Form Structure: Epworth Sleepiness Scale (ESS)

Short Name:
ESS
Description:
The ESS is a self-administered questionnaire with 8 questions. It provides a measure of a person’s general level of daytime sleepiness, or their average sleep propensity in daily life. It has become the world standard method for making this assessment. Reference: A New Method for Measuring Daytime Sleepiness: The Epworth Sleepiness Scale Murray W. Johns 1998. Copyright M.W. Johns 1990-97 http://epworthsleepinessscale.com/. The Questionnaire contact information and permission to use: Mapi Research Trust, Lyon, France. - Internet: https://eprovide.mapi-trust.org The current version of ESS was based on the information from 2016 and has the following PVDs: would never doze or sleep;slight chance of dozing or sleeping;moderate chance of dozing or sleeping;high chance of dozing or sleeping
Disease:
Traumatic Brain Injury
Organization:
Cleveland Clinic
Required Program Form:
No
Standardization:
Standard
Publication Date:
2016-09-30
Version:
1.2
Date Created:
2019-04-04
Created By:
Number of Data Elements:
22
eForms:
N

Attached Data Elements

# Title Short Description Variable Name Required? Type
1 GUID   Global Unique ID which uniquely identifies a subject GUID Required CDE
2 Subject identifier number   An identification number assigned to the participant/subject within a given protocol or a study. SubjectIDNum Optional CDE
3 Age in years   Value for participant's subject age recorded in years. AgeYrs Recommended CDE
4 Vital status   Status of participant/subject as alive or dead VitStatus Optional CDE
5 Visit date   Actual interview or visit date VisitDate Recommended CDE
6 Site name   The name of the site for the study SiteName Recommended CDE
7 Days since baseline   The number of days since baseline DaysSinceBaseline Optional CDE
8 Case control indicator   Indicator of whether subject is in the case or control arm of the study. CaseContrlInd Optional CDE
9 General notes text   General notes GeneralNotesTxt Optional CDE

Additional Element Groups

Listed below are your additional element groups.

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Form Administration (Appears Up To 1 Time)

# Title Short Description Variable Name Required? Type
1 Context type  The context to which the questions were answered ContextType Recommended CDE
2 Context type other text  The free-text related to ContextType specifying other text ContextTypeOTH Recommended CDE
3 Data source  Source of the data provided on the case report form DataSource Recommended CDE
4 Data source other text  The free-text field related to Data source specifying other text. Source of the data provided on the case report form DataSourceOTH Recommended CDE

Epworth Sleepiness Scale (Appears Exactly 1 Time)

# Title Short Description Variable Name Required? Type
1 Epworth Sleepiness Scale (ESS) - sitting and reading scale  The likelihood for the subject to doze off or fall asleep sitting and reading ESS_SittingReading Recommended UDE
2 Epworth Sleepiness Scale (ESS) -watching TV scale  The likelihood for the subject to fall asleep while watching TV ESS_WatchingTV Recommended UDE
3 Epworth Sleepiness Scale (ESS) - sitting inactive in public places scale  The likelihood for the subject to doze off or fall asleep in public places ESS_SittingInactive Recommended UDE
4 Epworth Sleepiness Scale (ESS) - passenger in car scale  The likelihood for the subject to doze off or fall asleep as a passenger in a car ESS_PassengerInCar Recommended UDE
5 Epworth Sleepiness Scale (ESS) - lying down to rest scale  The likelihood for the subject to doze off or fall asleep while lying down to rest in the afternoon ESS_LyingDownToRest Recommended UDE
6 Epworth Sleepiness Scale (ESS) - sitting and talking to someone scale  The likelihood for the subject to doze off or fall asleep while talking to someone ESS_SittingTalking Recommended UDE
7 Epworth Sleepiness Scale (ESS) - sitting after lunch no alcohol scale  The likelihood for the subject to doze off or fall asleep after a lunch (no alcohol ) ESS_SittingLunchNoAlc Recommended UDE
8 Epworth Sleepiness Scale (ESS) - dozing in traffic scale  The likelihood for the subject to doze off or fall asleep while in a car ESS_DozingInTraffc Recommended UDE
9 Epworth Sleepiness Scale (ESS) - total score value  The total score on the ESS ESS_TotalScore Recommended UDE