Grewe Fabian A, Roeder Maurice, Bradicich Matteo, Schwarz Esther I, Held Ulrike, Thiel Sira, Gaisl Thomas, Sievi Noriane A, Kohler Malcolm
Department of Pulmonology, University Hospital Zurich, Zurich, Switzerland.
Centre of Competence Sleep and Health Zurich, University of Zurich, Zurich, Switzerland.
J Clin Sleep Med. 2020 May 15;16(5):757-764. doi: 10.5664/jcsm.8350. Epub 2020 Feb 10.
The purpose of this study was to evaluate the short-term repeatability of the Epworth Sleepiness Scale (ESS) in patients with suspected obstructive sleep apnea and to determine whether transitory sleepiness of the patient influenced ESS results.
Adult participants with suspected obstructive sleep apnea taking part in a study on the diagnostic accuracy of repeated sleep studies were eligible. For assessment of repeatability, the agreement between 2 sequential ESS scores obtained within 1 day (same-day group) or on different days within 1 week (same-week group) was evaluated. By analyzing the within-day repeatability, a possible influence of situational sleepiness on ESS results was assessed. By comparing correlations of sequential scores between both groups, a potential influence of test day-specific sleepiness on ESS results was evaluated. Data were analyzed using Bland-Altman plots, intraclass correlation coefficients, standard error of measurement analysis, and relative amounts of ESS discrepancies beyond 2, 3, 5, and 7 points.
Forty participants (mean age, 47.7 ± 15.4 years; 67.5% men) were included in this study, with 20 in each group. Bland-Altman analysis demonstrated considerable variability of repeated scores (mean ± 1.96 × SD = 1.93 [-3.81 to 7.66]). Discrepancies of at least 3 points between sequential ESS scores were found in 48% of all participants. Comparison of ESS repeatability between both groups showed no evidence for a difference.
A clinically relevant variability in ESS scores was found, even when repeated on the same day, possibly because of situational sleepiness influencing ESS results. Changes in ESS in response to interventions should be interpreted with caution because of its low test-retest reliability.
本研究旨在评估爱泼沃斯思睡量表（ESS）在疑似阻塞性睡眠呼吸暂停患者中的短期重复性，并确定患者的短暂嗜睡是否会影响ESS结果。
纳入参与重复睡眠研究诊断准确性研究的疑似阻塞性睡眠呼吸暂停的成年参与者。为评估重复性，对在1天内（同日组）或1周内不同日期（同周组）获得的2个连续ESS评分之间的一致性进行评估。通过分析日内重复性，评估情境性嗜睡对ESS结果的可能影响。通过比较两组连续评分的相关性，评估特定测试日嗜睡对ESS结果的潜在影响。使用Bland-Altman图、组内相关系数、测量标准误差分析以及超过2、3、5和7分的ESS差异相对量对数据进行分析。
本研究纳入了40名参与者（平均年龄47.7±15.4岁；67.5%为男性），每组20名。Bland-Altman分析显示重复评分存在相当大的变异性（均值±1.96×标准差=1.93[-3.81至7.66]）。在所有参与者中，48%的人连续ESS评分之间的差异至少为3分。两组之间ESS重复性的比较未发现差异证据。
即使在同一天重复测量，ESS评分仍存在临床相关的变异性，可能是由于情境性嗜睡影响了ESS结果。由于其重测信度较低，对干预措施做出反应时ESS的变化应谨慎解释。
