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The Epworth Sleepiness Scale (ESS) is used as a clinical tool for determining excessive daytime sleepiness. However, the behavior and biology that underlie ESS scores remain to be elucidated. The main objective of this analysis is to determine objective behavioral and physiologic correlates of the ESS. Secondarily, we examine the relationship of the ESS to parallel subjective and objective endpoints that could represent measures of daytime sleepiness. Methods Using two separate machine learning algorithms, Random Forest and Lasso, we determined the association between ESS scores and 55 sleep and medical variables in individuals who participated in the Sleep Heart Health Study (N=2105). These variables include self-reported sleep characteristics (e.g., habitual sleep length and latency, frequency of not getting enough sleep), polysomnographic sleep measures from a single night, medication use, and mental and physical health status. Additional analyses were conducted on data stratified by age and gender. To investigate the relationship between ESS and other measures of daytime sleepiness, cross-correlation analysis was conducted on the ESS and five variables that could analog daytime sleepiness (feeling unrested, nap duration and frequency, sleep latency, frequency of not getting enough sleep). Results Analysis of the main dataset resulted in low explained variance (7.15 - 10.0%), with self-reported frequency of not getting enough sleep as most important predictor (10.3–13.9% of the model variance). Stratification by neither age nor gender significantly improved explained variance. Habitual sleep length was not an important predictor in any model. Cross-correlational analysis revealed low correlation of other daytime sleepiness measures to ESS score. Conclusion Data analyses indicate that ESS scores are not well explained by habitual or polysomnographic sleep values, or a variety of other biomedical characteristics. This suggests that there are different, potentially orthogonal dimensions of the concept of “daytime sleepiness” that may be driven by different aspects of sleep physiology. Caution should be used when considering the ESS as a clinical measure given that the physiologic correlates still remain to be elucidated. Support (if any):

110 Physiological correlates of the Epworth Sleepiness Scale reveal different dimensions of daytime sleepiness