Match and Mismatch between Lived Experiences of Daytime Sleepiness and Diagnostic Instruments: A Qualitative Study amongst Patients with Sleep Disorders

Round 1

Reviewer 1 Report

- Overall, I think the idea of this study is quite interesting to the field. I have only minor suggestions and comments for the authors. I hope it helps:

1. “Because of the exploratory 649 nature of this study, the sample size was set according to achievement of data saturation.” à please add a reference

2. Please make explicit the temporal range of data collection.

3. Please report IQR instead of SD as you present the median and not the mean.

4. Add references to justify the online nature of the study (e.g., other similar published qualitative studies).

5. A reference to a daytime sleepiness perception scale (for example, the DSPS-4 scale) could be included in "3.2. Assessing daytime sleepiness" section.

Author Response

December 22^nd , 2023

Subject: Letter to Reviewer 1,

Dear reviewer, 

Our deepest thanks for your consideration and review of our manuscript. We have made the necessary changes you requested. Below we copied your comments in red and respond to them in detail in black.

Because of the exploratory nature of this study, the sample size was set according to achievement of data saturation.” Please add a reference”

A reference as to what we considered data saturation was added on line 594.

Please make explicit the temporal range of data collection

The interviews were conducted between May and June 2021, as is now stated on lines 586-587.

Please report IQR instead of SD as you present the median and not the mean

We have replaced the standard deviation with the interquartile range in line 596.

Add references to justify the online nature of the study (e.g., other similar published qualitative studies)

We provided references of other qualitative studies employing individual virtual interviews in line 609. We also provided the reference of an opinion paper discussing the new methods of performing qualitative studies in a virtual context, where the authors highlight similarities with more classical methods of interviews.

A reference to a daytime sleepiness perception scale (for example, the DSPS-4 scale) could be included in "3.2. Assessing daytime sleepiness" section

We included the Daytime Sleepiness Perception Scale (DSPS-4) in the 3.2 section of the discussion, in lines 466-473.

Changes can be found highlighted in yellow (Deletions appear like so: […]).

Yours sincerely,

On behalf of the authors,

Vaida Verhoef

Reviewer 2 Report

This article investigated factors associated with excessive daytime sleepiness from interview transcripts of patients with sleep disorders who reported being sleepy. The analysis of the patients' conversations for the subjective measure of sleepiness was very interesting. However, the description of the methodology was vague, the introduction and discussion were redundant, and I did not understand the problem the authors were trying to solve and the answer to it.

The problem is that excessive daytime sleepiness is difficult to define because it manifests itself in a variety of ways, and previous EDS indices have not adequately assessed patients' excessive sleepiness. Therefore, the authors investigated excessive sleepiness based on patients' daily complaints. Is my understanding correct? The introduction is like a review article, and it is difficult to understand the previous studies, their problems, and what authors want to solve in this study.

Is the method used in this study a form of text mining? I am not sure what the authors are trying to claim since they only describe the content of the interviews.

Why did you choose only OSA and narcolepsy? There are many other conditions that patients claim sleepiness.

Analysis

I understood the image of the language in the interview that was being analyzed. I did not understand at all what this analysis would reveal. Please explain it more clearly with examples.

The results section was descriptive, not cohesive, and I did not understand what the key findings were.

Authors stated “We did this with the aims to delineate the construct of sleepiness, to clarify symptoms, and to gain knowledge on possible fluctuations over time.”　 However, the results section does not provide any answer to this objective.

Author Response

Please see the attachment.

Author Response File: Author Response.pdf

Round 2

Reviewer 2 Report

The authors responded well to my concerns.

In addition, the rewriting of the Methods and Discussion sections made it easier to understand the authors' intentions.