Summary and outlook

Although the MSLT and MWT have been used frequently, in many studies was found evidence that the reliability and validity of the procedures are unsatisfactory. In addition, the two test methods don't correspond to any real life situation (Johns, 2000). Even if it is objective and standardized measuring instruments, have been repeatedly confirmed weaknesses in the implementing objectivity of the individual tests as well as their generalization ability (Danker-Hopfe et al. 2006). John's criticism is that the reliability and validity verification of MWT and MSLT were not gone in any way according to objective and standardized criteria. The ESS compared to the MSLT and MWT has good reliability and validation criteria, sensitivity and specificity measures. Its only drawback lies in the fact that the subjective assessments are based on individual perception and trust and the honesty of the patient.

Johns (2000) emphasizes the need to find an objective test, such as the ESS is valid and able to quantify the alertness in various everyday situations. Such a test would represent a true gold standard. Result of this strong criticism and of the clinical relevance of developing a new measuring method, Rühle et al. (2005) analyzed the effect sizes of the ESS. They pursued the goal, to detect the daytime sleepiness of life situation as objective, reliable and valid as possible. The analysis of the ESS and its implications led to the experimental derivation, design and construction of the Reading test (pilot study: Rühle et al. 2007, main study: Erle et al. 2009).

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