Stanford Sleepiness Scale

Last updated
Stanford Sleepiness Scale
Purposemeasures level of sleepiness at night

The Stanford Sleepiness Scale(SSS), developed by William C. Dement and colleagues in 1972, is a one-item self-report questionnaire measuring levels of sleepiness throughout the day. The scale has been validated for adult populations [1] and is generally used to track overall alertness at each hour of the day. [2] [3] The SSS is used in both research and clinical settings to assess the level of intervention or effectiveness of a specific treatment in order to compare a client's progress. [1] [4]

Contents

Reliability and validity

Reliability

Reliability  refers to whether the scores are reproducible. Unless otherwise specified, the reliability scores and values come from studies done with a United States population sample.

Rubric for evaluating norms and reliability for the General Behavior Inventory (table from Youngstrom et al., extending Hunsley & Mash, 2008; *indicates new construct or category)
CriterionRating (adequate, good, excellent, too good*)Explanation with references
NormsNot applicableMean and standard deviation do not exist because the SSS is a single item questionnaire.
Internal consistency (Cronbach's alpha, split half, etc.)Not applicableSSS only has one question
Inter-rater reliability Not applicableDesigned originally as a self-report scale
Test-retest reliability (stability)Goodr = .88 [5]
RepeatabilityNot publishedNo published studies formally checking repeatability

Validity

Validity describes the evidence that an assessment tool measures what it was supposed to measure. Unless otherwise specified, the reliability scores and values come from studies done with a United States population sample.

CriterionRating (adequate, good, excellent, too good*)Explanation with references
Content validity AdequateFollows characteristics of alertness, but sleepiness is not unidimensional and difficult to quantify [1] [4]
Construct validity (e.g., predictive, concurrent, convergent, and discriminant validity)GoodShows convergent validity with other symptom scales such as ESS and Karolinska Sleepiness Scale, [6] prediction of performance after sleep deprivation [4]
Discriminative validityAdequateStudies do not report AUCs, some mention overlap between sleepiness, physical tiredness, and depression [4]
Validity generalizationGoodEvidence supports use in a variety of research and clinical settings, but only in persons of 18 years and older [1]
Treatment sensitivityNot applicableSSS is not intended for use as a measure of outcome
Clinical utilityAdequateFree (public domain), brief, easy administration

Development and history

The SSS was developed to measure subjective sleepiness in research and clinical settings. [4] Other instruments measuring sleepiness tend to examine the general experience of sleepiness over the course of a day, but the SSS met a need for a scale measuring sleepiness in specific moments of time. [1] Because it can be used to evaluate specific moments, the scale can be used repeatedly at different time intervals in a research study or for treatment intervention. [1]

Use in other populations

Since the development of the SSS, there have been other more specific and more recently developed sleepiness rating scales, such as the Epworth Sleepiness Scale, which is more commonly used in other populations. Due to the fact that it has only been translated into English, it is not significantly used in other populations.

Limitations

The primary limitations of the Stanford Sleepiness Scale is that it is a self-report measure, because of this, levels of sleepiness may be over or under reported based on personal biases.

See also

Related Research Articles

Hemiparesis, or unilateral paresis, is weakness of one entire side of the body. Hemiplegia is, in its most severe form, complete paralysis of half of the body. Hemiparesis and hemiplegia can be caused by different medical conditions, including congenital causes, trauma, tumors, or stroke.

Somnolence is a state of strong desire for sleep, or sleeping for unusually long periods. It has distinct meanings and causes. It can refer to the usual state preceding falling asleep, the condition of being in a drowsy state due to circadian rhythm disorders, or a symptom of other health problems. It can be accompanied by lethargy, weakness and lack of mental agility.

Hypersomnia is a neurological disorder of excessive time spent sleeping or excessive sleepiness. It can have many possible causes and can cause distress and problems with functioning. In the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), hypersomnolence, of which there are several subtypes, appears under sleep-wake disorders.

A microsleep is a sudden temporary episode of sleep or drowsiness which may last for a few seconds where an individual fails to respond to some arbitrary sensory input and becomes unconscious. Episodes of microsleep occur when an individual loses and regains awareness after a brief lapse in consciousness, often without warning, or when there are sudden shifts between states of wakefulness and sleep. In behavioural terms, MSs may manifest as droopy eyes, slow eyelid-closure, and head nodding. In electrical terms, microsleeps are often classified as a shift in electroencephalography (EEG) during which 4–7 Hz activity replaces the waking 8–13 Hz background rhythm.

<span class="mw-page-title-main">Obstructive sleep apnea</span> Sleeping and breathing disorder

Obstructive sleep apnea (OSA) is the most common sleep-related breathing disorder and is characterized by recurrent episodes of complete or partial obstruction of the upper airway leading to reduced or absent breathing during sleep. These episodes are termed "apneas" with complete or near-complete cessation of breathing, or "hypopneas" when the reduction in breathing is partial. In either case, a fall in blood oxygen saturation, a disruption in sleep, or both, may result. A high frequency of apneas or hypopneas during sleep may interfere with the quality of sleep, which – in combination with disturbances in blood oxygenation – is thought to contribute to negative consequences to health and quality of life. The terms obstructive sleep apnea syndrome (OSAS) or obstructive sleep apnea–hypopnea syndrome (OSAHS) may be used to refer to OSA when it is associated with symptoms during the daytime.

<span class="mw-page-title-main">Somnology</span> Scientific study of sleep

Somnology is the scientific study of sleep. It includes clinical study and treatment of sleep disorders and irregularities. Sleep medicine is a subset of somnology.

The Epworth Sleepiness Scale (ESS) is a scale intended to measure daytime sleepiness that is measured by use of a very short questionnaire. This can be helpful in diagnosing sleep disorders. It was introduced in 1991 by Dr Murray Johns of Epworth Hospital in Melbourne, Australia.

Shift work sleep disorder (SWSD) is a circadian rhythm sleep disorder characterized by insomnia, excessive sleepiness, or both affecting people whose work hours overlap with the typical sleep period. Insomnia can be the difficulty to fall asleep or to wake up before the individual has slept enough. About 20% of the working population participates in shift work. SWSD commonly goes undiagnosed, so it's estimated that 10–40% of shift workers have SWSD. The excessive sleepiness appears when the individual has to be productive, awake and alert. Both symptoms are predominant in SWSD. There are numerous shift work schedules, and they may be permanent, intermittent, or rotating; consequently, the manifestations of SWSD are quite variable. Most people with different schedules than the ordinary one might have these symptoms but the difference is that SWSD is continual, long-term, and starts to interfere with the individual's life.

Excessive daytime sleepiness (EDS) is characterized by persistent sleepiness and often a general lack of energy, even during the day after apparently adequate or even prolonged nighttime sleep. EDS can be considered as a broad condition encompassing several sleep disorders where increased sleep is a symptom, or as a symptom of another underlying disorder like narcolepsy, circadian rhythm sleep disorder, sleep apnea or idiopathic hypersomnia.

<span class="mw-page-title-main">Sleep medicine</span> Medical specialty devoted to the diagnosis and therapy of sleep disturbances and disorders

Sleep medicine is a medical specialty or subspecialty devoted to the diagnosis and therapy of sleep disturbances and disorders. From the middle of the 20th century, research has provided increasing knowledge of, and answered many questions about, sleep–wake functioning. The rapidly evolving field has become a recognized medical subspecialty in some countries. Dental sleep medicine also qualifies for board certification in some countries. Properly organized, minimum 12-month, postgraduate training programs are still being defined in the United States. In some countries, the sleep researchers and the physicians who treat patients may be the same people.

The sleep–wake activity inventory (SWAI) is a subjective multidimensional questionnaire intended to measure sleepiness.

A chronotype is the behavioral manifestation of underlying circadian rhythm's myriad of physical processes. A person's chronotype is the propensity for the individual to sleep at a particular time during a 24-hour period. Eveningness and morningness are the two extremes with most individuals having some flexibility in the timing of their sleep period. However, across development there are changes in the propensity of the sleep period with pre-pubescent children preferring an advanced sleep period, adolescents preferring a delayed sleep period and many elderly preferring an advanced sleep period.

<span class="mw-page-title-main">Sleep study</span> Sleep Medicine

A sleep study is a test that records the activity of the body during sleep. There are five main types of sleep studies that use different methods to test for different sleep characteristics and disorders. These include simple sleep studies, polysomnography, multiple sleep latency tests (MSLTs), maintenance of wakefulness tests (MWTs), and home sleep tests (HSTs). In medicine, sleep studies have been useful in identifying and ruling out various sleep disorders. Sleep studies have also been valuable to psychology, in which they have provided insight into brain activity and the other physiological factors of both sleep disorders and normal sleep. This has allowed further research to be done on the relationship between sleep and behavioral and psychological factors.

<span class="mw-page-title-main">Nap</span> Short period of sleep during typical waking hours

A nap is a short period of sleep, typically taken during daytime hours as an adjunct to the usual nocturnal sleep period. Naps are most often taken as a response to drowsiness during waking hours. A nap is a form of biphasic or polyphasic sleep, where the latter terms also include longer periods of sleep in addition to one period. For years, scientists have been investigating the benefits of napping, including the 30-minute nap as well as sleep durations of 1–2 hours. Performance across a wide range of cognitive processes has been tested.

The CDR computerized assessment system is a computerized battery of cognitive tests designed in the late 1970s by Professor Keith Wesnes at the University of Reading in Berkshire, England, for repeated testing in clinical trials. Task stimuli are presented in a laptop computer and participants respond via 'YES' and 'NO' buttons on a two-button response box, which records both the accuracy and reaction time.

Idiopathic hypersomnia(IH) is a neurological disorder which is characterized primarily by excessive sleep and excessive daytime sleepiness (EDS). The condition typically becomes evident in early adulthood and most patients diagnosed with IH will have had the disorder for many years prior to their diagnosis. As of August 2021, an FDA-approved medication exists for IH called Xywav, which is oral solution of calcium, magnesium, potassium, and sodium oxybates; in addition to several off-label treatments (primarily FDA-approved narcolepsy medications).

Sleep state misperception (SSM) is a term in the International Classification of Sleep Disorders (ICSD) most commonly used for people who mistakenly perceive their sleep as wakefulness, though it has been proposed that it be applied to those who severely overestimate their sleep time as well. While most sleepers with this condition will report not having slept in the previous night at all or having slept very little, clinical recordings generally show normal sleep patterns. Though the sleep patterns found in those with SSM have long been considered indistinguishable from those without, some preliminary research suggest there may be subtle differences.

The Somatic Symptom Scale - 8 (SSS-8) is a brief self-report questionnaire used to assess somatic symptom burden. It measures the perceived burden of common somatic symptoms. These symptoms were originally chosen to reflect common symptoms in primary care but they are relevant for a large number of diseases and mental disorders. The SSS-8 is a brief version of the popular Patient Health Questionnaire - 15 (PHQ-15).

The Pittsburgh Sleep Quality Index (PSQI) is a self-report questionnaire that assesses sleep quality over a 1-month time interval. The measure consists of 19 individual items, creating 7 components that produce one global score, and takes 5–10 minutes to complete. Developed by researchers at the University of Pittsburgh, the PSQI is intended to be a standardized sleep questionnaire for clinicians and researchers to use with ease and is used for multiple populations. The questionnaire has been used in many settings, including research and clinical activities, and has been used in the diagnosis of sleep disorders. Clinical studies have found the PSQI to be reliable and valid in the assessment of sleep problems to some degree, but more so with self-reported sleep problems and depression-related symptoms than actigraphic measures.

<span class="mw-page-title-main">Behavioral sleep medicine</span>

Behavioral sleep medicine (BSM) is a field within sleep medicine that encompasses scientific inquiry and clinical treatment of sleep-related disorders, with a focus on the psychological, physiological, behavioral, cognitive, social, and cultural factors that affect sleep, as well as the impact of sleep on those factors. The clinical practice of BSM is an evidence-based behavioral health discipline that uses primarily non-pharmacological treatments. BSM interventions are typically problem-focused and oriented towards specific sleep complaints, but can be integrated with other medical or mental health treatments. The primary techniques used in BSM interventions involve education and systematic changes to the behaviors, thoughts, and environmental factors that initiate and maintain sleep-related difficulties.

References

  1. 1 2 3 4 5 6 Shahid, Azmeh; Wilkinson, Kate; Marcu, Shai; Shapiro, Colin M. (2011-01-01). Shahid, Azmeh; Wilkinson, Kate; Marcu, Shai; Shapiro, Colin M. (eds.). STOP, THAT and One Hundred Other Sleep Scales . Springer New York. pp.  369–370. doi:10.1007/978-1-4419-9893-4_91. ISBN   9781441998927.
  2. Hoddes E. (1972). "The development and use of the stanford sleepiness scale (SSS)". Psychophysiology. 9 (150).
  3. "Management of Excessive Daytime Sleepiness Reviewed". Medscape. Retrieved 2021-04-07.
  4. 1 2 3 4 5 Maclean, Alistair W.; Fekken, G. Cynthia; Saskin, Paul; Knowles, John B. (1992-03-01). "Psychometric evaluation of the Stanford Sleepiness Scale". Journal of Sleep Research. 1 (1): 35–39. doi: 10.1111/j.1365-2869.1992.tb00006.x . ISSN   1365-2869. PMID   10607023.
  5. "American Thoracic Society - Stanford Sleepiness Scale (SSS)". www.thoracic.org. Retrieved 2016-11-13.
  6. Chokroverty, Sudhansu; Allen, Richard; Walters, Arthur (2013). Sleep and Movement Disorders. OUP USA. pp. 196–202.