The reliability and validity of the Thai version Epworth sleepiness scale for children and adolescents (ESS-CHAD) in pediatric obstructive sleep apnea

บทคัดย่อ

Background: Obstructive sleep apnea (OSA) is a sleep disorder that the upper airway collapses momentarily while sleeping, which leads to many symptoms, e.g. snoring, excessive daytime sleepiness, learning difficulties, and behavioral problems. On account of high global prevalence of OSA, many questionnaires were used to screen OSA patients. Epworth sleepiness scale (ESS) was successfully developed for screening excessive daytime sleepiness in adults. Subsequently, due to insufficient screening tools in children, ESS-CHAD was recently created. Objective: The objectives of this study are to evaluate the reliability and validity between Epworth sleepiness scale for children and adolescents (ESS-CHAD) and pediatric obstructive sleep apnea, and to investigate the correlation between Epworth sleepiness scale for children and adolescents (ESS-CHAD) and the severity of pediatric obstructive sleep apnea. Methods: A total of 41 subjects (31 males and 10 females) were recruited. In order to check the discriminant validity of the ESS-CHAD, we included 26 patients with obstructive sleep apnea (OSA) confirmed by polysomnography, 9 patients with mild OSA, 10 patients with moderate OSA, and 7 patients with severe OSA. The test-retest reliability was investigated in 41 subjects to check the responsiveness properties of the questionnaire. Results: The internal consistency demonstrated by Cronbach’s alpha coefficients for standardized item was 0.836. The test-retest reliability was shown by intra-class correlation coefficients of 0.982. There was a statistically significant difference between the mean of the ESS-CHAD scores of the mild OSA (3.33±1.87) and the severe OSA patients (9.85±5.43) (p < 0.05). Also, there was a statistically significant difference between the mean of the ESS-CHAD scores of the Pediatric Sleep Questionnairre (PSQ) negative patients (4.31±2.72) and the PSQ positive patients (7.36±5.74) (p < 0.05). The ESS-CHAD score had the highest sensitivity of 70.59% and the highest specificity of 77.78% with a cut-off score ≥ 5. However, there was no statistically significant difference in the correlation between ESS-CHAD scores and polysomnogram parameters. Conclusions: Our first Thai version of the ESS-CHAD showed an excellent internal consistency and test–retest reliability. It is able to discriminate between mild OSA patients and severe OSA patients with a cut-off value ≥ 5; however, it does not have a correlation with the polysomnogram parameters. Therefore, we recommend use it to combine with more comprehensive clinical evaluation in pediatric obstructive sleep disordered breathing patients.