Version Of Epworth Sleepiness Scale Research Articles

Construct validity and factor structure of Sinhalese version of Epworth Sleepiness Scale

Objective: This study is the first to validate the Epworth Sleepiness Scale (ESS) in Sri Lanka population. ESS is a tool used to evaluate patients’ habitual sleepiness during the day and is used worldwide. This work examined the psychometric properties of the Sinhalese version of eight items ESS among heavy vehicle drivers in Sri Lanka.Methods: A sample of 403 participants was randomly split into two to evaluate dimensionality by exploratory factor analyses (EFA) and confirmatory factor analyses(CFA).Results: Study findings suggest that the single version of ESS is a reliable and valid instrument for sleep evaluation. The analysis identified two-factor structures for the Sinhalese version of ESS. Factor one included sitting and talking, watching TV, car in traffic, sitting in public and sitting and reading, summarized as sitting and doing something. Factor two included lying down, being a car passenger, and sitting quietly, indicating sitting without engaging in any particular activity.Conclusions: Sinhalese version of the ESS is a bi-dimensional instrument that is reliable and valid for assessing daytime Sleepiness in Sri Lankan heavy vehicle drivers. However, the Sinhalese version of the ESS needs further evaluation among the general population and those with sleep disturbances.

Validation of the Malay version of Epworth sleepiness scale for children and adolescents (MESS-CHAD)

BackgroundEpworth Sleepiness Scale for Children and Adolescents (ESS-CHAD) is a valid and reliable eight-item self-administered questionnaire for the assessment of excessive daytime sleepiness and is commonly used to screen sleep-disordered breathing for children and adolescents. The cross-sectional study aimed to translate and cross-culturally adapt ESS-CHAD into a Malay version of Epworth Sleepiness Scale for Children and Adolescents (MESS-CHAD) for the Malaysian population, and to assess the validity and reliability of MESS-CHAD.MethodsForward-backward translation method was used to translate and cross-culturally adapt ESS-CHAD. Three linguistic experts and two paediatricians content validated the translated version. Face validity was conducted through audio-recorded semi-structured in-depth interviews with 14 native Malay-speaking children and adolescents followed by thematic analysis. The revised questionnaire was then proofread by a linguistic expert. A total of 40 subjects answered the MESS-CHAD twice, 2 weeks apart, for test-retest reliability and internal consistency. For criterion validity, 148 eligible subjects and their parents answered MESS-CHAD and the Malay version of Sleep-Related Breathing Disorder scale extracted from the Paediatric Sleep Questionnaire (M-PSQ:SRBD) concurrently. Variance Inflation Factor (VIF) and P values of the model’s outer weight and outer loading were analysed using SmartPLS software to assess the indicator’s multicollinearity and significance for formative construct validity.ResultsIntraclass Correlation Coefficient (ICC) ranging from 0.798 to 0.932 and Cronbach’s alpha ranging from 0.813 to 0.932 confirmed good to excellent test-retest reliability and internal consistency, respectively. Spearman Correlation Coefficient value of 0.789 suggested a very strong positive correlation between MESS-CHAD and M-PSQ:SRBD. VIF ranging from 1.109 to 1.455 indicated no collinearity problem. All questionnaire items in MESS-CHAD were retained as the P value of either outer model weight or outer model loading was significant (P < 0.05).ConclusionESS-CHAD has been translated and cross-culturally adapted into Malay version for the Malaysian population, and found to be valid and reliable.

Comparison of the clinical and electrophysiological characteristics between type 1 and type 2 narcolepsy: a cross-sectional study

IntroductionNarcolepsy is a chronic brain disease characterized by excessive sleepiness and classified into two types based on the presence of cataplexy or reduced level of cerebrospinal fluid orexin-A (hypocretine-1): narcolepsy type 1 (NT1) and narcolepsy type 2 (NT2). These two types differ in symptoms other than cataplexy, as well as in certain examination findings. The present study aimed to investigate the clinical and electrophysiological characteristics of NT1 by comparing its features with those of NT2.MethodsSubjects were 118 first diagnosed and untreated patients with narcolepsy. They underwent both polysomnography (PSG) and multiple sleep latency test (MSLT) as a sleep test. Diagnosis was established in accordance with International Classification of Sleep Disorders, Third Edition, and the type of narcolepsy was determined by the presence or absence of cataplexy, patients with cataplexy were diagnosed with NT1, and without cataplexy were diagnosed with NT2. We investigated characteristics of the patients, PSG and MSLT outcomes, and applied a suite of duly statistical analysis to account for each parameter.ResultsAmong the 118 subjects, 35 patients (29.7%) were NT1, and 83 patients (70.3%) were NT2. Excessive daytime sleepiness which was measured by Japanese version of Epworth sleepiness scale (JESS) was significantly higher in NT1 than NT2. Furthermore, the presence of sleep hallucination (n = 29, 82.9%), sleep paralysis (n = 18, 51.4%), difficult maintaining sleep (n = 22, 62.9%), and sleep related movement and behavior disorders (n = 7, 20.0%) were significantly higher in NT1 than those in NT2. Additionally, parameters indicative of sleep fragmentation, such as the arousal index and wake time after sleep onset measured in PSG, exhibited a statistically significant increase in NT1 when contrasted with NT2.ConclusionsFragmentation of nocturnal sleep which is explained by the high arousal index and the long wake time after sleep onset on PSG was considered a characteristic finding of NT1 compared with NT2, and the patients with NT1 experienced greater difficulty of maintaining sleep. Concomitantly, the prevalence of NT1 in this study may be a representative value of the prevalence of NT1 among the patients with narcolepsy in Japan.

Discrepancy between subjective and objective sleepiness in adolescents

BackgroundLack of correlation between subjective and objective measurements of daytime sleepiness is common. Here, the frequency of discrepancy between subjective and objective sleepiness, as well as possible predictors, were examined for an adolescent cohort. MethodsThis study included pediatric patients (aged 10–18 years, n = 211) with various sleep disorder symptoms were evaluated between August 2011 and February 2021. Subjective and objective sleepiness were assessed based on eleven or more scores of the Japanese version of Epworth Sleepiness Scale and a mean sleep latency of 8.0 min or less on the Multiple Sleep Latency Test, respectively. Patients were then classified as both subjectively and objectively sleepy, objectively sleepy, subjectively sleepy, and non-sleepy. Discrepancy-related factors were identified with multivariable logistic regression analysis. ResultsThe frequency of discrepancy between subjective and objective sleepiness was 46.4%, with 35.5% (75/211) of the patients exhibiting subjective sleepiness without objective sleepiness and 10.9% (23/211) of the patients exhibiting objective sleepiness without subjective sleepiness. Co-existence of neurodevelopmental disorders was associated more often with subjective sleepiness compared to non-sleepiness (odds ratio (OR), 4.12; 95% confidence interval (CI), 1.30 to 12.99) or concordant sleepiness (OR, 7.54; 95% CI, 2.43 to 23.38). ConclusionsNearly half of the patients exhibited discrepancy between subjective and objective sleepiness, and it more often involved subjective sleepiness. Furthermore, age, bedtime, and neurodevelopmental disorders were identified as significant factors related to subjective sleepiness without objective sleepiness.

Reliability and Validity of Gujarati Version of Epworth Sleepiness Scale: A Cross-sectional Study

Introduction: Daytime sleepiness is a common symptom of many sleep disorders. Epworth Sleepiness Scale (ESS) measures average sleep propensity of an individual for wide range of daily living activities. As it is a self-administered questionnaire, the Gujarati translation of ESS can be helpful for the evaluation of daytime sleepiness in clinical population. Aim: To find reliability and validity of Gujarati version of ESS. Materials and Methods: This cross-sectional study was conducted during August, 2020 to February, 2021. ESS is available in Gujarati language. Permission was taken to use and to find reliability and validity of Gujarati ESS from the Mapi Research Trust. This study was carried out in two phases: 1) Face and content validation by expert clinical review; 2) Test-retest reliability. The consensus method was used to find face and content validity of Gujarati ESS. The group of experts having mean experience of 10.5 years in different fields examined each item of Gujarati ESS. Each item of Gujarati ESS was scored either as rejected, accepted or accepted with modification. Procedure was continued till 80% of consensus for all items was achieved. Total 80 participants aged between 18-60 years were included in this study. To find reliability of Gujarati ESS, internal consistency and test-retest reliability was determined. The Statistical Package for Social Sciences (SPSS) version 24.0 was used to analyse the data. Test-retest reliability was determined by Intraclass Correlation Coefficient (ICC) and internal consistency was calculated by chronbach’s alpha. Results: Total of 80 participants (mean age 42.68±13.37 years; 34 males and 46 females) were studied. Normal BMI was observed for 20 participants, overweight were 26 and obese were 34. Gujarati version of ESS showed excellent test-retest reliability as evidenced by high ICC (ICC=0.94) and high Internal consistency (α=0.97). Mean score of Gujarati ESS at baseline 13±6.72 and after one week 12.98±5.65. Values for Content Validation Ratio (CVR), Item level Content Validation Index (I-CVI), Modified Kappa (K), and Proportion of agreement were 1. The content of translated items was understandable and were related to quality of sleep and its evaluation. Conclusion: Gujarati version of the ESS has excellent reliability and good face and content validity. It is adequate and useful for evaluation of day time sleepiness in Gujarati speaking population.

Validation of the Arabic Version of the Epworth Sleepiness Scale among the Yemeni Medical Students.

The study was conducted with the aim to assess the psychometric measures of an adapted Arabic version of the Epworth Sleepiness Scale (ESS) among medical students at Sana'a University, Yemen. The cross-sectional study targeted 360 students (males: 176; females: 184) from the preclinical 3rd year (N: 197) and the final clinical year (N: 163). Participants self-filled an Arabic and slightly modified version of the 8-item Epworth Sleepiness Scale. Exploratory Principal Component Analysis (PCA) and Confirmatory Factor Analyses (CFA) were conducted on two equal subsets of the sample (N: 180 each). The PCA yielded a two-dimension model subsequently confirmed by factor analysis. The first dimension was grouped on three items while the second dimension had five items reflecting the respondents' propensity to sleep during “interactive situations” and “sitting and lying,” respectively. The model had an acceptable goodness of fit measures for the overall ESS (CMINDF = 2.362, CFI = 0.91, IFI = 0.92) and acceptable reliability indicators (factor 1 α = 0.65, factor 2 α = 0.62). However, due to weak variance explanation (0.07) of item 6 (sitting and talking) in factor 1, analysis was repeated excluding this item. The 7-item model was also two-dimensional, valid, and reliable. The reliability indicators were acceptable with α = 0.65 for factor 1 (4 items of interactive situations) and 0.62 for factor 2 (3 items of sitting) and overall α = 0.68. Overall, the ESS is a useful tool. Factor analysis produced a two-factor model of 7 items with good validity and reasonable reliability that can be used in diagnosing daytime sleepiness among young Yemeni adults.

Self-Reported Sleep Quality Using the Malay Version of the Pittsburgh Sleep Quality Index (PSQI-M) In Malaysian Adults.

(1) Background: The Pittsburgh Sleep Quality Index (PSQI) is a useful tool for the assessment of subjective sleep quality in non-clinical and clinical settings. This study aimed to determine sleep quality in a general Malaysian adult population using a validated Malay version of the Pittsburgh sleep quality index (PSQI-M); (2) Methods: The original PSQI was translated into Malay following forward and backward translation guidelines. The final Malay version was administered to a sample of healthy working adults (n = 106; mean age: 35.3 ± 7.6 years) without history of sleep disorders. Reliability and agreement were assessed using Cronbach’s alpha, intra-class correlations coefficient (ICC), standard error of measurement (SEM), and Bland–Altman plot. Convergent validity of PSQI-M was examined with the Malay version of Epworth sleepiness scale (ESS-M) using Pearson’s correlation coefficient; (3) Results: Overall mean PSQI global score was 5.25 ± 1.85. About 45% of the sample had PSQI global score >5, indicating poor sleep quality. Total sleep duration per night was 5.95 ± 1.05 h, below the recommended amount. Sleep quality seems to be affected by age but not gender. Internal consistency as measured by Cronbach’s alpha in the whole sample was 0.74, with test–retest reliability (ICC) of 0.58 and SEM of 1.34. The PSQI test–retest scores indicated that most of the respondents (90%) lay within the 95% limits of agreement. The PSQI-M also showed significant correlation with ESS-M scores (r = 0.37, p < 0.01); (4) Conclusion: The PSQI-M showed acceptable reliability and is valid to be used in a general Malaysian adult population. Findings also indicate that a majority of the adults in our sample were experiencing inadequate sleep, thus further research is needed to identify the factors associated with poor sleep quality.

Construct Validation and Reliability Assessment of Tamil Version of Epworth Sleepiness Scale to Evaluate Daytime Sleepiness among Adolescents in Rural Puducherry, South India.

Background:Epworth sleepiness scale (ESS) has been used widely in the assessment of daytime sleepiness for research and clinical purposes. Hence, this study was done to translate the ESS in Tamil and to assess the construct validity and reliability of the Tamil version among adolescents in rural Puducherry, South India.Materials and Methods:Translation of the ESS by native language experts and pilot tested with subsample of adolescents. Final Tamil version was administered among 789 Tamil-speaking adolescents in the selected villages of rural Puducherry (union territory in South India). Construct validity was assessed by exploratory factor analysis through principal component method. Confirmatory factor analysis was done to obtain the goodness-of-fit. Reliability of questionnaire was assessed through Cronbach's alpha coefficient.Results:Two factor structures were obtained with Eigenvalues of 3.49 and 1.09, respectively. Both factors accounted for about 57.4% of the variance. Two-factor model assessed by confirmatory factor method found Chi-square value of 215.57 (P < 0.001). Goodness-of-fit revealed acceptable comparative fit indices (0.91). The reliability coefficient (Cronbach's alpha) for complete ESS was 0.81. Factor-based analysis showed that the Cronbach's reliability coefficient was 0.83 and 0.75 for the first and second factor, respectively.Conclusion:Our study concludes that the ESS questionnaire is internally valid and consistent with good reliability coefficient for application in Tamil-speaking rural adolescents. However, further research can be done to content validate the questionnaire with standard diagnostic tool.

Factors affecting fatigue severity in patients with obstructive sleep apnea.

A limited number of studies have investigated the relationships among fatigue, insomnia and obstructive sleep apnea (OSA). This study evaluated the factors affecting fatigue severity in patients with OSA. We investigated 633 OSA patients who were diagnosed by polysomnography. All patients completed sleep questionnaires including self-reported sleep duration, the Fatigue Severity Scale (FSS), the Korean version of Epworth Sleepiness Scale (K-ESS), Insomnia Severity Index (ISI), Korean version of Pittsburgh Sleep Quality Index (K-PSQI) and Beck Depression Inventory-2 (BDI-2). The subjects had a mean age of 48.7 ± 10.5 years and 72.5% (n = 459) were men. The subjects were distributed as follows: 160 with mild, 168 with moderate and 305 with severe OSA. A multiple regression model found that age (β = -0.146, P = .005), K-ESS (β = 0.689, P < .001), 8 ≤ ISI score < 15 (β = 3.801, P = .006), 15 ≤ ISI score (β = 4.565, P = .009), and K-PSQI (β = 0.684, P = .002) were predictors of a higher FSS score. BDI-2 (β = 0.007, P = .918), apnea-hypopnea index (AHI) (β = -0.006, P = .895), arousal index (β = 0.034, P = .415), and nadir O2 saturation (β = -0.044, P = .655) were not associated with FSS score. Our findings indicate that fatigue severity is more likely to be associated with younger age, sleepiness and insomnia, but less likely to be directly related to OSA severity.

Sleep Disorders in Hemodialysis Patients: Does RKF Matter?

Background: Sleep disorders are common in ESRD. Residual kidney function contributes significantly to the overall health and well-being of dialysis patients. The importance of RKF in patients on peritoneal dialysis is widely known, but only a few studies have examined RKF in patients on hemodialysis. Methods: Our study aimed to evaluate sleep disorders in hemodialysis patients and the effect of residual renal function on them. A cross sectional study was conducted on 80 HD patients who were divided into 2 groups. Group I included 30 HD patients with RKF and group II included 50 HD patients without RKF. RKF (Kru) was calculated using the equation: Interdialytic urine volume x Urine urea concentration/Interdialytic period/Mean BUN. Where Mean BUN= (BUN 1 + BUN 2)/2. BUN 1 was measured after first dialysis of week and BUN 2 was measured prior to second dialysis of week. Routine laboratory investigations were done to all patients. We assessed the following sleep disorders in both group: insomnia through insomnia severity index, the restless leg syndrome through international restless leg syndrome study group (IRLSSG) and the excessive Daytime sleepiness through the Italian version of Epworth sleepiness scale. Results: In group I, 43.3% were female and 56.7% were male with mean age 40.47 ± 13.96 years and mean dialysis duration 4.38 ± 2.86 years. In group II, 38% were female and 62% were male with mean age 54.68 ± 9.36 years and mean dialysis duration 6.90 ± 3.82 years. There was highly significant difference between both groups regarding age and dialysis duration (p=0.000, 0.002 respectively). There was highly significant difference between the two groups regarding iPTH (106.71 ± 57.34 pg/ml, 175.36 ± 15.71 pg/ml, p=0.000). The prevalence of insomnia was 62% followed by IRLS 18.7% and EDS 12.5%. There was no statistically significant difference between group I and group II regarding insomnia severity index, while there was statistically significant difference between them regarding international restless limb syndrome and epworth sleepiness (p=0.040, 0.004 respectively). There was no significant correlation between Kru and total score of insomnia severity index, total score of limb syndrome and total score of epworth sleepiness scale. In our study there was positive correlation between Phosph and total score of limb syndrome (p=0.010). Also the level of iPHT was correlated with the total score of limbs syndrome and total score of Epworth sleepiness scale (p=0.027, 0.038 respectively). Conclusion: Sleep disorders are quite common in the HD patients. Patients with high level of iPTH and phosphorus are at major risk of sleep disorders. Residual kidney function is very important to control Ca, phosphorus and iPTH level but its effect on the sleep disorders is not obvious in our study.

The Effects of Stress- and Sleep-Related Variables on the Quality of Life in Insomnia Patients

MethodsZZWe recruited 153 insomnia patients and 96 normal control (NC) subjects who visited three Public Health Centers in Kangwon-do from 2013 until 2015. The Pittsburgh Sleep Quality Index (PSQI), Korean version of Morningness-Eveningness Questionnaire (MEQ-K), Korean version of Epworth Sleepiness Scale, Ford Insomnia Response to Stress Test (FIRST), Hyperarousal Scale (HAS), Perceived Stress Scale (PSS), Anxiety-Sensitivity Index (ASI), Beck Depression Inventory (BDI), and Short Form-12 Health Survey Questionnaire (SF-12) were administered for each subject. We compared the scores of the above scales between the insomnia and control groups, using analysis of covariance to control for age. Stepwise regression analysis assessed the association of these variables with SF-12 scores.

Comparison of Hindi version of Epworth Sleepiness Scale (ESS) and Berlin Questionnaire (BQ) to established English version for analysis of Sleep disturbed breathing (SDB)

Comparison of Hindi version of Epworth Sleepiness Scale (ESS) and Berlin Questionnaire (BQ) to established English version for analysis of Sleep disturbed breathing (SDB)

Reliability and validity of the simplified Chinese version of Epworth sleepiness scale

To investigate the reliability and validity of the simplified Chinese version of Epworth sleepiness scale(ESS). Five hundred and eighty-five patients with suspected obstructive sleep apnea hypopnea syndrome (OSAHS) and 103 OSAHS patients who underwent operations were included in this study. The ESS was filled before polysomnography (PSG) monitoring under the direction of professional technicians. The patients who underwent operations did both PSG and ESS tests more than 6 months after operation. Fifty-one patients who underwent PSG at our hospital from July to August, 2010 were chosen to assess the ESS test-retest reliability on two separate occasions at least more than one week. The total Cronbach's Alpha of ESS was 0.814. The test-retest reliability of ESS total scores was 0.679 and for each item was from 0.473 to 0.698(P < 0.01). Split-half reliability was 0.817 (P < 0.01). In the analysis of discriminant validity with apnea hypopnea index (AHI), the ESS total scores and each item's scores had significant differences in severity in OSAHS patients and simple snoring patients (P < 0.05), and this was also true in different degrees of lowest saturation of arterial oxygen (LSaO(2)) patients and normal LSaO(2) patients (P < 0.05). The factor analysis of construct validity showed that 4 factors were extracted. The cumulative proportion was 74.270%. The loading was higher than 0.4 among every item. The correlation coefficiency of overall ESS scores and each item's scores was relatively high except the last item. The ESS had low consistency with clinical diagnosis(κ = 0.099, P < 0.01) and the predictive validity was not good (r = 0.138, P < 0.01).As for 103 patients who had operations, the initial assessment of total ESS scores were 15.0[10;20] (M[P(25); P(75)]), and improved to 4[1;6] after operation. The patients who got effective results had significant difference in the total ESS scores before and after operation (Z = -7.528, P < 0.01), so was the patients who got ineffective results (Z = -4.382, P < 0.01) . The simplified Chinese version of ESS had a good reliability and validity. It can be used to evaluate the chance of dozing in the daytime.

Can a Bengali version of Epworth Sleepiness Scale evaluate excessive daytime sleepiness: a validity study

Can a Bengali version of Epworth Sleepiness Scale evaluate excessive daytime sleepiness: a validity study

Isolated sleep paralysis linked to impaired nocturnal sleep quality and health-related quality of life in Chinese-Taiwanese patients with obstructive sleep apnea

Isolated sleep paralysis (ISP) is a rapid eye movement (REM) sleep parasomnia and has a special meaning in Chinese population. Worsening of obstructive sleep apnea (OSA) occurs especially during REM sleep. The relationship between ISP and OSA is unclear. The aim of this study was to investigate the impact of ISP on sleep and life quality in Chinese-Taiwanese OSA patients. We recruited 107 OSA patients diagnosed by polysomnography (PSG) in Southern Taiwan. ISP was evaluated by self-reported sleep questionnaire. We used Chinese version of Epworth Sleepiness Scale (ESS), Pittsburgh Sleep Quality Index (PSQI), and Short-Form 36 (SF36) to evaluate daytime sleepiness, nocturnal sleep quality, and health-related quality of life, respectively for OSA patients. Student's t-test was used to compare PSG parameters, ESS, PSQI, physical and mental component of SF-36 (P-SF36 and M-SF36) between OSA patients with and without ISP. Stepwise multiple regression was used to find out the factors independently associated with ESS, PSQI, P-SF36, and M-SF36. Forty-one of 107 patients (38.3%) had ISP. It showed no significant difference in PSG parameters between OSA patients with and without ISP. OSA patients with ISP had significantly higher ESS (P = 0.010), higher PSQI (P = 0.007), lower P-SF36 (P = 0.020), and lower M-SF36 (P = 0.001) than those without ISP. ISP was an independent factor associated with ESS (P = 0.017), PSQI (P = 0.001), and M-SF36 (P = 0.030) after adjusting for other confounding variables. ISP was independently associated with excessive daytime sleepiness, worse sleep quality, and impaired mental health-related quality of life in Chinese-Taiwanese OSA patients.

A two-tier screening model using quality-of-life measures and pulse oximetry to screen adults with sleep-disordered breathing

Using quality-of-life measures and pulse oximetry, this study developed a two-tiered prediction algorithm with an aim to prioritize sleep-disordered breathing patients for polysomnography. Data from 355 patients were evaluated to obtain their clinical information, Chinese version of Epworth sleepiness scale, and snore outcomes survey scores against respiratory disturbance index (RDI). In the first-tier screening, receiver-operating characteristics were calculated with an initial strategy of choosing optimal prediction sensitivity. The second-tier strategy investigated the association between pulse oximetry data (desaturation index of 3%) against RDI to optimize prediction specificity. The "SOS score of 55 and ESS score of 9" was the optimal combination that yielded the highest sensitivity (0.603) in the first-tier screening. The strategy can includ 94.93% possible patients (probability = 0.6) with positive predictive value of 0.997. The area under the curve (AUC) was 0.88 (p < 0.001). Desaturation index of 3% would optimized specificity (0.966, probability = 0.5) in the second-tier screening to exclude 54% of innocent patients, with negative predictive values of 0.93 and AUC of 0.951 (p < 0.001). The two-tier screening model jointly excluded 4.8% of innocent subjects and prioritized 40% of severe patients for polysomnography. The prediction model is sufficiently accurate and feasible for large-scale population screening.

Sleep Disorders in Hemodialysis Patients

The prevalence of sleep disorders is higher in patients with kidney failure than the general population. We studied the prevalence of sleep disorders in 88 (mean age; 41.59 +/- 16.3 years) chronic hemodialysis (HD) patients at the Urology and Nephrology Center, Mansoura University, Egypt over 4-month period. The investigated sleep disorders included insomnia, restless leg syndrome (RLS), obstructive sleep apnea syndrome (OSAS), excessive daytime sleepiness (EDS), narcolepsy and sleep walking, and we used a questionnaire in accordance with those of the International Restless Legs Syndrome Study Group, the Berlin questionnaire, Italian version of Epworth Sleepiness Scale, International Classification of Sleep Disorders, and the specific questions of Hatoum's sleep questionnaire. The prevalence of sleep disorders was 79.5% in our patients, and the most common sleep abnormality was insomnia (65.9%), followed by RLS (42%), OSAS (31.8%), snoring (27.3%), EDS (27.3%), narcolepsy (15.9%), and sleep walking (3.4%). Insomnia correlated with anemia (r=0.31, P= 0.003), anxiety (r=0.279, P= 0.042), depression (r=0.298, P= 0.24) and RLS (r=0.327, P= 0.002). Also, RLS correlated with hypoalbuminemia (r=0.41, P= < 0.0001), anemia (r=0.301 and P= 0.046), hyperphosphatemia (r=0.343 and P= 0.001). EDS correlated with OSAS (r=0.5, P= < 0.0001), snoring (r=0.341, P= 0.001), and social worry (r=0.27, P= 0.011). Sleep disorders are quite common in the HD patients, especially those who are anemic and hypoalbuminemic. Assessment of sleep quality, preferably with polysomnography, is necessary to confirm our results. Interventional studies for management of sleep disorders in HD patients are warranted.

Reliability and validity of a Norwegian version of the Epworth sleepiness scale

The objective of this study was to assess the reliability and validity of a Norwegian version of the self-administered Epworth sleepiness scale (ESS). Two samples responded to the ESS: (1) 226 patients previously evaluated for obstructive sleep apnea, of whom 51 also responded to a retest 2 weeks later, and (2) 37 ambulant patients complaining of excessive daytime sleepiness, who were referred to multiple sleep latency testing (MSLT). We assessed internal consistency reliability with Cronbach's alpha and test-retest reliability with weighted kappa (Kw) or an intraclass correlation coefficient (ICC). The validity of the Norwegian ESS was assessed by correlating ESS item and total scores with the number of times a patient fell asleep and the mean latency found on the MSLT. Internal consistency reliability, as assessed with Cronbach's alpha, was 0.84 (n = 154). Test-retest reliability for the eight ESS items ranged from Kw of 0.61 to 0.80 (n = 50) and for the total score. ICC was 0.81.There was only fair to moderate correlation of ESS item and total scores with MSLT variables, mainly in a subset of patients with total ESS score >10. The Norwegian version of the ESS had acceptable internal consistency and test-retest reliability. The association of the ESS items and total score with the MSLT was only fair to moderate, in line with previous studies.

VALIDATION OF THE FILIPINO VERSION OF THE EPWORTH SLEEPINESS SCALE

PURPOSE: The Epworth Sleepiness Scale (ESS) is a questionnaire currently the most utilized subjective test of daytime sleepiness in clinical practice. ESS is a standard, low cost, quick and easy to apply scale. It has been validated comparing to the gold standard of excessive daytime sleepiness (EDS) which is Multiple Sleep Latency Test. This study aims to validate the Filipino version of Epworth Sleepiness Scale as a tool for determining excessive daytime sleepiness among the general population.

Greek version of the Epworth Sleepiness Scale.

The Epworth Sleepiness Scale (ESS) questionnaire is widely used for the assessment of daytime sleepiness in patients with sleep apnea-hypopnea syndrome (SAHS). The aim of this study was to develop a Greek version of ESS, bearing in mind that language is a barrier for application in non-English speaking populations. The forward and backward translation method by bilinguals was applied. The Greek version of ESS (ESSgr) was then administered to 130 healthy age-matched controls and 211 patients with SAHS with various levels of severity. Reproducibility of ESSgr and also the sensitivity after continuous positive airway pressure (CPAP) treatment were tested. Patients' and controls' ESS score was 11.3 +/- 5.1 and 5.6 +/- 3.2, respectively ( p < 0.001). Total score and individual item score were correlated in both groups. ESSgr score was correlated with body mass index and apnea-hypopnea index ( p < 0.001) but not with age. Reproducibility was tested in 29 subjects, revealing no significant difference. A significant reduction was revealed (14.1 +/- 4.7 vs. 6.4 +/- 3.5; p < 0.001) in 37 patients who were evaluated after CPAP treatment. Our data validate the ESS for application in Greek-speaking populations. Despite relevant influences of language and cultural background, ESSgr is a valuable tool for clinical management and research.