Match and Mismatch between Lived Experiences of Daytime Sleepiness and Diagnostic Instruments: A Qualitative Study amongst Patients with Sleep Disorders
Abstract
:1. Introduction
2. Results
2.1. General Description
2.2. Theme 1: Distinct and Yet Closely Related Descriptors of Core Daytime Symptoms
2.2.1. Tired
2.2.2. Fatigued
2.2.3. Exhausted
2.2.4. Sleepy
2.2.5. Interchangeable Descriptors
2.2.6. Magnitude
2.3. Theme 2: The Use of Antipodes to Help Describe Daytime Complaints
2.3.1. Energy, Alertness, Rest, Wakefulness, and Efficiency: All Antipodes
2.3.2. A Mirror to Descriptors: Interchangeable Antipodes
2.4. Theme 3: An Image or a Metaphor to Illustrate Daytime Symptoms
2.4.1. A Reservoir Going on Empty
2.4.2. A Threshold Not to Cross
2.4.3. A Cost and a Bank Account Close to Zero
2.4.4. A Mental Fog
2.4.5. A Slowdown
2.5. Theme 4: Physical or Mental Signs to Help Describe Daytime Experiences
2.5.1. Physical Consequences
2.5.2. Cognitive Consequences
2.5.3. Affective Consequences
2.5.4. Mental vs. Physical Consequences
2.6. Theme 5: A Time Space for the Daytime Complaints
3. Discussion
3.1. Conceptualization of Sleepiness Amongst Daytime Complaints
3.2. Assessing Daytime Sleepiness
3.3. Strengths, Limitations, and Future Research
4. Conclusions
5. Materials and Methods
5.1. Study Design
5.2. Participants
5.3. Procedure
5.4. Analysis
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
References
- Garbarino, S. Excessive Daytime Sleepiness in Obstructive Sleep Apnea: Implications for Driving Licenses. Sleep Breath. 2020, 24, 37–47. [Google Scholar] [CrossRef] [PubMed]
- Ohayon, M.M. Epidemiology of Excessive Daytime Sleepiness. Sleep Med. Clin. 2006, 1, 9–16. [Google Scholar] [CrossRef]
- Pagel, J.F. Excessive Daytime Sleepiness. AFP 2009, 79, 391–396. [Google Scholar]
- Slater, G.; Steier, J. Excessive Daytime Sleepiness in Sleep Disorders. J. Thorac. Dis. 2012, 4, 608–616. [Google Scholar] [CrossRef]
- Chapman, J.L.; Serinel, Y.; Marshall, N.S.; Grunstein, R.R. Residual Daytime Sleepiness in Obstructive Sleep Apnea After Continuous Positive Airway Pressure Optimization. Sleep Med. Clin. 2016, 11, 353–363. [Google Scholar] [CrossRef] [PubMed]
- Guilleminault, C.; Brooks, S.N. Excessive Daytime sleepiness: A Challenge for the Practising Neurologist. Brain 2001, 124, 1482–1491. [Google Scholar] [CrossRef] [PubMed]
- Leibowitz, S.M.; Brooks, S.N.; Black, J.E. Excessive Daytime Sleepiness: Considerations for the Psychiatrist. Psychiatr. Clin. N. Am. 2006, 29, 921–945. [Google Scholar] [CrossRef]
- Pigeon, W.R.; Sateia, M.J.; Ferguson, R.J. Distinguishing between Excessive Daytime Sleepiness and Fatigue: Toward Improved Detection and Treatment. J. Psychosom. Res. 2003, 54, 61–69. [Google Scholar] [CrossRef]
- Rosenberg, R.; Schweitzer, P.K.; Steier, J.; Pepin, J.-L. Residual Excessive Daytime Sleepiness in Patients Treated for Obstructive Sleep Apnea: Guidance for Assessment, Diagnosis, and Management. Postgrad. Med. 2021, 133, 772–783. [Google Scholar] [CrossRef]
- Baiardi, S.; Mondini, S. Inside the Clinical Evaluation of Sleepiness: Subjective and Objective Tools. Sleep Breath. 2020, 24, 369–377. [Google Scholar] [CrossRef]
- Lopez, R.; Micoulaud-Franchi, J.-A.; Barateau, L.; Dauvilliers, Y. Une approche multi-dimensionnelle de l’hypersomnolence. Médecine du Sommeil 2022, 19, 206–220. [Google Scholar] [CrossRef]
- Hossain, J.L.; Ahmad, P.; Reinish, L.W.; Kayumov, L.; Hossain, N.K.; Shapiro, C.M. Subjective Fatigue and Subjective Sleepiness: Two Independent Consequences of Sleep Disorders? J. Sleep Res. 2005, 14, 245–253. [Google Scholar] [CrossRef] [PubMed]
- Shahid, A.; Shen, J.; Shapiro, C.M. Measurements of Sleepiness and Fatigue. J. Psychosom. Res. 2010, 69, 81–89. [Google Scholar] [CrossRef]
- Shen, J.; Barbera, J.; Shapiro, C.M. Distinguishing Sleepiness and Fatigue: Focus on Definition and Measurement. Sleep Med. Rev. 2006, 10, 63–76. [Google Scholar] [CrossRef] [PubMed]
- Chervin, R.D. Sleepiness, Fatigue, Tiredness, and Lack of Energy in Obstructive Sleep Apnea. Chest 2000, 118, 372–379. [Google Scholar] [CrossRef] [PubMed]
- Young, T.B. Epidemiology of Daytime Sleepiness: Definitions, Symptomatology, and Prevalence. J. Clin. Psychiatry 2004, 65, 12–16. [Google Scholar] [PubMed]
- Kim, H.; Young, T. Subjective Daytime Sleepiness: Dimensions and Correlates in the General Population. Sleep 2005, 28, 625–634. [Google Scholar] [CrossRef]
- Martin, V.P.; Lopez, R.; Dauvilliers, Y.; Rouas, J.-L.; Philip, P.; Micoulaud-Franchi, J.-A. Sleepiness in Adults: An Umbrella Review of a Complex Construct. Sleep Med. Rev. 2023, 67, 101718. [Google Scholar] [CrossRef]
- Martin, V.P.; Taillard, J.; Rubenstein, J.; Philip, P.; Lopez, R.; Micoulaud-Franchi, J.-A. Que nous disent les outils de mesure sur la somnolence et l’hypersomnolence chez l’adulte ? Approches historiques et perspectives futures. Médecine Sommeil 2022, 19, 221–240. [Google Scholar] [CrossRef]
- Guilleminault, C.; Billiard, M.; Montplaisir, J.; Dement, W.C. Altered States of Consciousness in Disorders of Daytime Sleepiness. J. Neurol. Sci. 1975, 26, 377–393. [Google Scholar] [CrossRef]
- Pilcher, J.J.; Pury, C.L.S.; Muth, E.R. Assessing Subjective Daytime Sleepiness: An Internal State Versus Behavior Approach. Behav. Med. 2003, 29, 60–67. [Google Scholar] [CrossRef] [PubMed]
- Benbadis, S.R.; Mascha, E.; Perry, M.C.; Wolgamuth, B.R.; Smolley, L.A.; Dinner, D.S. Association between the Epworth Sleepiness Scale and the Multiple Sleep Latency Test in a Clinical Population. Ann. Intern. Med. 1999, 130, 289–292. [Google Scholar] [CrossRef] [PubMed]
- Foster, S.N.; Hansen, S.L.; Scalzitti, N.J.; Matsangas, P.; Moore, B.A.; Mysliwiec, V. Residual Excessive Daytime Sleepiness in Patients with Obstructive Sleep Apnea Treated with Positive Airway Pressure Therapy. Sleep Breath. 2020, 24, 143–150. [Google Scholar] [CrossRef] [PubMed]
- Lok, R.; Zeitzer, J.M. Physiological Correlates of the Epworth Sleepiness Scale Reveal Different Dimensions of Daytime Sleepiness. Sleep Adv. 2021, 2, zpab008. [Google Scholar] [CrossRef] [PubMed]
- Cluydts, R.; De Valck, E.; Verstraeten, E.; Theys, P. Daytime Sleepiness and Its Evaluation. Sleep Med. Rev. 2002, 6, 83–96. [Google Scholar] [CrossRef] [PubMed]
- Smith, S.; Rossdale, J.; Serry, Y.; Sekaran, A.; Drakatos, P.; Steier, J. Multiple Dimensions of Excessive Daytime Sleepiness. J. Thorac. Dis. 2018, 10, S170. [Google Scholar] [CrossRef] [PubMed]
- Gandhi, K.D.; Mansukhani, M.P.; Silber, M.H.; Kolla, B.P. Excessive Daytime Sleepiness: A Clinical Review. Mayo Clin. Proc. 2021, 96, 1288–1301. [Google Scholar] [CrossRef] [PubMed]
- Maestri, M.; Romigi, A.; Schirru, A.; Fabbrini, M.; Gori, S.; Bonuccelli, U.; Bonanni, E. Excessive Daytime Sleepiness and Fatigue in Neurological Disorders. Sleep Breath. 2020, 24, 413–424. [Google Scholar] [CrossRef]
- Beurskens, A.; Bultmann, U.; Kant, I.; Vercoulen, J.; Bleijenberg, G.; Swaen, G. Fatigue among Working People: Validity of a Questionnaire Measure. Occup. Environ. Med. 2000, 57, 353–357. [Google Scholar] [CrossRef]
- Sunwoo, B.Y.; Kaufmann, C.N.; Murez, A.; Lee, E.; Gilbertson, D.; Bosompra, N.-O.; DeYoung, P.; Malhotra, A. The Language of Sleepiness in Obstructive Sleep Apnea beyond the Epworth. Sleep Breath. 2022, 27, 1057–1065. [Google Scholar] [CrossRef]
- Long, H.; Scott, H.; Lack, L. Sleepy, Tired, Drowsy, and Fatigue Have Different Meanings for a University Student Sample. J. Clin. Sleep Med. 2022, 18, 1235–1241. [Google Scholar] [CrossRef] [PubMed]
- Johns, M.W. A New Method for Measuring Daytime Sleepiness: The Epworth Sleepiness Scale. Sleep 1991, 14, 540–545. [Google Scholar] [CrossRef] [PubMed]
- Åkerstedt, T.; Gillberg, M. Subjective and Objective Sleepiness in the Active Individual. Int. J. Neurosci. 1990, 52, 29–37. [Google Scholar] [CrossRef] [PubMed]
- Marques, D.R.; Gomes, A.A.; De Azevedo, M.H.P. DSPS-4: A Brief Measure of Perceived Daytime Sleepiness. Curr. Psychol. 2019, 38, 579–588. [Google Scholar] [CrossRef]
- Hoddes, E.; Zarcone, V.; Smythe, H.; Phillips, R.; Dement, W.C. Quantification of Sleepiness: A New Approach. Psychophysiology 1973, 10, 431–436. [Google Scholar] [CrossRef]
- Chalder, T.; Berelowitz, G.; Pawlikowska, T.; Watts, L.; Wessely, S.; Wright, D.; Wallace, E.P. Development of a Fatigue Scale. J. Psychosom. Res. 1993, 37, 147–153. [Google Scholar] [CrossRef]
- Michielsen, H.J.; De Vries, J.; Van Heck, G.L. Psychometric Qualities of a Brief Self-Rated Fatigue Measure: The Fatigue Assessment Scale. J. Psychosom. Res. 2003, 54, 345–352. [Google Scholar] [CrossRef]
- Saboonchi, F.; Perski, A.; Grossi, G. Validation of Karolinska Exhaustion Scale: Psychometric Properties of a Measure of Exhaustion Syndrome. Scand. J. Caring Sci. 2013, 27, 1010–1017. [Google Scholar] [CrossRef]
- Droogleever Fortuyn, H.A.; Fronczek, R.; Smitshoek, M.; Overeem, S.; Lappenschaar, M.; Kalkman, J.; Renier, W.; Buitelaar, J.; Lammers, G.J.; Bleijenberg, G. Severe Fatigue in Narcolepsy with Cataplexy. J. Sleep Res. 2012, 21, 163–169. [Google Scholar] [CrossRef]
- Waldman, L.T.; Parthasarathy, S.; Villa, K.F.; Bron, M.; Bujanover, S.; Brod, M. Understanding the Burden of Illness of Excessive Daytime Sleepiness Associated with Obstructive Sleep Apnea: A Qualitative Study. Health Qual. Life Outcomes 2020, 18, 128. [Google Scholar] [CrossRef]
- Axelsson, J.; Kecklund, G.; Åkerstedt, T.; Donofrio, P.; Lekander, M.; Ingre, M. Sleepiness and Performance in Response to Repeated Sleep Restriction and Subsequent Recovery during Semi-Laboratory Conditions. Chronobiol. Int. 2008, 25, 297–308. [Google Scholar] [CrossRef] [PubMed]
- Franzen, P.L.; Siegle, G.J.; Buysse, D.J. Relationships between Affect, Vigilance, and Sleepiness Following Sleep Deprivation. J. Sleep Res. 2008, 17, 34–41. [Google Scholar] [CrossRef] [PubMed]
- Buysse, D.J.; Thompson, W.; Scott, J.; Franzen, P.L.; Germain, A.; Hall, M.; Moul, D.E.; Nofzinger, E.A.; Kupfer, D.J. Daytime Symptoms in Primary Insomnia: A Prospective Analysis Using Ecological Momentary Assessment. Sleep Med. 2007, 8, 198–208. [Google Scholar] [CrossRef] [PubMed]
- Schneider, C.; Fulda, S.; Schulz, H. Daytime Variation in Performance and Tiredness/Sleepiness Ratings in Patients with Insomnia, Narcolepsy, Sleep Apnea and Normal Controls. J. Sleep Res. 2004, 13, 373–383. [Google Scholar] [CrossRef] [PubMed]
- Guest, G.; Bunce, A.; Johnson, L. How Many Interviews Are Enough?: An Experiment with Data Saturation and Variability. Field Methods 2006, 18, 59–82. [Google Scholar] [CrossRef]
- Sy, M.; O’Leary, N.; Nagraj, S.; El-Awaisi, A.; O’Carroll, V.; Xyrichis, A. Doing Interprofessional Research in the COVID-19 Era: A Discussion Paper. J. Interprof. Care 2020, 34, 600–606. [Google Scholar] [CrossRef]
- Askari, S.; Harvey, K.; Sam-Odutola, M. Patients Experience of Cognitive Fatigue Post-Stroke: An Exploratory Study. Disabil. Rehabil. 2023, 1–8. [Google Scholar] [CrossRef]
- Dong, S.X.; Lin, R.J. Patient Experience with Absolute Voice Rest Following Phonomicrosurgery: A Qualitative Study. Laryngoscope 2024, 134, 361–366. [Google Scholar] [CrossRef]
- Saldana, J. The Coding Manual for Qualitative Researchers, 2nd ed.; SAGE: Los Angeles, CA, USA, 2013; ISBN 978-1-44624-736-5. [Google Scholar]
Participant Code ♦ | Gender | Age | Sleep Disorder(s) ♦♦ | Treatment ♦♦ |
---|---|---|---|---|
N1F21 | Female | 21 | Narcolepsy | NM |
N2F47 | Female | 47 | Narcolepsy | Modafinil |
N3M20 | Male | 20 | Narcolepsy | Long-acting methylphenidate |
N4M22 | Male | 22 | Narcolepsy | Hydroxybutyric acid |
N5F53 | Female | 53 | Narcolepsy | Methylphenidate |
A1M56 | Male | 56 | Obstructive sleep apnea | CPAP |
A2F54 | Female | 54 | Obstructive sleep apnea Delayed sleep phase syndrome | CPAP |
A3F55 | Female | 55 | Obstructive sleep apnea Insomnia | Antidepressant Antipsychotic CPAP |
A4F73 | Female | 73 | Obstructive sleep apnea Insomnia | CPAP Mirtazapine |
A5M50 | Male | 50 | Obstructive sleep apnea | BPAP |
A6F66 | Female | 66 | Obstructive sleep apnea Chronic insomnia Restless leg syndrome | BPAP |
A7M52 | Male | 52 | Obstructive sleep apnea Central sleep apnea | APAP |
A8F55 | Female | 55 | Obstructive sleep apnea | CPAP |
A9M49 | Male | 49 | Obstructive sleep apnea | CPAP Sleep medication |
A10F52 | Female | 52 | Obstructive sleep apnea | CPAP |
A11F62 | Female | 62 | Obstructive sleep apnea Periodic limb movement disorder | CPAP |
A12M69 | Male | 69 | Obstructive sleep apnea | CPAP |
A13F74 | Female | 74 | Obstructive sleep apnea | CPAP |
A14M61 | Male | 61 | Obstructive sleep apnea | CPAP |
A15F65 | Female | 65 | Obstructive sleep apnea | CPAP |
Disclaimer/Publisher’s Note: The statements, opinions and data contained in all publications are solely those of the individual author(s) and contributor(s) and not of MDPI and/or the editor(s). MDPI and/or the editor(s) disclaim responsibility for any injury to people or property resulting from any ideas, methods, instructions or products referred to in the content. |
© 2024 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
Share and Cite
Verhoef, V.T.R.; Smolders, K.C.H.J.; Remmelswaal, L.; Peeters, G.; Overeem, S.; de Kort, Y.A.W. Match and Mismatch between Lived Experiences of Daytime Sleepiness and Diagnostic Instruments: A Qualitative Study amongst Patients with Sleep Disorders. Clocks & Sleep 2024, 6, 24-39. https://doi.org/10.3390/clockssleep6010003
Verhoef VTR, Smolders KCHJ, Remmelswaal L, Peeters G, Overeem S, de Kort YAW. Match and Mismatch between Lived Experiences of Daytime Sleepiness and Diagnostic Instruments: A Qualitative Study amongst Patients with Sleep Disorders. Clocks & Sleep. 2024; 6(1):24-39. https://doi.org/10.3390/clockssleep6010003
Chicago/Turabian StyleVerhoef, Vaida T. R., Karin C. H. J. Smolders, Lysanne Remmelswaal, Geert Peeters, Sebastiaan Overeem, and Yvonne A. W. de Kort. 2024. "Match and Mismatch between Lived Experiences of Daytime Sleepiness and Diagnostic Instruments: A Qualitative Study amongst Patients with Sleep Disorders" Clocks & Sleep 6, no. 1: 24-39. https://doi.org/10.3390/clockssleep6010003