Reliability and Validity of the Chinese Version of the Epworth Sleepiness Scale

　　目的：本文旨在翻譯及發展中文版Epworth嗜睡量表，以提供臨床醫師篩檢及評估睡眠障礙的病人。方法：將英文版Epworth嗜睡量表(Epworth Sleepiness Scale)翻譯成中文。總計359名罹患睡眠呼吸疾病(sleep breathing disorders)之成年病人參與研究。求得量表之再測信度(test-retest reliability)，以及其內部一致性(internal consistency)數據；其中251位病患並與睡眠檢查結果比較以取得其效度資料(validity)。94名病人接受無線電波上呼吸道懸雍垂軟顎手術(radiofrequency uvulopalatal surgery)後三個月再度填寫量表，以標準化反應平均值(standard response mean, SRM)求得中文版"Epworth嗜睡量表之敏感度(sensitivity)。結果：中文版Epworth嗜睡量表"之各項問題呈現相當良好的再測信度，correlation coefficiency（相關係數）由0.22至0.86，Cronbach's α值為0.81。中文"打鼾量表"與睡眠檢查結果呈現有意義之相關。其SRM（標準化反應平均值）為0.86。結論：中文版"Epworth嗜睡量表"有良好的信度以及內部一致性，與睡眠檢查亦有相當好的效度，敏感度亦相當優良。
　　Background: A Chinese language version of a quality-of-life instrument to evaluate patients with complaints caused by sleep breathing disorders( SBD) is needed. The aims of this study were to translate and validate the Epworth Sleepiness Scale (ESS) in the Mandarin Chinese language. Materials and Methods: The ESS was translated into Mandarin Chinese (Chinese version ESS, CESS) following a standard survey translation protocol. A total of 359 patients aged 18 years and older with the chief complaints of daytime somnolence with a diagnosis of SBD according to what criteria participated in the study. Test-retest reliability coefficients for the CESS were obtained from 30 patients at 2- to 4-week intervals. Internal consistency was calculated using Cronbach α coefficient. A total of 251 sets of the CESS data were compared with polysomnography (PSG) data. Longitudinal sensitivity of the CESS, expressed as a standardized response mean (SRM), was obtained from 94 patients who underwent radiofrequency uvulopalatal surgery. Results: Individual items and total score of the CESS demonstrated good test-retest reliability (correlation coefficients ranging from 0.22 to 0.86). The Cronbach α coefficient was 0.81. The CESS score correlated well with the respiratory distress index (r=0.23, p=0.04). The SRMfor the CESS was 8.6. Conclusion: The Chinese language version of the CESS demonstrated good test-retest reliability and internal consistency. The CESS score was also significantly correlated with objective PSG data. The SRM for the CESS indicated excellent sensitivity to clinical change. This study has demonstrated that the CESS meets the criteria of a valid instrument to evaluate SDB adults with sleepiness complaints among the Chinese-speaking population.