Developing an Alternative Version of the Epworth Sleepiness Scale to Assess Daytime Sleepiness in Adults with Physical or Mental Disabilities

Abstract

<b><i>Introduction:</i></b> Excessive daytime sleepiness (EDS) is a frequent symptom with many possible causes, and many of these can be treated. EDS and its underlying causes have been associated with various negative health consequences. Recognition of EDS is thus an important public health concern. The concept of EDS is, however, not yet well defined, and different measures are used to diagnose EDS. The Epworth Sleepiness Scale (ESS) is the most widely used tool to assess daytime sleepiness in a broad range of populations. Its applicability in patients exhibiting physical or mental disabilities, like older multimorbid patients, is limited, since the ESS was not developed and validated in this patient group. <b><i>Methods:</i></b> Within an expert study with 35 sleep medicine experts and a pilot study with 52 geriatric in-patients, who frequently exhibit physical or mental disabilities, and patients’ close relatives, we adapted the original ESS to develop an alternative version to assess daytime sleepiness in adults with physical or mental disabilities (ESS-ALT). <b><i>Results:</i></b> In this adapted version, items 3 (sitting inactively in a public place) and 8 (sleepy in traffic) were replaced by 2 new items (sitting in a waiting room, sitting and eating a meal) and an interview format was used. This ESS-ALT achieved fewer missing responses (23 vs. 73%) and a higher level of internal consistency (Cronbach’s α = 0.64 vs. 0.23) than the original ESS while keeping its somnificity structure. <b><i>Conclusion:</i></b> The ESS-ALT achieves better psychometric properties than the original ESS for individuals with physical or mental disabilities.

Assessment of Sleep and Sleepiness in Patients With Mental Disorders: Applicability of the German Version of the SCOPA-Sleep Questionnaire

“…However, these differences reflect real sociodemographic differences between the 2 populations. 45 When interpreting our results, it should be taken into account that, although the PSQI and the ESS are considered "gold standards," these instruments were not designed for patients with mental disorders 37,38,46 and recent examinations have revealed that the ESS has shortcomings with regard to its psychometric properties. 47 Previous findings that sleep disorders are often underdiagnosed and undertreated in patients with mental illness were confirmed in our study: Up to 89% of our patients reported sleep-related difficulties on the screening questionnaires, strengthening the need for a routine clinical screening instrument that can be easily applied in practical psychiatry.…”

“…When interpreting our results, it should be taken into account that, although the PSQI and the ESS are considered “gold standards,” these instruments were not designed for patients with mental disorders37,38,46 and recent examinations have revealed that the ESS has shortcomings with regard to its psychometric properties 47…”

Schlaf und Schlafstörungen im hohen Lebensalter

“…Hilfreich sind zudem validierte Skalen wie Stop‐Bang oder der Berlin‐Fragebogen 15 . Die Quantifizierung der Tagesschläfrigkeit erfolgt häufig mithilfe der Epworth Sleepiness Scale (ESS) 16 , deren Aussagekraft bei gebrechlichen älteren Menschen jedoch eingeschränkt ist und möglicherweise einer Adaptation bedarf 17 .…”