Subjective fatigue and subjective sleepiness: Two independent consequences of sleep disorders?

Sleep Research Unit and Department of Psychiatry, University of Toronto, Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada.
Journal of Sleep Research (Impact Factor: 3.35). 10/2005; 14(3):245-53. DOI: 10.1111/j.1365-2869.2005.00466.x
Source: PubMed


The objective of this investigation was to evaluate subjective fatigue versus subjective sleepiness as independent consequences of sleep disorders. Furthermore, we tried to explore how these symptoms relate to alertness, depressive symptoms and illness intrusiveness. In a prospective observational study, 283 sleep-disordered patients referred to a hospital-based sleep laboratory for various indications over a 1-year period were evaluated vis-à-vis fatigue and sleepiness. All patients completed five subjective questionnaires, underwent objective sleep recording and attended a clinical interview with a sleep specialist. The subjective questionnaires included the Epworth Sleepiness Scale, the Fatigue Severity Scale, the Toronto Hospital Alertness Test, the Illness Intrusiveness Rating Scale and the Center for Epidemiologic Studies-Depression Scale. Only 4% of the total sample was referred to the sleep clinic due to a complaint of excessive fatigue compared with 17% for excessive daytime sleepiness. However, during the assessment, 64% of referred patients reported pathological fatigue without overlap of sleepiness and only 4% reported pathological sleepiness without overlap of fatigue. Pearson's correlation analysis indicated a weak association (r=0.18) between subjective fatigue and sleepiness in the total sample. Analysis of variance testing showed strong association between those patients with prominent fatigue and depressive symptoms (P<0.01) and illness intrusiveness (P<0.001). The findings support the notion that subjective fatigue and sleepiness can be independent manifestations of sleep disorders. Furthermore, predominantly fatigued individuals with sleep disorders seem vulnerable to additional negative consequences due to possible interplay between amplified fatigue and psychological distress.

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Article: Subjective fatigue and subjective sleepiness: Two independent consequences of sleep disorders?

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    • "Nonparametric versus parametric analyses were used according to the normality of the distributions. For aim 3, we sought to reduce the number of data variables consistent with previous analyses [33] [36] by classifying patients into four groups on the basis of their performance on sleep and fatigue measures. First, z-scores were calculated on each measure, and composite z-scores were created for each of the fatigue and sleep scores. "
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