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      Psychometric properties of the Epworth sleepiness scale in Ethiopian university students

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          Abstract

          Background

          Daytime sleepiness is highly prevalent across the globe. The Epworth sleepiness scale (ESS) is the most widely used tool for screening daytime sleepiness. The psychometric properties of the ESS have not been comprehensively examined in African populations.

          Material and methods

          A cross-sectional design with simple random sampling was used in the present study. The study recruited 600 students from Mizan-Tepi University, Ethiopia, of which 329 (age = 18–28 years and body mass index = 21.19 ± 3.17 kg/m 2) completed the study. ESS, a semi-structured socio-demographics questionnaire and a clinical interview to diagnose insomnia according to the International Classification of Sleep Disorders were employed.

          Results

          All except one item of the ESS showed a floor effect, while only one item score showed ceiling effect. However, no ceiling/floor effect was observed in the ESS total score. The Cronbach’s alpha (0.75) and composite reliability (0.75), indicated good internal consistency, while a moderate item-total score correlation ( r = 0.55–0.67) implied favorable internal homogeneity. The known-group validity was established by significantly higher scores for all the ESS item scores and the ESS total scores among those with symptoms of insomnia than among non-symptomatic students. Fit indices along with the consideration of inter-factor correlation coefficient, measures of item retention favored the unidimensional structure of the ESS.

          Conclusion

          The ESS has excellent psychometric validity for screening daytime sleepiness in Ethiopian university students.

          Electronic supplementary material

          The online version of this article (10.1186/s12955-019-1098-9) contains supplementary material, which is available to authorized users.

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          Most cited references22

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          Reliability and factor analysis of the Epworth Sleepiness Scale.

          The Epworth Sleepiness Scale (ESS) is a self-administered eight-item questionnaire that has been proposed as a simple method for measuring daytime sleepiness in adults. This investigation was concerned with the reliability and internal consistency of the ESS. When 87 healthy medical students were tested and retested 5 months later, their paired ESS scores did not change significantly and were highly correlated (r = 0.82). By contrast, ESS scores that were initially high in 54 patients suffering from obstructive sleep apnea syndrome returned to more normal levels, as expected, after 3-9 months' treatment with nasal continuous positive airway pressure. The questionnaire had a high level of internal consistency as measured by Cronbach's alpha (0.88). Factor analysis of item scores showed that the ESS had only one factor for 104 medical students and for 150 patients with various sleep disorders. The ESS is a simple and reliable method for measuring persistent daytime sleepiness in adults.
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            Is the Hospital Anxiety and Depression Scale (HADS) a valid measure in a general population 65–80 years old? A psychometric evaluation study

            Background The HADS (Hospital Anxiety and Depression Scale) aims to measure symptoms of anxiety (HADS Anxiety) and depression (HADS Depression). The HADS is widely used but has shown ambiguous results both regarding the factor structure and sex differences in the prevalence of depressive symptoms. There is also a lack of psychometric evaluations of the HADS in non-clinical samples of older people. The aim of the study was to evaluate the factor structure of the HADS in a general population 65–80 years old and to exam possible presence of differential item functioning (DIF) with respect to sex. Methods This study was based on data from a Swedish sample, randomized from the total population in the age group 65–80 years (n = 6659). Confirmatory factor analyses (CFA) were performed to examine the factor structure. Ordinal regression analyses were conducted to detect DIF for sex. Reliability was examined by both ordinal as well as traditional Cronbach’s alpha. Results The CFA showed a two-factor model with cross-loadings for two items (7 and 8) had excellent model fit. Internal consistency was good in both subscales, measured with ordinal and traditional alpha. Floor effects were presented for all items. No indication for meaningful DIF regarding sex was found for any of the subscales. Conclusions HADS Anxiety and HADS Depression are unidimensional measures with acceptable internal consistency and are invariant with regard to sex. Despite pronounced ceiling effects and cross-loadings for item 7 and 8, the hypothesized two-factor model of HADS can be recommended to assess psychological distress among a general population 65–80 years old.
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              Evaluation of the measurement properties of the Epworth sleepiness scale: a systematic review.

              To examine published evidence on the psychometric properties of the Epworth sleepiness scale (ESS) for describing the level of daytime sleepiness (DS) in adults.
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                Author and article information

                Contributors
                salahuddin.mmohammed@gmail.com
                Journal
                Health Qual Life Outcomes
                Health Qual Life Outcomes
                Health and Quality of Life Outcomes
                BioMed Central (London )
                1477-7525
                7 February 2019
                7 February 2019
                2019
                : 17
                : 30
                Affiliations
                [1 ]GRID grid.449051.d, Department of Nursing, College of Applied Medical Sciences, , Majmaah University, ; Majmaah, 11952 Saudi Arabia
                [2 ]GRID grid.449142.e, Department of Pharmacy, College of Medicine and Health Sciences, , Mizan-Tepi University (Mizan Campus), ; Mizan-Aman, Ethiopia
                [3 ]GRID grid.449142.e, Biomedical Sciences, College of Medicine and Health Sciences, , Mizan-Tepi University (Mizan Campus), ; Mizan-Aman, Ethiopia
                [4 ]Independent researcher, 652 Dufferin Street, Toronto, ON M6K 2B4 Canada
                [5 ]Somnogen Canada Inc., College Street, Toronto, ON Canada
                Article
                1098
                10.1186/s12955-019-1098-9
                6367806
                30732633
                85ac58b7-a720-41ff-9d66-e123012b65d6
                © The Author(s). 2019

                Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

                History
                : 12 July 2018
                : 24 January 2019
                Categories
                Research
                Custom metadata
                © The Author(s) 2019

                Health & Social care
                daytime sleepiness,insomnia,known-group validity,floor effect,ess
                Health & Social care
                daytime sleepiness, insomnia, known-group validity, floor effect, ess

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