Benn Edmund, Wirth Hugh, Short Teagan, Howarth Timothy, Heraganahally Subash S
College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia.
College of Health and Human Sciences, Charles Darwin University, Darwin, Northern Territory, Australia.
Nat Sci Sleep. 2021 Mar 4;13:315-328. doi: 10.2147/NSS.S298409. eCollection 2021.
To illustrate the utility of a newly developed culturally safe and clinically relevant subjective daytime sleepiness assessment tool "Top End Sleepiness Scale" (TESS) for use among Indigenous Australians.
The TESS questionnaire consists of pictorial representations of 6 items representing daily activities that would induce daytime sleepiness specific for Indigenous Australians living in the regional and remote Australia. Consecutive adult Indigenous patients who consented to pilot the TESS questionnaire prior to undergoing a diagnostic polysomnography (PSG) at the Top End Health Service region, Northern Territory of Australia were assessed. The TESS questionnaire was evaluated for its correlation in predicting obstructive sleep apnea (OSA) according to apnea-hypopnea index.
Eighty-two patients were included. The majority (70%) had moderate to severe OSA (AHI ≥15). Patients were aged in their mid-40's (45.47 95% CI (42.9, 48.05)) with a tendency to obesity (median BMI 33.67 IQR 30.86, 38.95) and a high prevalence of chronic conditions (72%) (hypertension, diabetes or heart disease). The TESS showed high internal consistency (Split half Spearman correlation=0.71, Cronbach's α =0.81), and a cut-off value ≥3 resulted in sensitivity 84%, specificity 38%. Comparison of area under the curve for TESS to Epworth Sleepiness Scale (ESS) in this sample showed the TESS to have greater sensitivity and specificity overall, which approached significance (p=0.072) when cut-off values of ≥3 and ≥8 (TESS & ESS respectively) were used. The sensitivity and specificity for TESS was also comparable to the other currently used questionnaires, such as the Berlin Questionnaire, STOP-BANG and OSA 50.
Currently, there are no subjective daytime sleepiness assessment toll available specifically for Indigenous population. The proposed TESS sleepiness screening tool represented in this study can potentially complement or adopted alongside other existing questionnaire, which may offer greater utility in the assessment of sleep disorders among Indigenous people.
阐述一种新开发的文化安全且临床相关的主观日间嗜睡评估工具“顶端嗜睡量表”（TESS）在澳大利亚原住民中的应用价值。
TESS问卷由6个项目的图片组成，这些项目代表了澳大利亚北部地区和偏远地区原住民日常生活中会导致日间嗜睡的活动。对在澳大利亚北领地顶端健康服务地区接受诊断性多导睡眠图（PSG）检查之前同意试用TESS问卷的成年原住民患者进行连续评估。根据呼吸暂停低通气指数评估TESS问卷在预测阻塞性睡眠呼吸暂停（OSA）方面的相关性。
纳入82例患者。大多数（70%）患有中度至重度OSA（呼吸暂停低通气指数≥15）。患者年龄在45岁左右（45.47，95%可信区间（42.9，48.05）），有肥胖倾向（BMI中位数33.67，四分位数间距30.86，38.95），慢性病患病率高（72%）（高血压、糖尿病或心脏病）。TESS显示出较高的内部一致性（分半斯皮尔曼相关性=0.71，克朗巴哈α系数=0.81），截断值≥3时，敏感性为84%，特异性为38%。在该样本中，将TESS的曲线下面积与爱泼华嗜睡量表（ESS）进行比较，结果显示TESS总体上具有更高的敏感性和特异性，当使用≥3和≥8（分别为TESS和ESS）的截断值时，接近显著性（p=0.072）。TESS的敏感性和特异性也与其他目前使用的问卷相当，如柏林问卷、STOP - BANG和OSA 50。
目前，尚无专门针对原住民的主观日间嗜睡评估工具。本研究中提出的TESS嗜睡筛查工具可能会补充或与其他现有问卷一起使用，这可能在评估原住民睡眠障碍方面具有更大的效用。
