Construct Validation and Reliability Assessment of Tamil Version of Epworth Sleepiness Scale to Evaluate Daytime Sleepiness among Adolescents in Rural Puducherry, South India

A systematic compilation of rating scales developed, translated, and adapted in India

Background

There is a lack of comprehensive data sources on various rating instruments that have been developed, translated, and adapted in Indian context.

Aim

Accordinly, this review aimed to compile the available scales/questionnaires/instruments developed, adapted, and translated for use in India.

Methods

For this, the search engines like PUBMED, Google Scholar, MedKnow, and Science Direct were searched for scales that have been developed, translated, and adapted in Indian context or an Indian language. Only articles reporting a scale/questionnaire development/interview schedules from India or in an Indian language were included.

Results

Available data suggests that most of the instruments that have been translated in the Indian context have been done so in Hindi language. Very few instruments are available in other languages. The scales/instruments that are available in multiple languages include Mini International Neuropsychiatric Interview (MINI), General Health Questionnaire (GHQ), Patient Health Questionnaire (PHQ), Montreal Cognitive Assessment (MoCA), Geriatric Depression Scale (GDS), Edinburgh postnatal depression, Epworth sleepiness scale to evaluate daytime sleepiness, Columbia-Suicide Severity Rating Scale (C-SSRS), Recovery quality of life, World Health Organization Quality of Life-Bref version, Subjective happiness scale, Hospital Anxiety and Depression scale (HADS), Perceived Stress Scale (PSS), Multidimensional Scale of Perceived Social Support (MSPSS), Internalized Stigma of Mental Illness (ISMI), COVID-19 stigma scale, Dyadic adjustment scale, Broad Autism Phenotype Questionnaire (BAPQ), Strength and Difficulties Questionnaire (SDQ), and Rosenzweig picture frustration study (Children's form). Overall, very few instruments have been developed in India.

Conclusion

To conclude, our review suggests that a limited number of scales have been developed in India and in terms of translation and adaptation, most of these have been done in Hindi only. Keeping these points in mind, there is a need to develop more psychometrically sound scales for research and routine clinical practice. Additionally, efforts must be made to translate and adapt scales available in different languages and subject the same to psychometric evaluations.

The Impact of Wireless Network Mobile Devices on College Students' Labour Concept Education in Artificial Intelligence Environment

To cultivate correct labour values and good labour quality of college students and effectively promote the development of their labour concept education, this work explores the impact of wireless network mobile devices on college students' labour concept education under the environment of artificial intelligence. Firstly, a questionnaire survey is used to investigate the labour concept of 400 college students. Secondly, the impact of wireless network mobile devices on college students' labour education is obtained by comparing group A (using artificial intelligence APPs for wireless network devices to learn about labour concepts) and group B (using traditional classroom teaching methods for to learn about labour concepts). According to the statistical survey results, about 20% of college students agree that “if they have enough money to live, they do not have to work”; while less than 50% agree that “they cannot be admitted to civil servants and senior managers in the company and are willing to engage in ordinary labour in the future”. Meanwhile, about 50%–60% of college students think that “housework has nothing to do with me, and it's all the work of adults”. In the question “What would you do when you find that the public area is dirty and poor, but it's not your turn to be on duty?”, only about 50% of college students are willing to clean actively. Comparing the data of group A and group B suggests that the labour view expressed in group A is more biased in the cognition of labour purpose, and students in group A is more negative and lazier in labour attitude and labour habits, which shows that wireless network mobile devices have a great negative impact on the overall labour view of college students. Therefore, it is revealed in this work that the correct use of artificial intelligence technology in the education of labour concept has extremely important value for the intelligent development of education methods.

Subjective Assessment of Sleep Quality and Excessive Daytime Sleepiness in Conventional Hemodialysis Population: A Single-Center Experience

Introduction

Sleep disturbances are common in patients with end-stage kidney disease on hemodialysis (hemodialysis population: HDP). Higher rates of primary sleep disorders, demographic characteristics, metabolic abnormalities, and the efficacy of treatment place HDP at higher risk. The pattern observed is delayed onset of sleep, frequent awakening episodes, insomnia, sleep apnoea, excessive daytime sleepiness, restless leg syndrome, abnormal limb movements, pain in limbs, confusion, and nightmares. Two commonly used subjective assessment scores are the Pittsburgh Sleep Quality Index (PSQI) to assess sleep quality and the Epworth Sleepiness Scale (ESS) to assess excessive daytime sleepiness.

Objective

Subjective assessment of sleep using PSQI and ESS scores in HDP and correlation with clinical and demographic characteristics.

Patients and Methods

A cross-sectional descriptive study of 148 patients with ESKD undergoing in-center hemodialysis. From June 2021 to October 2021 in Madurai medical college, Madurai, India. Subjective assessment with PSQI and ESS scores was done to identify sleep quality and daytime sleepiness, respectively.

Results

The median PSQI score was 6 (IQ:4–10), and as much as 68.24% scored >5 on the PSQI (poor sleepers). The median ESS score of the study participants was 4 (Iq range 3–7), and 19.59% had a total ESS score of more than 10 (excessive daytime sleepiness). The mean age of the participants was 44±14.5. Age more than 60, lower body mass index, unemployment, higher dialysis vintage of more than 2 years, lower hemoglobin, high calcium-phosphorus product are statistically significant for both PSQI and ESS scores.

Conclusion

The prevalence of poor sleep quality and excessive daytime sleepiness is high in HDP. Subjective assessment scores (PSQI and ESS) on the bedside are valuable tools in identifying sleep quality and EDS where objective assessment methods are not feasible and will help in the short time identification and management of sleep disturbances.

Evidence Base Update on Assessing Sleep in Youth

BACKGROUND

Sleep is vital to youth well-being and when it becomes disturbed - whether due to environmental or individual factors - mental and physical health suffer. Sleep problems can also be a symptom of underlying mental health disorders. Assessing different components of sleep, including quality and hygiene, can be useful both for identifying mental health problems and for measuring changes in well-being over time. However, there are dozens of sleep-related measures for youth and it can be difficult to determine which to select for a specific research or clinical purpose. The goal of this review was to identify sleep-related measures for clinical and/or research use in youth mental health settings, and to update the evidence base on this topic.

METHOD

We generated a list of candidate measures based on other reviews and searched in PubMed and PsycINFO using the terms "sleep" AND (measure OR assessment OR questionnaire) AND (psychometric OR reliability OR validity). Search results were limited to studies about children and adolescents (aged 2-17) published in English. Additional criteria for inclusion were that there had to be at least three publications reporting on the measure psychometrics in community or mental health populations. Sleep measures meeting these criteria were evaluated using the criteria set by De Los Reyes and Langer (2018).

RESULTS

Twenty-six measures, across four domains of sleep - insomnia, sleep hygiene, sleepiness, sleep quality - met inclusion criteria. Each measure had at least adequate clinical utility. No measure(s) emerged as superior across psychometric domains.

CONCLUSION

Clinicians and researchers must evaluate sleep measures for each use case, as the intended purpose will dictate which measure is best. Future research is necessary to evaluate measure performance in transdiagnostic mental health populations, including youth with serious mental illness.

The difference in sleep, depression, anxiety, and Internet addiction between Korean adolescents with different circadian preference

OBJECTIVES

Compared to adults, adolescents tend to prefer evening times developmentally. The orientation toward evening times is associated with behavioral and emotional problems. Thus, this study examined the association of circadian preference with sleep-related variables, depression, anxiety, and Internet addiction in Korean adolescents.

MATERIALS AND METHODS

Participants completed the questionnaires measuring sleep pattern, sleep problem, depression, anxiety, and Internet addiction.

RESULTS

Among 765 students (age range: 13-17 years), 211 students (N _male= 134) were allocated into morning types (MT) and 258 adolescents (N _male= 147) were allocated into evening types (ET) based on scores of the Morningness-Eveningness Scale. Adolescents without circadian preference (N = 296) were defined as neither type (NT). ET, compared to MT and NT, woke up later in the weekend, showed delays in bedtimes, and spent shorter time sleeping. They also reported a higher level of daytime sleepiness, insomnia, and depression than NT. However, the group difference in wake time on school days was not significant, and adolescents showed mild insomnia regardless of their circadian preference. Although smartphone using time in the weekend was significantly different between groups, group difference in Internet addiction was significant only when gender was adjusted.

CONCLUSION

Circadian preference was associated with sleep patterns and sleep problems in Korean adolescents. ET showed significantly different sleep patterns compared to MT and NT. ET not only reported a higher level of daytime sleepiness and insomnia but also more depressive symptoms compared to NT. These findings suggest that the uniqueness of adolescence and environmental factors seemed to influence the association of circadian preference with mental problem.

Pediatric Sleep Tools: An Updated Literature Review

Since a thorough review in 2011 by Spruyt, into the integral pitfalls of pediatric questionnaires in sleep, sleep researchers worldwide have further evaluated many existing tools. This systematic review aims to comprehensively evaluate and summarize the tools currently in circulation and provide recommendations for potential evolving avenues of pediatric sleep interest. 144 "tool"-studies (70 tools) have been published aiming at investigating sleep in primarily 6-18 years old per parental report. Although 27 new tools were discovered, most of the studies translated or evaluated the psychometric properties of existing tools. Some form of normative values has been established in 18 studies. More than half of the tools queried general sleep problems. Extra efforts in tool development are still needed for tools that assess children outside the 6-to-12-year-old age range, as well as for tools examining sleep-related aspects beyond sleep problems/disorders. Especially assessing the validity of tools has been pursued vis-à-vis fulfillment of psychometric criteria. While the Spruyt et al. review provided a rigorous step-by-step guide into the development and validation of such tools, a pattern of steps continue to be overlooked. As these instruments are potentially valuable in assisting in the development of a clinical diagnosis into pediatric sleep pathologies, it is required that while they are primary subjective measures, they behave as objective measures. More tools for specific populations (e.g., in terms of ages, developmental disabilities, and sleep pathologies) are still needed.

Validation of the Arabic Version of the Epworth Sleepiness Scale among the Yemeni Medical Students

The study was conducted with the aim to assess the psychometric measures of an adapted Arabic version of the Epworth Sleepiness Scale (ESS) among medical students at Sana'a University, Yemen. The cross-sectional study targeted 360 students (males: 176; females: 184) from the preclinical 3^rd year (N: 197) and the final clinical year (N: 163). Participants self-filled an Arabic and slightly modified version of the 8-item Epworth Sleepiness Scale. Exploratory Principal Component Analysis (PCA) and Confirmatory Factor Analyses (CFA) were conducted on two equal subsets of the sample (N: 180 each). The PCA yielded a two-dimension model subsequently confirmed by factor analysis. The first dimension was grouped on three items while the second dimension had five items reflecting the respondents' propensity to sleep during “interactive situations” and “sitting and lying,” respectively. The model had an acceptable goodness of fit measures for the overall ESS (CMINDF = 2.362, CFI = 0.91, IFI = 0.92) and acceptable reliability indicators (factor 1 α = 0.65, factor 2 α = 0.62). However, due to weak variance explanation (0.07) of item 6 (sitting and talking) in factor 1, analysis was repeated excluding this item. The 7-item model was also two-dimensional, valid, and reliable. The reliability indicators were acceptable with α = 0.65 for factor 1 (4 items of interactive situations) and 0.62 for factor 2 (3 items of sitting) and overall α = 0.68. Overall, the ESS is a useful tool. Factor analysis produced a two-factor model of 7 items with good validity and reasonable reliability that can be used in diagnosing daytime sleepiness among young Yemeni adults.