Subjective fatigue and subjective sleepiness: two independent consequences of sleep disorders?

The objective of this investigation was to evaluate subjective fatigue versus subjective sleepiness as independent consequences of sleep disorders. Furthermore, we tried to explore how these symptoms relate to alertness, depressive symptoms and illness intrusiveness. In a prospective observational study, 283 sleep-disordered patients referred to a hospital-based sleep laboratory for various indications over a 1-year period were evaluated vis-à-vis fatigue and sleepiness. All patients completed five subjective questionnaires, underwent objective sleep recording and attended a clinical interview with a sleep specialist. The subjective questionnaires included the Epworth Sleepiness Scale, the Fatigue Severity Scale, the Toronto Hospital Alertness Test, the Illness Intrusiveness Rating Scale and the Center for Epidemiologic Studies-Depression Scale. Only 4% of the total sample was referred to the sleep clinic due to a complaint of excessive fatigue compared with 17% for excessive daytime sleepiness. However, during the assessment, 64% of referred patients reported pathological fatigue without overlap of sleepiness and only 4% reported pathological sleepiness without overlap of fatigue. Pearson's correlation analysis indicated a weak association (r=0.18) between subjective fatigue and sleepiness in the total sample. Analysis of variance testing showed strong association between those patients with prominent fatigue and depressive symptoms (P<0.01) and illness intrusiveness (P<0.001). The findings support the notion that subjective fatigue and sleepiness can be independent manifestations of sleep disorders. Furthermore, predominantly fatigued individuals with sleep disorders seem vulnerable to additional negative consequences due to possible interplay between amplified fatigue and psychological distress.

Subjective and objective evaluation of sleep and performance in daytime versus nighttime sleep in extended-hours shift-workers at an underground mine.

Extended hours of shift work has the potential for adverse consequences for workers, particularly during the nightshift, such as poorer sleep quality during the day, increased worker fatigue, and fatigue-related accidents and decreased work performance. This study examined subjective and objective measurements of sleep and performance in a group of underground miners before and after the change from a backward-rotating 8-hour to a forward-rotating 10-hour shift schedule. The purpose of this study was to evaluate the short- and long-term impact of a shift schedule change on sleep and performance. The results demonstrated improved subjective and objective measures of sleep and performance on the new 10-hour nightshift schedule. The 10-hour nightshift workers subjectively reported more refreshing sleep, fewer performance impairments and driving difficulties than 8-hour nightshift workers. The results of the objective measures of sleep and performance on the 10-hour nightshifts were overall similar or possibly better than those measured on the 10-hour dayshifts. These are some of the first data to suggest that a nightshift that does not encompass the entire night period could have significant benefits to shift-workers. We suggest that these benefits are mostly the result of the timing of the new nightshift start and end times rather than other shift-schedule factors.

Development of an adjective checklist to measure five FACES of fatigue and sleepiness. Data from a national survey of insomniacs.

Development and initial validation of the FACES of fatigue and sleepiness adjective checklist. An initial item pool of 65 adjectives, descriptive of fatigue, sleepiness and related deprivation states, was developed and administered to 372 individuals referred by their family physicians for psychiatric investigation and treatment of severe insomnia. Participants attended one of six Canadian university-affiliated sleep clinics where they completed a psychiatric assessment and a 766-item questionnaire, including a number of standard indices of sleep-related behavior and symptoms, medical history, sleep hygiene, psychosocial well-being and psychopathology. Principal-components and item analyses were undertaken to refine the initial 65-item pool to a smaller 50-item set, consisting of five subscales: Fatigue, Anergy, Consciousness, Energized and Sleepiness. Coefficient alpha was calculated and indicated high internal consistency reliability for all subscales. Convergent and discriminant validity were also evaluated by calculating correlations between FACES subscales and a number of independent indices. The resulting five-scale FACES questionnaire appears to offer a promising self-report instrument for the measurement of fatigue and related subjective experiences.