[Show abstract][Hide abstract] ABSTRACT:
The Epworth Sleepiness Scale (ESS) was designed to be self-completed by the patient. However, it may not be understood by all, and unrecognised problems with literacy can impair the process. The ESS has been translated into a pictorial version for use in those with normal or diminished literacy skills.
An evaluation of the patients' ability to self-complete the ESS was undertaken in sleep and non-sleep respiratory clinics. Errors or problems encountered were recorded on a standard questionnaire. With the aid of a medical artist, pictorial representations of the eight ESS questions were developed and the new pictorial ESS was offered to patients alongside the traditional ESS. The two scales were compared for agreement with a kappa statistic, and patients were asked to record a preference for either the written or the pictorial scale.
Evaluation of the traditional ESS showed that 33.8% (27/80) of ESS-naive patients made errors and 22.5% (18/80) needed help completing the questionnaire. The translated pictorial ESS showed good agreement with the traditional ESS on most questions; median kappa score 0.63, IQR 0.04. Fifty-five per cent reported a preference for the pictorial scale compared with the standard written ESS. Despite the fact that errors were frequently made on the traditional ESS, 96.8% of participants in the second study reported both scales to be easy to complete. More people (75.6%) reported the pictorial ESS to be very easy, in comparison with (64.6%) the worded ESS questionnaire.
Errors are common when patients self-complete the traditional written ESS. Pictures with words have been shown to enhance the understanding and translation of medical information, and a pictorial translation of the ESS produces scores comparable with the traditional ESS and may be a suitable alternative for those with normal or diminished literacy.
[Show abstract][Hide abstract] ABSTRACT:
Routine assessment of daytime function in Sleep Medicine has focused on "tendency to fall asleep" in soporific circumstances, to the exclusion of "wakefulness inability" or inability to maintain wakefulness, and fatigue/tiredness/lack of energy. The objective was to establish reliability and discriminant validity of a test for wakefulness inability and fatigue, and to test its superiority against the criterion standard for evaluation of sleepiness-the Epworth Sleepiness Scale (ESS).
A 12-item self-administered instrument, the Sleepiness-Wakefulness Inability and Fatigue Test (SWIFT), was developed and administered, with ESS, to 256 adults ≥ 18 years of age (44 retook the tests a month later); consecutive patients with symptoms of sleep disorders including 286 with obstructive sleep apnea ([OSA], apnea-hypopnea index ≥ 5/h sleep on polysomnography [PSG]), 49 evaluated with PSG and multiple sleep latency test for narcolepsy and 137 OSA patients treated with continuous positive airway pressure (CPAP).
SWIFT had internal consistency 0.87 and retest intraclass coefficient 0.82. Factor analysis revealed 2 factors-general wakefulness inability and fatigue (GWIF) and driving wakefulness inability and fatigue (DWIF). Normal subjects differed from patients in ESS, SWIFT, GWIF, and DWIF. SWIFT and GWIF (but not DWIF) had higher area under ROC curve, Youden's index, and better positive and negative likelihood ratios than ESS. ESS, SWIFT, GWIF, and DWIF improved with CPAP. Improvements in SWIFT, GWIF, and DWIF (but not ESS) were significantly correlated with CPAP compliance.
SWIFT is reliable and valid. SWIFT and its factor GWIF have a discriminant ability superior to that of the ESS. CITATION: Sangal RB. Evaluating sleepiness-related daytime function by querying wakefulness inability and fatigue: Sleepiness-Wakefulness Inability and Fatigue Test (SWIFT). J Clin Sleep Med 2012;8(6):701-711.
Journal of clinical sleep medicine: JCSM: official publication of the American Academy of Sleep Medicine 01/2012; 8(6):701-11. DOI:10.5664/jcsm.2270 · 2.93 Impact Factor
Sleep Medicine 09/2007; 8(5):541-2. DOI:10.1016/j.sleep.2006.08.012 · 3.10 Impact Factor
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