Sleep Disorders Center, Cleveland Clinic, Cleveland, OH, USA.
Quantitative Health Sciences, Cleveland Clinic, Cleveland, OH, USA.
Epilepsy Behav. 2021 Aug;121(Pt A):108099. doi: 10.1016/j.yebeh.2021.108099. Epub 2021 Jun 5.
The Epworth Sleepiness Scale (ESS) is the most common instrument for measuring subjective sleep propensity in people with epilepsy but has not yet been validated in this population.
We aimed to systematically assess the validity, performance, and internal consistency of the ESS, as well as correlations between the ESS and disease-specific variables and patient-reported outcome measures in a cohort of adults with epilepsy (AWE).
Ninety-five AWE completed sleep and seizure diaries, in-laboratory polysomnography (PSG) and patient-reported outcome measures, including the ESS, Insomnia Severity Index (ISI), and the Beck Depression Inventory (BDI). Demographic information and data from 95 matched controls referred for PSG for suspected obstructive sleep apnea (OSA) was taken from the electronic medical record. Frequencies of high ESS item ratings (item score ≥2) were calculated for each group. Cronbach's α and factor analysis were performed to assess the internal consistency and validity of the ESS within cases and controls. Multivariable linear models were used to assess the association between ESS and predictors of interest, adjusting for demographic and disease-specific variables, including seizure type, frequency, and anti-seizure medication (ASM) therapy.
While suspected OSA controls had significantly greater mean ESS total scores (9.9 vs 7.9, p = 0.004) and proportion with ESS >10 (42% vs 25%, p = 0.014), there were no significant differences in the severity of item responses, with the exception of "lying down to rest in the afternoon when circumstances permit," for which more controls rated as likely/very likely (79% vs 64%), p = 0.024). AWE with ESS >10 had higher mean standardized ASM dose (2.5 vs 1.7, p = 0.026). All ESS items were significantly correlated with the total score within each group. Cronbach's α was 0.75 for cases and 0.85 for controls, indicating good internal consistency of the ESS for both groups. After adjusting for demographic and sleep characteristics, higher ESS scores were associated with greater insomnia scores on the ISI (p = 0.024) and depressive symptoms on the BDI (p = 0.018).
This study provides validity for the use of the ESS in adult populations with epilepsy.
Epworth 嗜睡量表（ESS）是衡量癫痫患者主观睡眠倾向最常用的工具，但尚未在该人群中得到验证。
我们旨在系统评估 ESS 的有效性、性能和内部一致性，以及 ESS 与疾病特异性变量和患者报告的结局测量之间的相关性，在一组癫痫成人（AWE）中。
95 名 AWE 完成了睡眠和癫痫发作日记、实验室多导睡眠图（PSG）和患者报告的结局测量，包括 ESS、失眠严重程度指数（ISI）和贝克抑郁量表（BDI）。从电子病历中获取了 95 名匹配的对照组患者的人口统计学信息和疑似阻塞性睡眠呼吸暂停（OSA）进行 PSG 的数据。计算了每组高 ESS 项目评分（项目得分≥2）的频率。在病例和对照组中进行了 Cronbach's α 和因子分析，以评估 ESS 的内部一致性和有效性。使用多变量线性模型评估 ESS 与感兴趣的预测因子之间的关联，调整了人口统计学和疾病特异性变量，包括癫痫发作类型、频率和抗癫痫药物（ASM）治疗。
虽然疑似 OSA 对照组的 ESS 总分明显更高（9.9 与 7.9，p=0.004），ESS>10 的比例更高（42%与 25%，p=0.014），但在项目反应的严重程度方面没有显著差异，除了“下午在情况允许时躺下休息”，更多的对照组认为可能/非常可能（79%与 64%，p=0.024）。ESS>10 的 AWE 具有更高的平均标准化 ASM 剂量（2.5 与 1.7，p=0.026）。ESS 的所有项目在每组内均与总分显著相关。病例的 Cronbach's α 为 0.75，对照组为 0.85，表明两组 ESS 的内部一致性均较好。在调整人口统计学和睡眠特征后，较高的 ESS 评分与 ISI 的失眠评分（p=0.024）和 BDI 的抑郁症状（p=0.018）呈正相关。
本研究为 ESS 在癫痫成人人群中的使用提供了有效性。
