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Sleepiness is not the inverse of alertness: evidence from four sleep disorder patient groups

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Abstract

The constructs “sleepiness” and “alertness” are often assumed to be reciprocal states of consciousness. This distinction is of increasing concern in relation to psychomotor performance tasks such as driving. We developed two separate subjective scales of alertness to complement existing sleepiness scales. Subjective sleepiness and alertness were compared in four groups of sleep-disordered patients. In a 175-patient cohort [25 narcoleptics and 50 each with sleep apnea, insomnia and periodic leg movement disorder (PLMD)], the Epworth Sleepiness Scale (ESS) was used to measure sleepiness while the Toronto Hospital Alertness Test (THAT) and ZOGIM Alertness Scale (ZOGIM-A) were used to measure alertness. Significant differences existed for sleepiness scores, with narcoleptics scoring highest on the ESS, followed by sleep apnea, with similar ESS scores for insomnia and PLMD. By contrast, alertness scores on both the THAT and ZOGIM-A did not differ significantly between the four groups. Sleepiness scores show a correlation of close to nil to alertness scores for the combined sleep disorder patient cohort, with the exception of insomnia patients, where a modest but significant inverse relationship was noted between sleepiness and alertness. Subjective states of impaired alertness and excessive sleepiness are independent constructs in the evaluation of sleep-disordered patients. The specific primary sleep disorder diagnosis may play a relevant role in mitigating this interrelationship.

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Abbreviations

CPAP:

Continuous positive airway pressure

ESS:

Epworth sleepiness scale

MSLT:

Multiple sleep latency test

MWT:

Maintenance of wakefulness test

PLMD:

Periodic limb movements disorder

SPSS:

Statistical package for the social sciences

SSS:

Stanford sleepiness scale

THAT:

Toronto Hospital alertness test

ZOGIM-A:

ZOGIM alertness scale

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Acknowledgment

Dr Moller funded through Canadian Institute of Health Research Postdoctoral Fellowship (INMHA and Rx & D Programs).

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Authors and Affiliations

  1. Sleep Research Unit, Toronto Western Hospital, University Health Network, 399 Bathurst Street, Toronto, ON, Canada, M5T-2S8

    Henry J. Moller, Jianhua Shen & Colin M. Shapiro

  2. Department of Psychiatry, University of Toronto, Toronto, Canada

    Henry J. Moller, Gerald M. Devins, Jianhua Shen & Colin M. Shapiro

  3. Toronto General Hospital, University Health Network, Toronto, Canada

    Gerald M. Devins

Authors
  1. Henry J. Moller
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  2. Gerald M. Devins
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  3. Jianhua Shen
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  4. Colin M. Shapiro
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Corresponding author

Correspondence to Henry J. Moller.

Appendix: The ESS, THAT and ZOGIM-A scales

Appendix: The ESS, THAT and ZOGIM-A scales

 

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Moller, H.J., Devins, G.M., Shen, J. et al. Sleepiness is not the inverse of alertness: evidence from four sleep disorder patient groups. Exp Brain Res 173, 258–266 (2006). https://doi.org/10.1007/s00221-006-0436-4

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  • DOI: https://doi.org/10.1007/s00221-006-0436-4

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