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J Clin Sleep Med. 2015 Nov 15;11(11):1289-98. doi: 10.5664/jcsm.5188.

The Barcelona Sleepiness Index: A New Instrument to Assess Excessive Daytime Sleepiness in Sleep Disordered Breathing.

Guaita M1,2, Salamero M1,3,2,4, Vilaseca I1,5,6,4, Iranzo A1,7,2,8, Montserrat JM1,9,6,4, Gaig C1,7,8, Embid C1,9,6, Romero M1,2, Serradell M1,10, León C1,9, de Pablo J1,3,2,4, Santamaria J1,7,2,8,4.

Author information

1
Multidisciplinary Sleep Disorders Unit, Hospital Clínic of Barcelona, Barcelona, Spain.
2
Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain.
3
Department of Psychiatry, Hospital Clínic of Barcelona, Barcelona, Spain.
4
University of Barcelona Medical School, Barcelona, Spain.
5
Department of Otorhinolaryngology, Hospital Clínic of Barcelona, Barcelona, Spain.
6
Ciber Enfermedades Respiratorias (CIBERES), Madrid, Spain.
7
Department of Neurology, Hospital Clínic of Barcelona, Barcelona, Spain.
8
Ciber Enfermedades Neurológicas (CIBERNED), Madrid, Spain.
9
Department of Pneumology, Hospital Clínic of Barcelona, Barcelona, Spain.
10
Fundació Clínic per a la Recerca Biomèdica, Barcelona, Spain.

Abstract

STUDY OBJECTIVES:

To develop the Barcelona Sleepiness Index (BSI), an interviewer-administered instrument for assessing excessive daytime sleepiness (EDS) in sleep-disordered breathing (SDB) that correlates well with objective measures of EDS and which is sensitive to change with treatment.

METHODS:

(1) Generation of a preliminary item list: Fifty-three consecutive SDB patients complaining of EDS and their bed partners were interviewed using a focus group methodology to generate a list of situations prone to cause sleepiness. Sixty different consecutive SDB patients were then evaluated using cognitive interviews to refine this list. (2) Construct validity: The maintenance of wakefulness test (MWT), the multiple sleep latency test (MSLT) and the sustained attention to response task (SART) test were used in an additional 98 consecutive SDB patients with and without EDS. The item combination that best correlated with the objective tests constituted the BSI. Cutoff values were determined to differentiate between patients with and without EDS. (3) Sensitivity to change: Thirty patients requiring continuous positive airway pressure (CPAP) were evaluated after satisfactory treatment.

RESULTS:

A combination of two items, "in the morning, when relaxing" and "in the afternoon, standing inactive, in a public place," presented the highest correlations with the MWT (r: -0.50, p < 0.001), the MSLT (r: -0.21, p = 0.07), and the SART (r: 0.27, p < 0.02) and constituted the BSI. The BSI significantly correlated with oxyhemoglobin saturation measures (nadir SpO2: r: -0.28, p = 0.01; CT 85: r: 0.23, p = 0.04) and showed a high sensitivity to change with CPAP treatment (t: 3.4, p = 0.002). A score of 2 or more identified patients with objective EDS (sensitivity = 64.9%, specificity = 72.1%).

CONCLUSION:

The Barcelona Sleepiness Index is a simple, brief instrument for measuring subjective EDS in SDB.

KEYWORDS:

Barcelona Sleepiness Index; MSLT; MWT; SART; excessive daytime sleepiness; focus group; sleep disordered breathing

PMID:
26094931
PMCID:
PMC4623127
DOI:
10.5664/jcsm.5188
[Indexed for MEDLINE]
Free PMC Article

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