Chen Po-Yi, Wang Min-Heng, Chang Chih-Ning, Yang Chien-Ming, Chao Tzi-Yang
Department of Educational Psychology and Counseling, National Taiwan Normal University, No. 162, Section 1, Heping East Road, Da-an District, Taipei, 106308, Taiwan.
Graduate Institute of Public Affairs, National Taiwan University, Taipei, 10617, Taiwan.
Sleep Breath. 2024 Oct;28(5):2247-2254. doi: 10.1007/s11325-024-03111-3. Epub 2024 Jul 24.
Although the validity of the Epworth Sleepiness Scale (ESS) as an effectiveness measure for sleep apnea treatments such as continuous positive airway pressure (CPAP) has been supported by multiple studies, some researchers continue to challenge it. They suggest that in addition to its impact on relieving patients' daytime sleepiness, CPAP also alters the internal standards patients use to evaluate their sleepiness (i.e., response shift; RS), confounding the meaning of the difference in the ESS scores. We believe an issue yet to be addressed in this debate is that all existing evidence of RS has been obtained through the then-test approach, a retrospective method sensitive to various cognitive mechanisms. Thus, in the current study, we re-examined this issue using the structural equation modeling (SEM) approach, a method that can be directly applied to randomized clinical trial (RCT) data without retrospective measures.
With the ESS data from two independent RCTs, we conducted cross-sectional and longitudinal measure invariance tests in SEM to examine whether CPAP would lead to RS.
The ESS demonstrated cross-sectional and longitudinal scalar invariance against CPAP treatments. Its factorial pattern, loadings, and thresholds were invariant between the treatment and control groups and pre- and post-treatment, supporting the comparability of the observed mean ESS scores across time and groups.
Our results support the validity of the average difference scores of the ESS for quantifying the effectiveness of CPAP on group-level daytime sleepiness in RCTs with relatively large sample sizes.
尽管多项研究支持爱泼沃斯思睡量表（ESS）作为持续气道正压通气（CPAP）等睡眠呼吸暂停治疗有效性测量指标的有效性，但一些研究人员仍对其提出质疑。他们认为，CPAP除了能缓解患者白天的嗜睡症状外，还会改变患者用于评估自身嗜睡程度的内部标准（即反应转移；RS），从而混淆了ESS评分差异的意义。我们认为，这场辩论中一个尚未解决的问题是，所有现有的RS证据都是通过事后检验方法获得的，这是一种对各种认知机制敏感的回顾性方法。因此，在本研究中，我们使用结构方程模型（SEM）方法重新审视了这个问题，该方法可直接应用于随机临床试验（RCT）数据，无需回顾性测量。
利用来自两项独立RCT的ESS数据，我们在SEM中进行了横断面和纵向测量不变性检验，以检查CPAP是否会导致RS。
ESS在CPAP治疗中表现出横断面和纵向的标量不变性。其因子模式、载荷和阈值在治疗组和对照组之间以及治疗前和治疗后是不变的，这支持了不同时间和组间观察到的平均ESS评分的可比性。
我们的结果支持在样本量相对较大的RCT中，ESS平均差异分数在量化CPAP对群体水平白天嗜睡有效性方面的有效性。
