Psychometric analysis of Epworth Sleepiness Scale and its correlation with Pittsburgh sleep quality index in poor sleepers among Indian university students

Daytime sleepiness in Chinese professional, semi professional and students soccer players in the Shanghai lockdown

PURPOSE

April-May 2021 Shanghai city was under strict lockdown. Soccer players suffered from the restrictions, being unable to train and have a social life. The aim of this study was to compare differences in daytime sleepiness between genders and qualification levels in a cohort university Chinese soccer player under 0 Covid policy restrictions in the urban area of Shanghai.

METHODS

491 questionnaires of Epworth Sleepiness Scales (ESS) were compiled online by male and female Soccer Students (SS), Semi-Professional players (SP) and Professional Players (PP) during the ongoing restriction measures post Shanghai lockdown. ANOVA was performed for players levels and gender.

RESULTS

Significant differences were found between the 3 levels and between males and females. PP showed a very low score in the ESS (5,97) well below the threshold of 8 for daytime sleepiness, while SS and SP showed an ESS score above the threshold. Female showed higher scores in comparison to males. Differences between males and females reflect the confinement conditions in the ESS items, showing more difference in the item of ESS which are related with indoor situations.

CONCLUSIONS

This study shows the first data on sleepiness in Chinese soccer players of different level of qualification immediately post lockdown condition. Professional male's players sleepiness was lower, than females, SS and SP after the exceptional lockdown measures. The reasons can reside in the more ordered lifestyle of PP in comparison to SS and SP, which mitigated the effects of the lockdown. Our results suggest that measures to improve sleep in females' soccer player should be adopted if these exceptional conditions will happen again.

Epworth sleepiness scale: A meta-analytic study on the internal consistency

OBJECTIVE/BACKGROUND

The Epworth Sleepiness Scale (ESS) is one of the most used self-reported instruments to assess sleepiness. Thus, several adaptations into different Languages have been performed worldwide over the years. The scale has produced disparate psychometric properties when applied in different settings. In the current study, our aim was to perform a Reliability Generalization meta-analysis of the Cronbach᾽s alphas of all published studies on ESS, specifically with a psychometric focus.

PATIENTS/METHODS

Three reference databases (Scopus, PubMed and Web of Science) were searched since 1991 to October 2022 and all the records on psychometric or validation studies that reported Cronbach's alphas, from clinical and nonclinical groups, were included. In total, data from 46 publications (63 estimates) were extracted, comprising 92,503 participants.

RESULTS

Using a Random-Effects Model, the cumulative Cronbach's alpha for the 63 estimates was about 0.82 (CI: 0.798, 0.832) which can be considered as a good measure. However, and as expected, it was observed a high level of heterogeneity (I2 = 98.96%). Moderation analyses considering setting, date, continent, risk of bias, sex, age and language were performed in order to account for the heterogeneity. Even so, only the variables study setting and continent were significant, and had little importance in explaining the heterogeneity.

CONCLUSIONS

The ESS is a reliable tool to measure sleepiness; however, further studies are needed to investigate what variables might explain the observed variability. Moreover, it will be important to include empirical studies beyond psychometric ones.

The association between nutritional status and sleep quality of Chinese community-dwelling older adults

BACKGROUND

Sleep disorders are a common syndrome and could affect the life quality of the older adults.

AIMS

This study aimed to investigate the association between nutritional status and sleep quality in the Chinese community-dwelling older adults.

METHODS

A total of 2,878 participants ≥ 65 years old from the Yiwu Elderly Cohort were included in the study. Nutritional status was assessed using the Mini Nutritional Assessment Short Form (MNA-SF). Participants were categorized as subjects with malnutrition, at risk of malnutrition or well-nourished based on their MNA-SF score. Pittsburgh Sleep Quality Index (PSQI) was used to identify sleep disorders. PSQI score ≥ 6 was categorized as poor sleep quality.

RESULTS

Among the 2,878 participants (mean age 72.71 ± 5.79 years, 50.3% men), 31.5% (n = 906) were classified as having sleep disorders, and 25.5% were identified as malnutrition or at risk of malnutrition. We found a significantly relationship between nutritional status and sleep quality in older adults, and the results showed well-nourished decreased the risk of sleep disorders (OR = 0.32, 95% CI = 0.13, 0.75). And well-nourished status was significantly associated with less daytime dysfunction, adequate sleep duration, and good subjective sleep quality (all P < 0.05).

CONCLUSION

There was a close association of nutritional status and sleep quality in older adults. We should pay more attention to the nutritional status of older people with sleep problems, as well as the sleep quality of older adults with malnutrition.

Prevalence And Predictors of Restless Leg Syndrome in Adolescent and Young Adults in Bengaluru City, India - a Cross Sectional Study

INTRODUCTION

Restless leg syndrome (RLS) is a sensorimotor disease characterized by an urge to move the legs, often caused by uncomfortable and unpleasant sensations in the legs. It affects the quality of sleep which in turn affects scholastic performance in children and predisposes them to cardiovascular diseases in the long run. Hence, the primary aim of this study was to assess the prevalence and predictors of RLS, poor sleep quality and excessive daytime sleepiness (EDS) Methods: This was a cross sectional observational study conducted between September 2017 and March 2020 in Bengaluru, India including all consenting Pre - university college, Degree college, and Higher secondary school students. After parental consent and assent (if applicable) was obtained, a semi-structured standardized pilot tested questionnaire consisting of the RLS diagnostic criteria, Pittsburgh sleep quality index (PSQI), Epworth sleepiness scale (ESS) and questions on sleep hygiene was administered. The prevalence was expressed as proportions and 95% confidence intervals (95% CI). Regression analysis was done to determine the predictors.

RESULTS

The overall prevalence (95CI; frequency) of students with RLS, poor sleep quality and EDS in our study population was 8.36% (7.54, 9.24; n=1544/4211), 36.67% (35.21, 38.14; n=1544/4211) and 39.87% (38.39, 41.37; n=1679/4211), respectively. PSQI and Epworth score were the significant predictors of RLS. Age, Epworth score, knowledge score and the number of unacceptable sleep habits were the significant predictors of sleep quality. Female gender, PSQI, RLS, knowledge score and the number of unacceptable sleep habits were the significant predictors of EDS.

CONCLUSIONS

The prevalence of RLS, those with poor sleep quality and EDS among adolescents and young adults was higher when compared to the historical data of general population in the same city.

Reliability and validity of the Pittsburgh Sleep Quality Index among frontline COVID-19 health care workers using classical test theory and item response theory

STUDY OBJECTIVES

The applicability of sleep-related scales to frontline medical staff for the COVID-19 pandemic has not been fully proved, so sleep survey results lack credibility and accuracy, creating difficulties for the guidance and treatment of frontline medical staff with sleep disorders, which is not conducive to the prevention and control of COVID-19. This study sought to analyze the reliability and validity of the Pittsburgh Sleep Quality Index (PSQI) among frontline medical staff fighting the COVID-19 pandemic.

METHODS

A network questionnaire survey was used to investigate the PSQI among frontline medical staff who fought COVID-19 in Wuhan, China from March 19 to April 15, 2020. Combined with classical test theory and item response theory, the content validity, internal consistency, construct validity, and other aspects of the PSQI were evaluated.

RESULTS

According to classical test theory, content validity, criterion validity, and construct validity of the PSQI were good. But the internal consistency was better after the deletion of the "daytime dysfunction" subscale. With regard to item response theory, difficulty, the differential item function, and the Wright map performed well.

CONCLUSIONS

The original PSQI showed acceptable applicability in frontline COVID-19 medical staff, and its characteristics moderately improved after the "daytime dysfunction" subscale was removed.

CITATION

Wang L, Wu Y-X, Lin Y-Q, et al. Reliability and validity of the Pittsburgh Sleep Quality Index among frontline COVID-19 health care workers using classical test theory and item response theory. J Clin Sleep Med. 2022;18(2):541-551.

Lower 24-h urinary potassium excretion is negatively associated with excessive daytime sleepiness in the general population

OBJECTIVES

Uncertainty remains about the association of potassium (K) intake and sleepiness. Therefore, we aimed to explore the relationship between K excretion using 24-h urine samples and excessive daytime sleepiness (EDS) in the general population.

METHODS

In a cross-sectional study, we used multi-stage proportional random sampling to obtain a study sample aged ≥ 18 years from Emin, China between March and June 2019. We collected timed 24-h urine specimens and conducted EDS assessments using the Epworth Sleepiness Scale (ESS) questionnaire. Subjects were divided into two groups by the median of 24-h urinary potassium (24-h UK). EDS was defined as ESS score ≥ 10. Multi-variable linear regression was used to examine the association between the 24-h UK and the odds of prevalent EDS. We performed a sensitivity analysis by excluding subjects under anti-hypertensive treatment and those with sleep disordered breathing by the NoSAS scale.

RESULTS

A total of 470 participants with complete 24-h urine samples and ESS data (62% women, mean age 49.6 years, mean ESS score of 9.0 ± 5.2) were enrolled. The mean ESS score was significantly lower in the upper half of 24-h UK group than in the lower half (9.5 ± 5.3 vs 8.5 ± 5.1, P = 0.044), and accordingly, prevalent EDS was significantly greater in the lower half than in the higher half (49% vs 40%, P = 0.039). In further improving the propensity matching score, the results remained consistent with the overall results. In multiple linear regression, 24-h UK was negatively correlated with ESS score (β =  - 0.180 (- 0.276, - 0.085), < 0.001). Sensitivity analysis demonstrated augmented results in those without anti-hypertensive treatment.

CONCLUSION

Lower potassium intake, as suggested by lower UK excretion, may be implicated in the presence of EDS in the general population.

Worry and insomnia as risk factors for depression during initial stages of COVID-19 pandemic in India

The biggest nationwide COVID-19 pandemic lockdown worldwide was enforced in India for an initial period of 21-days. Emerging evidence suggests that pandemic situations and associated lockdowns have an adverse impact on sleep and mental health. However, prediction of sleep health from sociodemographic characteristics and the public’s worry during the initial stages of the COVID-19 pandemic has not been extensively explored so far. It’s also unclear whether sleep outcomes mediate the association between worry and mental health during pandemic situations. A web-survey (N = 391) on sociodemographic characteristics, COVID-19 related worry, sleep health (insomnia and daytime sleepiness), and depression was conducted during the initial 21-days of the COVID-19 stringent lockdown in India. Multiple regression analyses showed that variables, including sex, age, income level, and worry score, contributed to the significant regression equation for insomnia but not for daytime sleepiness. Specifically, the female, younger, lower income, and highly worried populations contributed significantly more than the male, elderly, higher income, and less worried populations, respectively, to the prediction of insomnia. Mediation analyses showed that insomnia, but not daytime sleepiness, fully mediated the relationship between worry score and severity of depressive symptoms. We provide evidence that the female, younger, lower income, and worried populations may be at higher risk for insomnia during pandemic situations. Current evidence gives hope that improving sleep may reduce depressive symptoms during a pandemic situation. This underscores the importance of the implementation of effective public health policies in conjunction with strategical responses to the COVID-19 pandemic.

Effect of Football on Fatigue of Patients with Breast Cancer Treated with Nano-Chemotherapy

Cancer-related fatigue is one of the most common and uncontrollable subjective and persistent fatigue feelings in patients after breast cancer surgery, which seriously affects the rehabilitation effect and quality of life of patients. The purpose of this study was to investigate the effect of football intervention on cancer-related fatigue and quality of life in patients with breast cancer after nano-chemotherapy. The objective of this study is to explore the exercise program that can make patients actively carry out rehabilitation exercise and achieve good rehabilitation effect, so as to provide a theoretical and empirical basis for the study of cancer fatigue and quality of life of patients after breast cancer surgery. In this study, a quasi-experimental study method was used to conveniently select 60 breast cancer outpatients with tumor-related fatigue symptoms in a tertiary hospital in Liaoning Province. According to the convenience group, they were divided into a control group and an intervention group, 30 cases in each group. The control group received routine hospital nursing, while the intervention group received football intervention for 6 months on the basis of routine hospital nursing. The intervention measures include explaining the related knowledge of cancer-related fatigue, helping patients develop football projects, guiding patients to record football sports diaries, checking patients’ football sports diary records at the beginning of each chemotherapy cycle, and discussing football sports feelings with patients. After six months of intervention, the researchers assessed cancer-related fatigue symptoms and quality of life. Football can improve the fatigue, physiological, psychological, and psychological states of breast cancer patients after nano-chemotherapy; reduce fatigue, anxiety, and depression; improve sleep; and ultimately improve the quality of life.