ArticleJournal of clinical sleep medicine : JCSM : official publication of the American Academy of Sleep Medicine2018
The Epworth Sleepiness Scale: Validation of One-Dimensional Factor Structure in a Large Clinical Sample.
Article in Journal of clinical sleep medicine : JCSM : official publication of the American Academy of Sleep Medicine, 2018. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT06174558 (Is My Sleep Tracker Tracking my Sleep? Validation of Two Wearable Fitness Sleep Trackers on Sleep Staging and Nocturnal Hypoxemia in Sleep Medicine Patients Referred for Diagnostic Polysomnogram), which is not on this map. Cited by 57 papers, 3 of them syntheses that pooled it.
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Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Is My Sleep Tracker Tracking my Sleep? Validation of Two Wearable Fitness Sleep Trackers on Sleep Staging and Nocturnal Hypoxemia in Sleep Medicine Patients Referred for Diagnostic Polysomnogram
Who cites it
57 citing papers in PubMed, 3 syntheses or guidelines pooled it.
- Diagnostic utility of obstructive sleep apnea screening questionnaires: a comprehensive meta-analysis.Sleep & breathing = Schlaf & Atmung · 2024Pooled it
- Effects of aerobic exercise and resistance training on obstructive sleep apnea: a systematic review and meta-analysis.Journal of clinical sleep medicine : JCSM : official publication of the American Academy of Sleep Medicine · 2024Pooled it
- Measuring Subjective Sleep Quality: A Review.International journal of environmental research and public health · 2021Pooled it
- Assessing the Feasibility and Efficacy of Pre-Sleep Dim Light Therapy for Adults with Insomnia: A Pilot Study.Medicina (Kaunas, Lithuania) · 2024Trial
- Feasibility and Efficacy of Morning Light Therapy for Adults with Insomnia: A Pilot, Randomized, Open-Label, Two-Arm Study.Medicina (Kaunas, Lithuania) · 2023Trial
- What do we know about the Epworth Sleepiness Scale in women? A review of the evidence.Sleep medicine reviews · 2026Review
- The prevalence of insomnia disorder in inpatient psychiatric care.European archives of psychiatry and clinical neuroscience · 2026Article
- Including auxiliary cases to address missing data issues through multiple-group models.Behavior research methods · 2026Article
- Daytime Sleepiness and Dispositional Optimism Are Related to Awake Bruxism Among Patients With Painful Temporomandibular Disorders.Journal of oral rehabilitation · 2026Article
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- White matter microstructure differences in obstructive sleep apnea severity groups assessed by diffusion tensor metrics and biophysical modeling.Scientific reports · 2026Article
- Effects of Whole-Body Cryostimulation on Stress Biomarkers and Psychological Well-Being in Parkinson's Disease: A Pilot Study.Journal of clinical medicine · 2026Article
- Development and validation of the tiredness identification index: a combined scale for the assessment of fatigue and sleepiness.Sleep advances : a journal of the Sleep Research Society · 2026Article
- Article
- Relational study between sleep quality, daytime sleepiness state, anxiety, stress, depression in possible bruxist and non-bruxist: cross-sectional study.Odontology · 2026Article
- Association between chronotype and dual-task gait cost across distinct cognitive domains in healthy young adults.PloS one · 2026Article
- Association of sleep patterns assessed by a smartphone application with work productivity loss among Japanese employees.NPJ digital medicine · 2025Article
- Dimensionality and reliability of the Epworth Sleepiness Scale in dental patients referred for oral appliance therapy.Journal of oral & facial pain and headache · 2025Article
- Open label placebo to treat fatigue in people with multiple sclerosis: feasibility and preliminary effects.Pilot and feasibility studies · 2025Article
- Neurological and Immunological Insights Into Post-COVID-19 Syndrome: A Single-Center Retrospective Study.Cureus · 2025Article
Corrections and comments
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Authors and funding
4 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
STUDY
objectivesThe Epworth Sleepiness Scale (ESS) is used by clinicians and researchers to determine level of daytime sleepiness. The number of factors included in the scale has been debated. Our study objective was to clarify the dimensionality of the ESS using a large clinical sample.
methodsA retrospective cohort study included all patients presenting for care in a tertiary care sleep disorders center who answered all items on the ESS from January 8, 2008 to September 28, 2012. Dimensionality was assessed using scree plot, eigenvalues, factor loadings, principal factor analysis, and confirmatory factor analysis. Multigroup confirmatory factor analysis (MGCFA) evaluated dimensionality within 10 subgroups of clinical interest.
resultsThe mean age of the 10,785 study participants was 50 (± 15) years with 49% female, and 81% white. The one-factor solution explained 63% of the variability in responses with high factor loadings (> .67 for all 8 items). The scree plot identified one factor with eigenvalue > 1. Results of confirmatory factor analysis demonstrated a one-factor solution had acceptable goodness of fit as assessed by root mean square error of approximation of .094 (90% confidence interval: .089-.099). MGCFA confirmed measurement invariance within all 10 demographic and clinical subgroups.
conclusionsOur study confirmed the unidimensionality of the ESS in a large diverse clinical population. Results from this study can be used to justify the interpretation of the ESS within clinical populations, and supports valid comparisons between groups based on the ESS. Future studies are warranted to further understand the items comprising the ESS and potentially eliminate redundant items for increased efficiency in clinical settings.
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