Epworth嗜睡量表简体中文版信度和效度评价

摘要

目的 探讨Epworth嗜睡量表(Epworth sleepiness scale,ESS)简体中文版的信度和效度.方法以585例疑似阻塞性睡眠呼吸暂停低通气综合征(OSAHS)患者及103例确诊并进行手术的OSAHS患者为研究对象,多道睡眠图(PSG)监测前填写ESS量表简体中文版,进行手术的患者术后6个月以上再次进行了PSG监测和填写ESS量表.从585例患者中选取2010年7至8月间的51例患者重新进行ESS量表评分(时间至少间隔1周).结果 ESS量表简体中文版总的Cronbach'α系数为0.814;ESS总分重测信度为0.679,表中各项条目信度为0.473～0.698(P<0.01);分半信度R=0.817(P<0.01).ESS量表效度分析中,区分效度用呼吸暂停低通气指数(AHI)指标来区分单纯鼾症和轻、中及重度OSAHS患者,单纯鼾症与不同病情程度的OSAHS患者ESS量表总评分及各个项目评分差异有统计学意义(P<0.05).用最低血氧饱和度(LSaO2)指标来区分正常血氧饱和度、轻、中及重度低血氧饱和度患者,正常血氧饱和度与不同程度低氧血症患者ESS量表总评分及各个项目评分差异有统计学意义(P<0.05).因素分析中有4个公因子,累积贡献率达74.270%,每项条目负荷大于0.4;各因子分值与ESS量表总分进行相关分析发现除开车等红绿灯或遇堵车停几分钟时与其他各因子的相关性较低外,其他因子之间及ESS总分之间相关性均较高(P<0.01).量表评估与临床诊断的一致率较差(Kappa值为0.099,P<0.01),预测效度差(r=0.138,P<0.01).手术前后ESS总分由15.0[10;20]分降到4[1;6]分(M[P25;P75]),手术治疗有效、无效患者在手术前后ESS总分的差异均有统计学意义(Z=-7.528,P<0.01;Z=-4.382,P<0.01).结论 Epworth嗜睡量表简体中文版具有较好的信度和效度,可以作为白天嗜睡程度自我评估工具.%Objective To investigate the reliability and validity of the simplified Chinese version of Epworth sleepiness scale(ESS). Methods Five hundred and eighty-five patients with suspected obstructive sleep apnea hypopnea syndrome (OSAHS) and 103 OSAHS patients who underwent operations were included in this study. The ESS was filled before polysomnography (PSG) monitoring under the direction of professional technicians. The patients who underwent operations did both PSG and ESS tests more than 6 months after operation. Fifty-one patients who underwent PSG at our hospital from July to August, 2010 were chosen to assess the ESS test-retest reliability on two separate occasions at least more than one week. Results The total Cronbach's Alpha of ESS was 0. 814. The test-retest reliability of ESS total scores was 0.679 and for each item was from 0.473 to 0.698 ( P ＜ 0.01 ). Split-half reliability was 0.817 ( P ＜ 0.01 ). In the analysis of discriminant validity with apnea hypopnea index (AHI), the ESS total scores and each item's scores had significant differences in severity in OSAHS patients and simple snoring patients( P ＜ 0.05 ), and this was also true in different degrees of lowest saturation of arterial oxygen ( LSaO2 ) patients and normal LSaO2 patients(P＜0.05). The factor analysis of construct validity showed that 4 factors were extracted.The cumulative proportion was 74.270%. The loading was higher than 0. 4 among every item. The correlation coefficiency of overall ESS scores and each item's scores was relatively high except the last item.The ESS had low consistency with clinical diagnosis(κ =0.099,P ＜0.01 ) and the predictive validity was not good (r =0.138, P ＜0.01 ). As for 103 patients who had operations, the initial assessment of total ESS scores were 15.0[10;20] ( M[P25 ;P75] ) ,and improved to 4[1 ;6] after operation. The patients who got effective results had significant difference in the total ESS scores before and after operation ( Z = - 7.528,P＜0.01) ,so was the patients who got ineffective results(Z= -4.382, P＜0.01) . Conclusions The simplified Chinese version of ESS had a good reliability and validity. It can be used to evaluate the chance of dozing in the daytime.