A Low Epworth Score Does Not Settle Sleep-Apnea Referral

An Epworth Sleepiness Scale score should not decide referral on its own. NICE’s August 2021 assessment summary places the scale alongside a sleep history and assessment for suspected obstructive sleep apnea/hypopnea syndrome. It also says clinicians can consider STOP-Bang.¹

The mistaken shortcut: the score closes the conversation

A score may be the easiest part of the paperwork to remember. If yours seems low, you may wonder whether it is worth mentioning the waking, headaches or breathing concerns that led you to seek help.

NICE lists possible apnea features including snoring, witnessed pauses in breathing, unrefreshing sleep, waking headaches, sleepiness, tiredness or fatigue, nighttime urination, choking during sleep, fragmented sleep or insomnia, and cognitive or memory difficulties. Its assessment approach includes the sleep history.¹

Tell the clinician which experiences brought you to the visit. If someone else has observed a breathing change, describe what they noticed and when. If you sleep alone, say that; do not invent an observation to complete the story.

Put the score beside the concern

You could say: “This is the questionnaire result, and these are the sleep changes I am worried about. How do you interpret them together? Is further assessment appropriate, and what would it add?”

Ask which question the clinician is trying to answer. If another questionnaire is proposed, ask what it contributes. Request an explanation of the next step and what to do if the current plan does not resolve the concern.

Bring your medicine list and relevant reports. Tell the team if the wording on a form was confusing, or if you were unsure which experience an answer should describe. Ask for help interpreting it rather than changing answers to achieve a particular total.

Discuss safety as well as symptoms

NICE’s referral information includes the effect of excessive sleepiness on safe driving and occupational risk. Its suggested referral details include assessment scores and how sleepiness affects the person.¹

Tell the clinician about any safety concern rather than waiting for the score to communicate it. Ask for advice specific to your work, travel and local requirements. Keep that advice with the assessment plan.

Leave with a plan beyond the number

Before the appointment ends, confirm what has been considered, whether another assessment is being arranged and who will explain the findings. If no referral is recommended now, ask what to monitor, when to review the plan and which changes should prompt contact sooner.

Did I Do That in My Sleep? includes a Visit Brief. Use it to organize your concerns and appointment questions alongside any questionnaire your clinician provides. Explore the sleep playbook.