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Objective/Background: The utility of the pictorial Epworth sleepiness scale (pESS) has been assessed by only a few studies in a clinical population. Some of its questions may be inappropriate in certain patient groups. The aim of this study was to assess the utility of the pESS in the adult Down syndrome (DS) population in the United Kingdom (UK). Patients/Methods: A modified sleep questionnaire including the pESS was administered to 5430 adults with DS living in the UK. Standard statistical analysis was undertaken. Results: Of 1105 valid responses (20.35%), the pESS was incomplete in 129 (11.67%) cases. Of the incomplete responses, “Q1. Likelihood of dozing/falling sleep while sitting and reading?” was most frequently missed (63.6% of 129 responses). Conclusions: The pESS may not be entirely appropriate in certain populations such as those with intellectual disability where literacy levels may be low. Question modification may be necessary. Clinical trial registration number: ISRCTN55685305.

Original publication




Journal article


Sleep Medicine

Publication Date





165 - 167