Burkhalter Hanna, Wirz-Justice Anna, Cajochen Christian, Weaver Terri, Steiger Jürg, Fehr Thomas, Venzin Reto Martin, De Geest Sabina
University of Basel, Switzerland University Hospital Basel, Switzerland.
Prog Transplant. 2013 Sep;23(3):220-8. doi: 10.7182/pit2013788.
Daytime sleepiness in kidney transplant recipients has emerged as a potential predictor of impaired adherence to the immunosuppressive medication regimen. Thus there is a need to assess daytime sleepiness in clinical practice and transplant registries.
To evaluate the validity of a single-item measure of daytime sleepiness integrated in the Swiss Transplant Cohort Study (STCS), using the American Educational Research Association framework.
Using a cross-sectional design, we enrolled a convenience sample of 926 home-dwelling kidney transplant recipients (median age, 59.69 years; 25%-75% quartile [Q25-Q75], 50.27-59.69), 63% men; median time since transplant 9.42 years (Q25-Q75, 4.93-15.85). Daytime sleepiness was assessed by using a single item from the STCS and the 8 items of the validated Epworth Sleepiness Scale. Receiver operating characteristic curve analysis was used to determine the cutoff for the STCS daytime sleepiness item against the Epworth Sleepiness Scale score.
Based on the receiver operating characteristic curve analysis, a score greater than 4 on the STCS daytime sleepiness item is recommended to detect daytime sleepiness. Content validity was high as all expert reviews were unanimous. Concurrent validity was moderate (Spearman ϱ, 0.531; P< .001) and convergent validity with depression and poor sleep quality although low, was significant (ϱ, 0.235; P<.001 and ϱ, 0.318, P=.002, respectively). For the group difference validity: kidney transplant recipients with moderate, severe, and extremely severe depressive symptom scores had 3.4, 4.3, and 5.9 times higher odds of having daytime sleepiness, respectively, as compared with recipients without depressive symptoms.
The accumulated evidence provided evidence for the validity of the STCS daytime sleepiness item as a simple screening scale for daytime sleepiness.
肾移植受者的日间嗜睡已成为免疫抑制药物治疗依从性受损的潜在预测指标。因此，有必要在临床实践和移植登记中评估日间嗜睡情况。
使用美国教育研究协会的框架，评估瑞士移植队列研究（STCS）中纳入的一项日间嗜睡单项测量指标的有效性。
采用横断面设计，我们纳入了926名居家肾移植受者的便利样本（中位年龄59.69岁；四分位数间距[Q25-Q75]为50.27-59.69），男性占63%；移植后的中位时间为9.42年（Q25-Q75为4.93-15.85）。通过使用STCS中的一个单项和经过验证的爱泼沃斯思睡量表的8个项目来评估日间嗜睡情况。采用受试者工作特征曲线分析来确定STCS日间嗜睡项目相对于爱泼沃斯思睡量表得分的临界值。
基于受试者工作特征曲线分析，建议STCS日间嗜睡项目得分大于4分以检测日间嗜睡情况。内容效度较高，因为所有专家评审意见一致。同时效度中等（斯皮尔曼相关系数ϱ为0.531；P<0.001），与抑郁和睡眠质量差的收敛效度虽然较低，但具有显著性（ϱ分别为0.235；P<0.001和ϱ为0.318，P = 0.002）。对于组间差异效度：与无抑郁症状的受者相比，中度、重度和极重度抑郁症状评分的肾移植受者出现日间嗜睡的几率分别高出3.4倍、4.3倍和5.9倍。
累积证据为STCS日间嗜睡项目作为日间嗜睡的简单筛查量表的有效性提供了依据。
