Validity of the new 'Top End Sleepiness Scale' against the STOP-Bang tool in predicting obstructive sleep apnoea among Indigenous Australian adults.

BACKGROUND: The validity of the newly developed sleepiness assessment tool, the 'Top End Sleepiness Scale' (TESS), against other established obstructive sleep apnoea (OSA) screening tools has not been evaluated. AIMS: To compare the utility and validity of the culturally safe and clinically relevant subjective daytime sleepiness assessment tool, the 'TESS' was used among Indigenous Australians against STOP-Bang screening tool for predicting OSA in a regional and remote Indigenous Australian cohort. METHODS: The TESS questionnaire, consisting of pictorial representations of six items representing daily activities that would induce daytime sleepiness specific for Indigenous Australians, was assessed for its correlation in predicting moderate to severe OSA according to Apnoea-Hypopnoea Index (AHI, ≥15) against the STOP-Bang screening tool. RESULTS: Eighty Indigenous Australian patients (51% male; mean age 45.1 ± 11.5 years) were included in this study with the majority (n = 70; 88%) having OSA, of which 65 (93%) had an AHI ≥ 15. Area under the curve statistics for overall scores showed no significant difference between TESS or STOP-Bang in the prediction of OSA (P = 0.16). A moderate risk score of TESS (≥3) was superior to STOP-Bang (score 3-4) in sensitivity (84% vs 33%) and specificity (39% vs 30%). The sensitivity for a high-risk score for the STOP-Bang (≥5) was superior to the TESS (≥8; 60% vs 33%), although specificity was comparable (83% vs 91% respectively). CONCLUSIONS: The TESS screening tool could be a useful standalone or could be adopted alongside the STOP-Bang OSA screening tools in the clinical assessment of sleep disorders among Indigenous Australians.

The Top End Sleepiness Scale (TESS): A New Tool to Assess Subjective Daytime Sleepiness Among Indigenous Australian Adults.

PURPOSE: 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. PATIENTS AND METHODS: 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. RESULTS: 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. CONCLUSION: 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.