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

Abstract

Introduction: 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. Methods: 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). Results: 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. Conclusion: The ESS-ALT achieves better psychometric properties than the original ESS for individuals with physical or mental disabilities.