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Is the Epworth sleepiness scale suitable for use in stroke?
R J Mills1, M Koufali, A Sharma
1Lancashire Teaching Hospitals NHS Foundation Trust, Preston, UK The Walton Centre NHS Foundation Trust, Liverpool, UK.
Topics in Stroke Rehabilitation
|November 26, 2013
Summary
The Epworth Sleepiness Scale (ESS-8) is valid for assessing sleepiness in stroke patients. Removing the driving item (ESS-7) is suitable for measuring high sleepiness levels in mixed driver/non-driver groups.
Area of Science:
- Neurology
- Sleep Medicine
- Psychometrics
Background:
- The Epworth Sleepiness Scale (ESS-8) is widely used in stroke research but lacks validation for this population.
- Concerns exist regarding the driving item (item 8) and its suitability.
- A score of 10 or higher on the ESS-8 indicates pathological sleepiness.
Purpose of the Study:
- To validate the construct of the ESS-8 in stroke patients using Rasch analysis.
- To assess if omitting item 8 affects the scale's validity.
Main Methods:
- The ESS-8 and sleep/demographic questionnaires were mailed to 999 stroke survivors.
- Data from 269 participants were analyzed for Rasch model fit.
Main Results:
- The ESS-8 demonstrated unidimensionality and good fit to the Rasch model, with no differential item functioning by age or sex.
- Item 4 showed disordered thresholds.
- The ESS without item 8 (ESS-7) also proved to be a valid scale.
- No significant differences were observed between ESS-8 and ESS-7 scores below a raw score of 18.
Conclusions:
- The ESS-8 is a valid and reliable tool for detecting pathological sleepiness in stroke patients at a cut-point of 10.
- Scores below 18 are unaffected by omitting item 8 for non-drivers.
- The ESS-7 is recommended for measuring high sleepiness levels in samples including both drivers and non-drivers.
