Supplementary Material for: Developing an Alternative Version of the Epworth Sleepiness Scale to Assess Daytime Sleepiness in Adults with Physical or Mental Disabilities

<b><i>Introduction:</i></b> Excessive daytime sleepiness (EDS) is a frequent symptom with many possible causes, and many of these can be treated. EDS and its underlying causes have been associated with various negative health consequences. Recognition of EDS is thus an important public health concern. The concept of EDS is, however, not yet well defined, and different measures are used to diagnose EDS. The Epworth Sleepiness Scale (ESS) is the most widely used tool to assess daytime sleepiness in a broad range of populations. Its applicability in patients exhibiting physical or mental disabilities, like older multimorbid patients, is limited, since the ESS was not developed and validated in this patient group. <b><i>Methods:</i></b> Within an expert study with 35 sleep medicine experts and a pilot study with 52 geriatric in-patients, who frequently exhibit physical or mental disabilities, and patients’ close relatives, we adapted the original ESS to develop an alternative version to assess daytime sleepiness in adults with physical or mental disabilities (ESS-ALT). <b><i>Results:</i></b> In this adapted version, items 3 (sitting inactively in a public place) and 8 (sleepy in traffic) were replaced by 2 new items (sitting in a waiting room, sitting and eating a meal) and an interview format was used. This ESS-ALT achieved fewer missing responses (23 vs. 73%) and a higher level of internal consistency (Cronbach’s α = 0.64 vs. 0.23) than the original ESS while keeping its somnificity structure. <b><i>Conclusion:</i></b> The ESS-ALT achieves better psychometric properties than the original ESS for individuals with physical or mental disabilities.

**引言：** 过度日间嗜睡（Excessive Daytime Sleepiness, EDS）是一类常见症状，诱因多样且多数可通过干预改善。EDS及其潜在病因与多种不良健康结局存在关联，因此对EDS的识别是一项重要的公共卫生议题。然而，目前EDS的概念尚未得到清晰界定，临床中也采用多种评估手段进行EDS的诊断。爱泼沃斯嗜睡量表（Epworth Sleepiness Scale, ESS）是目前在各类人群中应用最广泛的日间嗜睡评估工具，但由于该量表并非针对躯体或精神障碍患者群体开发并验证，其在这类人群——如合并多种疾病的老年患者——中的适用性受限。

**方法：** 本研究开展两项子研究：一项纳入35名睡眠医学专家的专家研究，以及一项纳入52名常存在躯体或精神障碍的老年住院患者及其直系亲属的预试验。基于上述研究，我们对原版ESS进行改良，开发出适用于躯体或精神障碍成年人群的日间嗜睡评估替代量表（ESS-ALT）。

**结果：** 改良后的量表将原条目3（在公共场所静坐时）与条目8（在交通场景下嗜睡）替换为2个新条目（在候诊室静坐时、坐着用餐时），并采用访谈式施测。与原版ESS相比，ESS-ALT的缺失应答率更低（23% vs 73%），内部一致性更高（克朗巴赫α系数（Cronbach’s α）=0.64 vs 0.23），且保留了原版量表的嗜睡相关维度结构。

**结论：** 针对躯体或精神障碍人群，ESS-ALT的心理测量学性能优于原版爱泼沃斯嗜睡量表。