curve,and the heterogeneity of the included studies were calculated by usingthe Meta-Disk1.4software.Results:Eleven studies which were identified from726references met the inclusion criteria,total3059patients.The summary sensitivity,specificity,+LR,–LR,and DOR values were0.71［95%CI(0.69，0.73)],0.60[95%CI(0.57，0.63)],2.17[95%CI（1.60，2.93）],0.39[95%CI（0.26，0.57）],and6.10［95%CI（3.00，12.41）］.Respectively,the area under of SROC curve was0.7898, demonstratingsignificant heterogeneity (I2>50%).Through the Meta regression,we found that the choiceof the object was the main source of heterogeneity, according to the group forhomogeneity analysis,total3059patients.The summary sensitivity, specificity,+LR,–LR,and DOR values were0.63［95%CI（0.60，0.66）］,0.54［95%CI（0.50，0.57）］,1.36［95%CI（1.18，1.57）］,0.67［95%CI（0.60，0.75）］and2.08［95%CI（1.64，2.64）］.TheAUC of SROC curve was0.6462.Sensitivity analysis showed that the object impacted theheterogeneity of overall,didn’t each effect size.Conclusion:The use of ESS for OSASdiagnosis has only a low sensitivity and specificity. The overall accuracy of ESS diagnosisis relatively low,there is significant heterogeneity between the studies,so more high qualitystudies are needed.Besides, using ESS alone to diagnose OSAS is not sufficient,it isnecessary in combination with other clinical evaluations.