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Inside the clinical evaluation of sleepiness: subjective and objective tools

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Abstract

Purpose

To critically review the available tools for evaluating excessive daytime sleepiness (EDS) in clinical practice.

Methods

Objective tests and subjective scales were divided into three groups in accordance with the different dimensions of sleepiness they measure, namely physiological, manifest, and introspective. Strengths, weaknesses, and limitations of each test have been analysed and discussed along with the available recommendations for their use in clinical practice.

Results

The majority of the tests developed for sleepiness evaluation do not have practical usefulness outside the research setting. The suboptimal correlation between different tests mainly depends on the different dimensions of sleepiness they analyse. Most importantly in-laboratory tests poorly correlate with sleepiness in real-life situations and, to date, none is able to predict the risk of injuries related to EDS, especially on an individual level.

Conclusions

There exists not the one best test to assess EDS, however, clinicians can choose a more specific test to address a specific diagnostic challenge on the individual level. The development of novel performance tests with low cost and easy to administer is advisable for both screening purposes and fitness for duty evaluations in populations at high risk of EDS-related injuries, for example professional drivers.

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Acknowledgments

The authors wish to thank Cecilia Baroncini for the English revision.

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Authors and Affiliations

  1. Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy

    Simone Baiardi

  2. IRCCS Istituto delle Scienze Neurologiche di Bologna, Ospedale Bellaria, Via Altura 1/8, 40139, Bologna, Italy

    Simone Baiardi

  3. Neurology Unit, Sant’Orsola-Malpighi University Hospital, Bologna, Italy

    Susanna Mondini

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Correspondence to Simone Baiardi.

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This article is part of the Topical Collection on Excessive Daytime Sleepiness

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Baiardi, S., Mondini, S. Inside the clinical evaluation of sleepiness: subjective and objective tools. Sleep Breath 24, 369–377 (2020). https://doi.org/10.1007/s11325-019-01866-8

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