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Psychometric properties of the Ethos Brief Index (EBI) using factorial structure and Rasch Analysis among patients with obstructive sleep apnea before and after CPAP treatment is initiated
Jönköping University, Sweden;Linköping University Hospital, Sweden.
Jönköping University, Sweden;Qazvin Univ Med Sci, Iran.
Linköping University, Sweden.
Linnaeus University, Faculty of Health and Life Sciences, Department of Health and Caring Sciences. (Centre of Interprofessional Collaboration within Emergency care (CICE))
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2019 (English)In: Sleep and Breathing, ISSN 1520-9512, E-ISSN 1522-1709, Vol. 23, no 3, p. 761-768Article in journal (Refereed) Published
Abstract [en]

Background Continuous positive airway treatment (CPAP) is the recommended treatment for patients with obstructive sleep apnea (OSA). Outcome measures often focus on clinical and/or self-rated variables related to the medical condition. However, a brief validated instrument focusing on the whole life situation (i.e., ethos) suitable for clinical practice is missing. The aim of this study was to investigate factorial structure, categorical functioning of the response scale, and differential item functioning across sub-populations of the Ethos Brief Index (EBI) among patients with obstructive sleep apnea (OSA) before and after initiation of continuous positive airway pressure (CPAP). Methods A prospective design, including 193 patients with OSA (68% men, 59.66 years, SD 11.51) from two CPAP clinics, was used. Clinical assessment and overnight respiratory polygraphy were used to diagnose patients. Questionnaires administered before and after 6 months of CPAP treatment included EBI, Epworth Sleepiness Scale (ESS), Hospital Anxiety and Depression Scale, and global perceived health (initial item in SF-36). The validity and reliability of the EBI were investigated using Rasch and confirmatory factor analysis models. Measurement invariance, unidimensionality, and differential item functioning across gender groups, Apnea-Hypopnea Index, and ESS groups were assessed. Results The reliability of the EBI was confirmed using composite reliability and Cronbach's alpha. The results supported unidimensionality of the EBI in confirmatory factor analysis and the Rasch model. No differential item functioning was found. A latent profile analysis yielded two profiles of patients with low (n = 42) and high (n = 151) ethos. Patients in the low ethos group were younger and had higher depression scores, lower perceived health, and higher body mass index. Conclusions The EBI is a valid tool with robust psychometric properties suitable for use among patients with OSA before and after treatment with CPAP is initiated. Future studies should focus on its predictive validity.

Place, publisher, year, edition, pages
Springer, 2019. Vol. 23, no 3, p. 761-768
Keywords [en]
Obstructive sleep apnea, Continuous positive airway treatment, Ethos, Validity, Reliability
National Category
Other Health Sciences
Research subject
Health and Caring Sciences
Identifiers
URN: urn:nbn:se:lnu:diva-89258DOI: 10.1007/s11325-018-1762-zISI: 000482433800006PubMedID: 30523558OAI: oai:DiVA.org:lnu-89258DiVA, id: diva2:1354345
Available from: 2019-09-25 Created: 2019-09-25 Last updated: 2019-11-08Bibliographically approved

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Fridlund, Bengt

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