Relations Between Performance and Subjective Ratings of Sleepiness During a Night Awake
Abstract
The present study validated the nine-point Karolinska Sleepiness Scale (KSS) and the new Accumulated Time with Sleepiness (ATS) scale against performance of laboratory tasks. The ATS scale was designed as a method for integrating subjective sleepiness over longer time periods. The subjects were asked if certain symptoms of sleepiness had occurred and, if so, for how long. Six subjects participated twice. Each time they were kept awake during the night (except for a short nap occurring during one of the nights in a counterbalanced order) and were tested at 2200, 0200, 0400 and 0600 hours. The tests included a 10-minute rest period, a 28-minute visual vigilance task and an 11-minute single reaction time task. KSS and visual analogue scale (VAS) ratings were given before each test, and ATS ratings were given after. Performance deteriorated clearly, and all three rating scales reflected increased sleepiness with time of night. Scores on the KSS and VAS showed high correlations with performance tasks (mean intraindividual correlations were between 0.49 and 0.71). Performance correlated even higher with the ATS ratings (r = 0.73-0.79). Intercorrelations between rating scales were also high (r = 0.65-0.86). It was concluded that there were strong relations between ratings of sleepiness and performance, that the ATS rating scale was at least as good as the other scales and that the ratings were affected by type of task.
The claims and statistics of this paper haven’t been checked yet.
Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.
Integrity signals
Registry
Cites
Statistics
Claims the paper makes
The claims and statistics of this paper haven’t been checked yet.
Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
The Karolinska Sleepiness Scale is a 9-point Likert scale with valid point values, where odd numbers have descriptions from 1 (extremely alert) to 9 (extremely sleepy).
“The KSS is a 9-point Likert scale with all numbers having valid point values, but only the odd numbers have descriptions: 1 representing ' extremely alert, ' 3 representing ' alert, ' 5 representing ' neither alert nor sleepy, ' and 9 representing ' extremely sleepy ' (9, 41).”
From Evening use of light-emitting eReaders negatively affects sleep, circadian timing, and next-morning alertness. (2015) · cites this paper as [41]
The Methods (p. 2) describe the KSS as a nine-point scale from 1 (“very alert”) to 9 (“very sleepy, fighting sleep, an effort to keep awake”), with verbal descriptions at every second point. Our copy does not give the descriptions for points 3 and 5, so those specific labels in the citing sentence are not verified. (LLM, conf=0.84)
Experimental — accuracy not yet measured
Self-check
Percentages, sums and reported differences re-computed from the paper’s own numbers.
The self-check needs the paper’s full text.
Cites
The publisher hasn’t deposited this paper’s reference list.
Research works printed but not linked: 15
- [1]1. Torsvall L, Åkerstedt T. Sleepiness on the job: continuously measured EEG changes in train drivers. Electroencephalogr Clinical Neurophysiol 1987;66:502–11. Ratings predicted performance to a high degree; 35– 50% of the variance in performance scores could be explained by the prior KSS ratings, and this was slightly better than for the VAS ratings. In recent studies John-o,, odt d t St t t ( ot jective" sleepiness measures (multiple sleep latency test and lapses in a tapping task). However, their design and methods for analyzing data might not have been optimal for the purpose of demonstrating relationships. The correlations were calculated across individuals on data aggregated over several measurements, a method that might adequately reveal individual differences but not the sensitivity of self-rating methods. Furthermore, there might have been a restriction of variance due to inadequate manipulation of the underlying sleepiness. Similarly, Herscovitch and Broughton (6) found no correspondence between SSS and performance. The temporal relations between ratings and performance were not clear, however, with the exception of ratings given immediately after tests.
- [2]2. Kecklund G, Åkerstedt T. Sieepiness in long distance truck driving: an ambulatory EEG study of night driving. Ergonomics 1993;36:1007-17. There was an even closer covariation between the quality of performance and the ensuing rating of symptoms of sleepiness (ATS). The explained variances were around 50–60%. Glenville and Broughton (5) reported similar correlations for SSS with vigilance and reaction time performance. The higher correlations after tests might be explained by the fact that it may be easier to rate with precision after a specific task because the situation limits extraneous (uncontrolled) influences on alertness and, furthermore, because subjects may be influenced by their perceived quality of performance when rating their sleepiness. These explanations are supported by findings that show higher self-rated sleepiness during or immediately after a performance task
- [4]4. Åkerstedt T, Gillberg M. Subjective and objective sleepiness in the active individual. Internat Neurosci 1990;52:29–37.
- [3]3. Torsvall L, Åkerstedt T, Gillander K, Knutsson A. Sleep on the night shift: 24-hour EEĠ monitoring of spontaneous sleep/wake behaviour. Psychophysiology 1989;26:112–8.
- [5]5. Glenville M, Broughton R. Reliability of the Stanford Sleepiness Scale compared to short duration performance tests and the Wilkinson auditory vigilance task. In: Passouant P, Oswald I, eds. Pharmacology of the states of alertness. Oxford: Pergamon, 1979:235-44.
- [7]7. Johnson LC, Spinweber CL, Gomez SA, Matteson LT. Daytime sleepiness, performance, mood, nocturnal sleep: the effect of benzodiazepine and caffeine on their relationship. Sleep 1990; 13:121-35.
- [6]6. Herscovitch J, Broughton R. Sensitivity of the Stanford sleepiness scale to the effects of cumulative partial sleep deprivation and recovery oversleeping. Sleep 1981;4:83–92.
- [8]8. Johnson LC, Freeman CR, Spinweber CL, Gomez SA. Subjective and objective measures of sleepiness: the effect of benzo- - diazepine and caffeine on their relationship. Psychophysiology 13. Greenhouse SW, Geisser S. On methods in the analysis of profile 1991;28:65-71. data. Psychometrica 1959;24:377–93.
- [14]14. Angus RG, Heslegrave RJ. Effects of sleep loss on sustained cognitive performance during a command and control simulation. Behav Res Methods, Instruments and Computers 1985;17: 55-67.
- [9]9. Akerstedt T, Gillberg M. The circadian variation of experimentally displaced sleep. Sleep 1981;4:159–69.
- [11]11. Lisper H-O, Kjellberg A. Éffects of 24-hour sleep deprivation on rate of decrement in a 10-minute reaction time task. J Exp Psychol 1972;96:287–90.
- [10]10. Gillberg M, Akerstedt T. Possible measures of "sleepiness" for the evaluation of disturbed and displaced sleep. In: Reinberg A, Vieux N, Andlauer P, eds. Night and shiftwork—biological and social aspects. Oxford: Pergamon, 1981:155–60.
- [15]15. Dinges DF, Orne MT, Orne EC. Sleepiness during sleep deprivation: the effects of performance demands and circadian phase. Sleep Res 1984;13:189.
- [12]12. Puri ML. Non-parametric techniques in statistical inference. Cambridge: Cambridge University Press, 1970.
- [16]16. Babkoff H, Caspy T, Mikulincer M. Subjective sleepiness ratings: the effects of sleep deprivation, cirċadian rhythmicity and cognitive performance. Sleep 1991;14:534–9.
Cited by
Sorted by citations
Chang, A.-M., Aeschbach, D., Duffy, J. F., & Czeisler, C. A. (2015) · Proceedings of the National Academy of Sciences · doi:10.1073/pnas.1418490112 · Cited by 1,430 · see citing works
“The KSS is a 9-point Likert scalewith all numbers havingvalid point values, butonly the oddnumbers have descriptions: 1 representing “extremely alert,” 3 representing “alert,” 5 representing “neither alert nor sleepy,” and 9 representing “extremely sleepy” (9, 41).”
BackgroundValidation of the Karolinska sleepiness scale against performance and EEG variables
Kaida, K., Takahashi, M., Åkerstedt, T., Nakata, A., Otsuka, Y., Haratani, T., & Fukasawa, K. (2006) · Clinical Neurophysiology · doi:10.1016/j.clinph.2006.03.011 · Cited by 1,016 · see citing works
“The results are similar to a number of other studies showing relatively high correlations between performance measures and subjective sleepiness (Åkerstedt et al., 2005; Gillberg et al., 1994; Hoddes et al., 1973).”
BackgroundResultSelf-citationCajochen, C., Münch, M., Kobialka, S., Kräuchi, K., Steiner, R., Oelhafen, P., Orgül, S., & Wirz-Justice, A. (2005) · The Journal of Clinical Endocrinology & Metabolism · doi:10.1210/jc.2004-0957 · Cited by 939 · see citing works
“Because the participants wore goggles during the light exposure and during the no-light condition, the Karolinska Sleepiness Scale and the visual analog scale were read out loud by a technician and transmitted via the interphone to the volunteers’ room.”
MethodInfluentialVigilance, alertness, or sustained attention: physiological basis and measurement
Oken, B. S., Salinsky, M. C., & Elsas, S. M. (2006) · Clinical Neurophysiology · doi:10.1016/j.clinph.2006.01.017 · Cited by 887 · see citing works
Pilcher, J. J., Ginter, D. R., & Sadowsky, B. (1997) · Journal of Psychosomatic Research · doi:10.1016/s0022-3999(97)00004-4 · Cited by 841 · see citing works
The link between fatigue and safety
Williamson, A. M., Lombardi, D. A., Folkard, S., Stutts, J. C., Courtney, T. K., & CONNOR, J. L. (2010) · Accident Analysis & Prevention · doi:10.1016/j.aap.2009.11.011 · Cited by 824 · see citing works
A time to think: circadian rhythms in human cognition
Schmidt, C., Collette, F., Cajochen, C., & Peigneux, P. (2007) · Cognitive Neuropsychology · doi:10.1080/02643290701754158 · Cited by 778 · see citing works
“…that it does not take the interplay between clock- and sleepdependent processes into account (sleep pressure, circadian sleep propensity, sleep inertia, etc.) and therefore makes it impossible to segregate the respective contributions of the homeostatic S and circadian C processes to performance.”
BackgroundCajochen, C., Frey, S., Anders, D., Späti, J., Bues, M., Pross, A., Mager, R., Wirz-Justice, A., & Stefani, O. (2011) · Journal of Applied Physiology · doi:10.1152/japplphysiol.00165.2011 · Cited by 730 · see citing works
“Inset, right: Karolinska Sleepiness Scale (KSS) levels during the presentation of the movie from 21:45–22:15 h. Results of the LED computer screen condition ( ); data of the non-LED computer screen condition (Œ).”
MethodCajochen, C., Zeitzer, J. M., Czeisler, C. A., & Dijk, D.-J. (2000) · Behavioural Brain Research · doi:10.1016/s0166-4328(00)00236-9 · Cited by 653 · see citing works
Questions and controversies in the study of time-varying functional connectivity in resting fMRI
Lurie, D. J., Kessler, D., Bassett, D. S., Betzel, R. F., Breakspear, M., Kheilholz, S., Kucyi, A., Liégeois, R., Lindquist, M. A., McIntosh, A. R., et al. (2020) · Network Neuroscience · doi:10.1162/netn_a_00116 · Cited by 648 · see citing works
Sleep loss and fatigue in shift work and shift work disorder
Åkerstedt, T., & Wright, K. P. (2009) · Sleep Medicine Clinics · doi:10.1016/j.jsmc.2009.03.001 · Cited by 639 · see citing works
“This seems to be the case(81;95), although the relation between subjective sleepiness and many performance tasks appears moderate(82;96–102).”
BackgroundSelf-citationSleep Restriction for 1 Week Reduces Insulin Sensitivity in Healthy Men
Buxton, O. M., Pavlova, M., Reid, E. W., Wang, W., Simonson, D. C., & Adler, G. K. (2010) · Diabetes · doi:10.2337/db09-0699 · Cited by 604 · see citing works
“Every 3 hours during wake periods, subjects completed a short test battery including the Karolinska Sleepiness Scale (34) and the Psychomotor Vigilance Task (PVT) (3,24).”
MethodViola, A. U., James, L. M., Schlangen, L. J., & Dijk, D.-J. (2008) · Scandinavian Journal of Work, Environment & Health · doi:10.5271/sjweh.1268 · Cited by 565 · see citing works
“The KSS assessed sleepiness during the past 10 minutes and the RSME questionnaire assessed effort needed for activities that had just been completed.”
MethodInfluentialChellappa, S. L., Steiner, R., Blattner, P., Oelhafen, P., Götz, T., & Cajochen, C. (2011) · PLoS ONE · doi:10.1371/journal.pone.0016429 · Cited by 546 · see citing works
“Subjective sleepiness was assessed every 40 minutes on the Karolinska Sleepiness Scale (KSS) [21] along with visual analogue scales (VAS) were for mood and alertness on a 100 mm scale.”
MethodPER3 polymorphism predicts sleep structure and waking performance
Viola, A. U., Archer, S. N., James, L. M., Groeger, J. A., Lo, J. C. Y., Skene, D. J., von Schantz, M., & Dijk, D.-J. (2007) · Current Biology · doi:10.1016/j.cub.2007.01.073 · Cited by 520 · see citing works
Wyatt, J. K., Cecco, A. R.-D., Czeisler, C. A., & Dijk, D. (1999) · American Journal of Physiology-Regulatory, Integrative and Comparative Physiology · doi:10.1152/ajpregu.1999.277.4.r1152 · Cited by 473 · see citing works
Phipps-Nelson, J., Redman, J. R., Dijk, D.-J., & Rajaratnam, S. M. W. (2003) · Sleep · doi:10.1093/sleep/26.6.695 · Cited by 394 · see citing works
Fatigue, sleep restriction and driving performance
Philip, P., Sagaspe, P., Moore, N. D., Taillard, J., Charles, A., Guilleminault, C., & Bioulac, B. H. (2005) · Accident Analysis & Prevention · doi:10.1016/j.aap.2004.07.007 · Cited by 389 · see citing works
Ingre, M., Åkerstedt, T., Peters, B., Anund, A., & Kecklund, G. (2006) · Journal of Sleep Research · doi:10.1111/j.1365-2869.2006.00504.x · Cited by 361 · see citing works
“…al., 1999; Horne and Baulk, 2004; Torsvall and Åkerstedt, 1987) and subjective sleepiness has been found to predict performance (Dorrian et al., 2000; Gillberg et al., 1994), it has been pointed out that subjective sleepiness is far from perfect in predicting performance (Rogers and Dinges, 2003).”
BackgroundSelf-citationFunctional link between distal vasodilation and sleep-onset latency?
Kräuchi, K., Cajochen, C., Werth, E., & Wirz-Justice, A. (2000) · American Journal of Physiology-Regulatory, Integrative and Comparative Physiology · doi:10.1152/ajpregu.2000.278.3.r741 · Cited by 356 · see citing works
“During the CRs, subjective sleepiness was assessed at onehalf-hour intervals on the Karolinska sleepiness scale (12) together with collection of saliva for measurement of Mel using a highly specific direct double-antibody RIA (32).”
Jewett, M. E., Dijk, D., Kronauer, R. E., & Dinges, D. F. (1999) · SLEEP · doi:10.1093/sleep/22.2.171 · Cited by 352 · see citing works
Subjective sleepiness is a sensitive indicator of insufficient sleep and impaired waking function
Åkerstedt, T., Anund, A., Axelsson, J., & Kecklund, G. (2014) · Journal of Sleep Research · doi:10.1111/jsr.12158 · Cited by 324 · see citing works
Self-citationFatigue, Sleepiness, and Performance in Simulated Versus Real Driving Conditions
Philip, P., Sagaspe, P., Taillard, J., Valtat, C., Moore, N. D., Åkerstedt, T., Charles, A., & Bioulac, B. H. (2005) · SLEEP · doi:10.1093/sleep/28.12.1511 · Cited by 294 · see citing works
Self-citationvan der Lely, S., Frey, S., Garbazza, C., Wirz-Justice, A., Jenni, O. G., Steiner, R., Wolf, S., Cajochen, C., Bromundt, V., & Schmidt, C. (2015) · Journal of Adolescent Health · doi:10.1016/j.jadohealth.2014.08.002 · Cited by 290 · see citing works
“In parallel with the Karolinska Sleepiness Scale, study volunteers provided saliva samples every 30minutes during scheduled wakefulness using Salivettes (Sarstedt AG, Sevelen, Switzerland).”
MethodAge-Related Reduction in Daytime Sleep Propensity and Nocturnal Slow Wave Sleep
Dijk, D., Groeger, J. A., Stanley, N., & Deacon, S. (2010) · SLEEP · doi:10.1093/sleep/33.2.211 · Cited by 268 · see citing works
Leproult, R., Colecchia, E. F., Berardi, A., Stickgold, R., Kosslyn, S. M., & Cauter, E. V. (2003) · American Journal of Physiology-Regulatory, Integrative and Comparative Physiology · doi:10.1152/ajpregu.00197.2002 · Cited by 256 · see citing works
“, between 0600 and 0800 in most young adults (13, 19, 22, 27).”
Work hours, sleepiness and the underlying mechanisms
ÅKERSTEDT, T. (1995) · Journal of Sleep Research · doi:10.1111/j.1365-2869.1995.tb00221.x · Cited by 253 · see citing works
Self-citationHärmä, M., Sallinen, M., Ranta, R., Mutanen, P., & Müller, K. (2002) · Journal of Sleep Research · doi:10.1046/j.1365-2869.2002.00294.x · Cited by 240 · see citing works
Acoustics and psychosocial environment in intensive coronary care
Blomkvist, V., Eriksen, C. A., Theorell, T., Ulrich, R. S., & Rasmanis, G. (2005) · Occupational and Environmental Medicine · doi:10.1136/oem.2004.017632 · Cited by 239 · see citing works
Quantifying the performance impairment associated with fatigue
Lamond, N., & Dawson, D. E. (1999) · Journal of Sleep Research · doi:10.1046/j.1365-2869.1999.00167.x · Cited by 238 · see citing works
Kräuchi, K., Cajochen, C., & Wirz-Justice, A. (1997) · Journal of Applied Physiology · doi:10.1152/jappl.1997.83.1.134 · Cited by 227 · see citing works
Boyle, J., Eriksson, M., Gribble, L., Gouni, R., Johnsen, S., Coppini, D., & Kerr, D. E. (2012) · Diabetes Care · doi:10.2337/dc12-0656 · Cited by 229 · see citing works
Sagaspe, P., Sánchez-Ortuño, M. M., Charles, A., Taillard, J., Valtat, C., Bioulac, B. H., & Philip, P. (2005) · Brain and Cognition · doi:10.1016/j.bandc.2005.10.001 · Cited by 223 · see citing works
Long-term effects of mild traumatic brain injury on cognitive performance
Dean, P. J. A., & Sterr, A. (2013) · Frontiers in Human Neuroscience · doi:10.3389/fnhum.2013.00030 · Cited by 224 · see citing works
“A measure of sleep propensity [Karolinska Sleepiness Scale, KSS; (Gillberg et al., 1994)] was taken before (KSS Pre) and after (KSS Post) the behavioral task.”
MethodHealthy Older Adults Better Tolerate Sleep Deprivation Than Young Adults
Duffy, J. F., Willson, H. J., Wang, W., & Czeisler, C. A. (2009) · Journal of the American Geriatrics Society · doi:10.1111/j.1532-5415.2009.02303.x · Cited by 209 · see citing works
“Throughout each CR, subjective alertness was assessed twice per hour using the Karolinska Sleepiness Scale (KSS(12)), which required the subject to select a number spanning the range from 1 (very alert) to 9 (very sleepy); subjective estimates from this task oscillate with circadian phase(13) and are sensitive to acut…”
MethodDiurnal Spectral Sensitivity of the Acute Alerting Effects of Light
Rahman, S. A., Flynn‐Evans, E. E., Aeschbach, D., Brainard, G. C., Czeisler, C. A., & Lockley, S. W. (2014) · SLEEP · doi:10.5665/sleep.3396 · Cited by 201 · see citing works
Karolinska Sleepiness Scale (KSS)
Shahid, A., Wilkinson, K., Marcu, S., & Shapiro, C. M. (2011) · Springer eBooks · doi:10.1007/978-1-4419-9893-4_47 · Cited by 201 · see citing works
Age, performance and sleep deprivation
Philip, P., Taillard, J., Sagaspe, P., Valtat, C., Sánchez-Ortuño, M. M., Moore, N. D., Charles, A., & Bioulac, B. H. (2004) · Journal of Sleep Research · doi:10.1111/j.1365-2869.2004.00399.x · Cited by 196 · see citing works
“Then they performed a 10-min simple RT test on a PALM personal organizer (Gillberg et al., 1994; Philip et al., 1999).”
MethodSeparation of circadian and wake duration-dependent modulation of EEG activation during wakefulness
Cajochen, C., Wyatt, J. K., Czeisler, C. A., & Dijk, D. (2002) · Neuroscience · doi:10.1016/s0306-4522(02)00209-9 · Cited by 192 · see citing works
Pigeau, R., Naitoh, P., Buguet, A., McCann, C., Baranski, J. V., Taylor, M. M., Thompson, M. M., & MACK, I. (1995) · Journal of Sleep Research · doi:10.1111/j.1365-2869.1995.tb00172.x · Cited by 191 · see citing works
“1991; Gillberg et al. 1994). These effects, however, were influenced by the presence of the 15 minute break, as the significant main effect for break (for all tasks) demonstrated. Mood, fatigue and performance were moderately ameliorated after a short rest period, when compared with results one hour later after contin…”
ResultInfluentialSleep as a Mediator of the Relationship between Socioeconomic Status and Health: A Hypothesis
VAN CAUTER, E., & SPIEGEL, K. (1999) · Annals of the New York Academy of Sciences · doi:10.1111/j.1749-6632.1999.tb08120.x · Cited by 179 · see citing works
Dynamics of frontal EEG activity, sleepiness and body temperature under high and low sleep pressure
Cajochen, C., Knoblauch, V., Kräuchi, K., Renz, C., & Wirz‐Justice, A. (2001) · Neuroreport · doi:10.1097/00001756-200107200-00046 · Cited by 163 · see citing works
Two circadian rhythms in the human electroencephalogram during wakefulness
Aeschbach, D., Matthews, J. R., Postolache, T. T., Jackson, M., Giesen, H. A., & Wehr, T. A. (1999) · American Journal of Physiology-Regulatory, Integrative and Comparative Physiology · doi:10.1152/ajpregu.1999.277.6.r1771 · Cited by 163 · see citing works
“Subjective alertness has been shown to correlate with performance in vigilance tasks (22), and minutescale fluctuations in performance in an auditory detection task have been found to covary with concurrent changes in EEG power at 10–11 Hz (32).”
BackgroundAge-related attenuation of the evening circadian arousal signal in humans
Münch, M. Y., Knoblauch, V., Blatter, K., Schroder, C. M., Schnitzler, C., Kräuchi, K., Wirz‐Justice, A., & Cajochen, C. (2005) · Neurobiology of Aging · doi:10.1016/j.neurobiolaging.2005.03.004 · Cited by 158 · see citing works
The ULg multimodality drowsiness database (called DROZY) and examples of use
Massoz, Q., Langohr, T., Francois, C., & Verly, J. (2016) · IEEE Winter Conference on Applications of Computer Vision · doi:10.1109/wacv.2016.7477715 · Cited by 150 · see citing works
“In experimental settings, one can also ask a subject to (self-)evaluate his/her LoD on the Karolinska Sleepiness Scale (KSS) [1, 6, 10].”
BackgroundMethodWallace, J. C., Vodanovich, S. J., & Restino, B. M. (2003) · Personality and Individual Differences · doi:10.1016/s0191-8869(02)00050-8 · Cited by 148 · see citing works
Phipps‐Nelson, J., Redman, J. R., Schlangen, L. J. M., & Rajaratnam, S. M. W. (2009) · Chronobiology International · doi:10.1080/07420520903044364 · Cited by 146 · see citing works
“Between 17:00 and Blue Light Exposure Reduces Sleepiness during Nighttime 895 18:00 h, sensors were fitted to the scalp and face for EEG and EOG recordings.”
MethodInfluentialKräuchi, K., Cajochen, C., Werth, E., & Wirz‐Justice, A. (2002) · Journal of Biological Rhythms · doi:10.1177/074873040201700409 · Cited by 146 · see citing works
“During the CRs, subjective sleepiness was assessed at half-hourly intervals on the Karolinska Sleepiness Scale (Gillberg et al., 1994; results reported in Kräuchi et al., 1998), together with collection of saliva for measurement of melatonin using a highly specific direct double-antibody radioimmunoassay (Weber et al.…”
MethodInfluentialWilliamson, A. M., Feyer, A.-M., Mattick, R. P., Friswell, R., & Finlay-Brown, S. (2001) · Accident Analysis & Prevention · doi:10.1016/s0001-4575(00)00045-2 · Cited by 146 · see citing works
Balkin, T. J., Rupp, T. L., Picchioni, D., & Wesensten, N. J. (2008) · CHEST Journal · doi:10.1378/chest.08-1064 · Cited by 147 · see citing works
Simulated train driving: Fatigue, self-awareness and cognitive disengagement
Dorrian, J., Roach, G. D., Fletcher, A., & Dawson, D. E. (2006) · Applied Ergonomics · doi:10.1016/j.apergo.2006.03.006 · Cited by 144 · see citing works
“As demonstrated previously, increasing fatigue resulted in impaired alertness (Dorrian et al., 2000; Gillberg et al., 1994) and sustained attention (Dinges and Powell, 1988, 1989; Doran et al., 2001).”
BackgroundCzeisler, C. A., Walsh, J. K., Wesnes, K. A., Roth, T. G., & Arora, S. (2009) · Mayo Clinic Proceedings · doi:10.1016/s0025-6196(11)60666-6 · Cited by 141 · see citing works
Effectiveness of Melatonin in the Treatment of Sleep Disturbances in Children with Asperger Disorder
Paavonen, E. J., Wendt, T. N., Vanhala, R., Aronen, E. T., & von Wendt, L. (2003) · Journal of Child and Adolescent Psychopharmacology · doi:10.1089/104454603321666225 · Cited by 140 · see citing works
“A teacher’s questionnaire was used to evaluate performance at school (Owens et al. 2000), and the Karolinska Sleepiness Scale was used as a measurement of day-time sleepiness (Gillberg et al. 1994).”
Effect of daylight LED on visual comfort, melatonin, mood, waking performance and sleep
Cajochen, C., Freyburger, M., Basishvili, T., Garbazza, C., Rudzik, F., Renz, C., Kobayashi, K., Shirakawa, Y., Stefani, O., & Weibel, J. (2019) · Lighting Research & Technology · doi:10.1177/1477153519828419 · Cited by 131 · see citing works
Daytime melatonin administration enhances sleepiness and theta/alpha activity in the waking EEG
Cajochen, C., Kräuchi, K., von Arx, M.-A., Möri, D., Graw, P., & Wirz-Justice, A. (1996) · Neuroscience Letters · doi:10.1016/0304-3940(96)12517-9 · Cited by 126 · see citing works
Lázár, A. S., Slak, A., Lo, J. C.-Y., Santhi, N., von Schantz, M., Archer, S. N., Groeger, J. A., & Dijk, D. (2012) · Chronobiology International · doi:10.3109/07420528.2011.641193 · Cited by 134 · see citing works
“Daytime sleepiness, as measured by the KSS, was lowest in PER35/5 homozygotes (Table 3).”
BackgroundMethodInfluentialThe ability to self‐monitor performance when fatigued
Dorrian, J., Lamond, N., & Dawson, D. E. (2000) · Journal of Sleep Research · doi:10.1046/j.1365-2869.2000.00195.x · Cited by 125 · see citing works
Morning Work: Effects of Early Rising on Sleep and Alertness
Kecklund, G., Åkerstedt, T., & Löwden, A. (1997) · SLEEP · doi:10.1093/sleep/20.3.215 · Cited by 125 · see citing works
Self-citationWeaver, T. E. (2001) · Sleep Medicine Reviews · doi:10.1053/smrv.2001.0152 · Cited by 123 · see citing works
Sleepiness: evaluating and quantifying methods
Curcio, G., Casagrande, M., & Bertini, M. (2001) · International Journal of Psychophysiology · doi:10.1016/s0167-8760(01)00138-6 · Cited by 122 · see citing works
Philip, P., Sagaspe, P., Taillard, J., Moore, N. D., Guilleminault, C., Sánchez-Ortuño, M. M., Åkerstedt, T., & Bioulac, B. H. (2003) · SLEEP · doi:10.1093/sleep/26.3.277 · Cited by 122 · see citing works
Self-citationThe effects of sleep inertia on decision‐making performance
Bruck, D., & Pisani, D. L. (1999) · Journal of Sleep Research · doi:10.1046/j.1365-2869.1999.00150.x · Cited by 119 · see citing works
Cajochen, C., Khalsa, S. B. S., Wyatt, J. K., Czeisler, C. A., & Dijk, D.-J. (1999) · American Journal of Physiology-Regulatory, Integrative and Comparative Physiology · doi:10.1152/ajpregu.1999.277.3.r640 · Cited by 349 · see citing works
“EBs were counted per 30-s epoch during the 4-min eyes-open segment of each KDT.”
MethodInfluentialArnedt, J. T., Rohsenow, D. J., Almeida, A. B., Hunt, S. K., Gokhale, M., Gottlieb, D. J., & Howland, J. (2011) · Alcoholism Clinical and Experimental Research · doi:10.1111/j.1530-0277.2010.01417.x · Cited by 118 · see citing works
“, 1973) and Karolinska Sleepiness Scale (KSS; (Gillberg et al., 1994) were administered before and after sleep to assess sleepiness.”
MethodPhilip, P., Taillard, J., Quera-Salva, M.-A., Bioulac, B. H., & Åkerstedt, T. (1999) · Journal of Sleep Research · doi:10.1046/j.1365-2869.1999.00127.x · Cited by 118 · see citing works
Self-citationAltered sleep/wake patterns and mental performance
Åkerstedt, T. (2006) · Physiology & Behavior · doi:10.1016/j.physbeh.2006.09.007 · Cited by 119 · see citing works
Self-citationSubjective sleepiness and accident risk avoiding the ecological fallacy
Ingre, M., Åkerstedt, T., Peters, B., Anund, A., Kecklund, G., & Pickles, A. R. (2006) · Journal of Sleep Research · doi:10.1111/j.1365-2869.2006.00517.x · Cited by 116 · see citing works
Self-citationSilva, E. J., Wang, W., Ronda, J. M., Wyatt, J. K., & Duffy, J. F. (2010) · Sleep · doi:10.1093/sleep/33.4.481 · Cited by 114 · see citing works
Adenosine, Caffeine, and Performance: From Cognitive Neuroscience of Sleep to Sleep Pharmacogenetics
Urry, E., & Landolt, H. (2014) · Current topics in behavioral neurosciences · doi:10.1007/7854_2014_274 · Cited by 108 · see citing works
“For example, research incorporating a 40-hour constant routine protocol revealed a clear circadian modulation of subjective sleepiness (Karolinska Sleepiness Scale) (Gillberg et al. 1994) and cognitive performance (psychomotor vigilance task [PVT]) (Dinges and Powell 1985), even in the absence of strong homeostatic sl…”
MethodInfluentialZhou, X., Ferguson, S. A., Matthews, R. W., Sargent, C., Darwent, D., Kennaway, D. J., & Roach, G. D. (2011) · Journal of Sleep Research · doi:10.1111/j.1365-2869.2011.00924.x · Cited by 107 · see citing works
Bjorvatn, B., Stangenes, K. M., Øyane, N., Forberg, K., Löwden, A., Holsten, F., & Åkerstedt, T. (2006) · SLEEP · doi:10.1093/sleep/29.6.821 · Cited by 108 · see citing works
Self-citationDingus, T. A., Neale, V. L., Klauer, S. G., Petersen, A., & Carroll, R. J. (2006) · Accident Analysis & Prevention · doi:10.1016/j.aap.2006.05.001 · Cited by 103 · see citing works
The impact of a week of simulated night work on sleep, circadian phase, and performance
Lamond, N., Dorrian, J., Roach, G. D., McCulloch, K. M., Holmes, A. L., Burgess, H. J., Fletcher, A., & Dawson, D. E. (2003) · Occupational and Environmental Medicine · doi:10.1136/oem.60.11.e13 · Cited by 101 · see citing works
Sleep deprivation increases the costs of attentional effort: Performance, preference and pupil size
Massar, S. A. A., Lim, J., Sasmita, K., & Chee, M. W. L. (2018) · Neuropsychologia · doi:10.1016/j.neuropsychologia.2018.03.032 · Cited by 95 · see citing works
“Throughout the SD night participants performed hourly vigilance test (grad-CPT; Esterman et al., 2013) and sleepiness ratings (Karolinksa Sleepiness Scale; Gillberg et al., 1994).”
Portable Drowsiness Detection through Use of a Prefrontal Single-Channel Electroencephalogram
Ogino, M., & Mitsukura, Y. (2018) · Sensors · doi:10.3390/s18124477 · Cited by 96 · see citing works
Leproult, R., Reeth, O. V., Byrne, M. M., Sturis, J., & Cauter, E. V. (1997) · Journal of Biological Rhythms · doi:10.1177/074873049701200306 · Cited by 94 · see citing works
Is Sleep per se a Zeitgeber in Humans?
Danilenko, K. V., Cajochen, C., & Wirz‐Justice, A. (2003) · Journal of Biological Rhythms · doi:10.1177/0748730403251732 · Cited by 92 · see citing works
“In both CR protocols, subjective estimates of sleepiness were assessed at 30-min intervals using the Karolinska Sleepiness Scale (Gillberg et al., 1994), together with 2 visual analog scales for energy and mood.”
MethodA 30-Minute, but Not a 10-Minute Nighttime Nap is Associated with Sleep Inertia
Hilditch, C. J., Centofanti, S. A., Dorrian, J., & Banks, S. (2016) · SLEEP · doi:10.5665/sleep.5550 · Cited by 90 · see citing works
Arnardóttir, E. S., Nikonova, E. V., Shockley, K. R., Podtelezhnikov, A. A., Anafi, R. C., Tanis, K. Q., Maislin, G., Stone, D. J., Renger, J. J., Winrow, C. J., et al. (2014) · SLEEP · doi:10.5665/sleep.4064 · Cited by 87 · see citing works
D'Rozario, A. L., Cross, N. E., Vakulin, A., Bartlett, D. J., WONG, K. K. H., Wang, D., & Grunstein, R. R. (2016) · Sleep Medicine Reviews · doi:10.1016/j.smrv.2016.10.003 · Cited by 91 · see citing works
“circadian timing, and these correspond with changes in cognitive processing [22, 27, 28].”
BackgroundAlerting, orienting and executive control: the effects of sleep deprivation on attentional networks
Martella, D., Casagrande, M., & Lupiáñez, J. (2011) · Experimental Brain Research · doi:10.1007/s00221-011-2605-3 · Cited by 88 · see citing works
“Sleep loss increases sleepiness (Carskadon and Dement 1979; Gillberg et al. 1994) and negatively aVects performance on cognitive tasks (e.”
BackgroundSatterfield, B. C., & Dongen, H. P. A. V. (2013) · Fatigue Biomedicine Health & Behavior · doi:10.1080/21641846.2013.798923 · Cited by 86 · see citing works
“There is some (anecdotal) evidence that self- and peer-monitoring and other informal “fatigue proofing” procedures can be effective for detecting and managing fatigue,[111] especially when individuals are reminded to pay attention to specific symptoms such as heavy eyelids or the effort required to fight sleep.[112] H…”
BackgroundRajaratnam, S. M. W., Dijk, D., Middleton, B., Stone, B. M., & Arendt, J. (2003) · The Journal of Clinical Endocrinology & Metabolism · doi:10.1210/jc.2003-030460 · Cited by 86 · see citing works
Lee, H.-A., Cho, C., & Kim, L. (2014) · Sleep Medicine and Psychophysiology · doi:10.14401/kasmed.2014.21.2.51 · Cited by 86 · see citing works
Wyatt, J. K., Stepanski, E. J., & Kirkby, J. (2006) · SLEEP · doi:10.1093/sleep/29.8.1075 · Cited by 85 · see citing works
Philip, P., Sagaspe, P., Prague, M., Tassi, P., Capelli, A., Bioulac, B., Commenges, D., & Taillard, J. (2012) · SLEEP · doi:10.5665/sleep.1968 · Cited by 84 · see citing works
Bjorvatn, B., Stangenes, K. M., Øyane, N., Forberg, K., Löwden, A., Holsten, F., & Åkerstedt, T. (2007) · Scandinavian Journal of Work Environment & Health · doi:10.5271/sjweh.1129 · Cited by 84 · see citing works
Self-citationBjorvatn, B., Kecklund, G., & Åkerstedt, T. (1999) · Journal of Sleep Research · doi:10.1046/j.1365-2869.1999.00146.x · Cited by 83 · see citing works
“Subjective ratings The Karolinska Sleepiness Scale (KSS; Åkerstedt and Gillberg RESULTS 1990) and the Accumulated Time with Sleepiness (ATS; Gillberg et al. 1994) were used to obtain ratings of sleepiness.”
MethodResultSelf-citationGonzález, J. L., Jiménez, B. M., Garrosa, E., & López‐López, A. (2005) · International Journal of Industrial Ergonomics · doi:10.1016/j.ergon.2005.02.007 · Cited by 82 · see citing works
“The qualitative aspects of fatigue most frequently described have been physical fatigue and mental fatigue (Chalder et al., 1993; Grandjean, 1979), while other aspects of the construct usually studied are sleepiness (Gillberg et al., 1994) and discomfort (Cameron, 1996).”
BackgroundShiftwork and different dimensions of fatigue
Åhsberg, E., Kecklund, G., Åkerstedt, T., & Gamberale, F. (2000) · International Journal of Industrial Ergonomics · doi:10.1016/s0169-8141(00)00007-x · Cited by 80 · see citing works
Self-citationSpecific sleepiness symptoms are indicators of performance impairment during sleep deprivation
Howard, M. E., Jackson, M. L., Berlowitz, D. J., O’Donoghue, F. J., Swann, P., Westlake, J., Wilkinson, V. E., & Pierce, R. J. (2013) · Accident Analysis & Prevention · doi:10.1016/j.aap.2013.09.003 · Cited by 78 · see citing works
Sagaspe, P., Taillard, J., Amieva, H., Beck, A., Rascol, O., Dartigues, J., Capelli, A., & Philip, P. (2012) · PLoS ONE · doi:10.1371/journal.pone.0039410 · Cited by 77 · see citing works
“A 10-min simple reaction time test (SRTT) on a PALM personal organizer [55] was performed to evaluate sustained attention.”
Åkerstedt, T. (1995) · Neurophysiologie Clinique · doi:10.1016/0987-7053(96)84910-0 · Cited by 78 · see citing works
Self-citationPhipps‐Nelson, J., Redman, J. R., & Rajaratnam, S. M. W. (2010) · Journal of Sleep Research · doi:10.1111/j.1365-2869.2010.00900.x · Cited by 77 · see citing works
“Following each driving session, participants also performed the PVT (duration 10 min; Dinges et al., 1997; Kribbs and Dinges, 1994) and the Karolinska Drowsiness Test (KDT; duration 5 min; Åkerstedt and Gillberg, 1990; Gillberg et al., 1994).”
BackgroundMethodPerformance vigilance task and sleepiness in patients with sleep-disordered breathing
Sforza, E., Haba‐Rubio, J., de Bilbao, F., Rochat, T., & Ibanez, V. (2004) · European Respiratory Journal · doi:10.1183/09031936.04.00091903 · Cited by 75 · see citing works
Kaida, K., Åkerstedt, T., Kecklund, G., Nilsson, J., & Axelsson, J. (2007) · Industrial Health · doi:10.2486/indhealth.45.520 · Cited by 75 · see citing works
Self-citationPerformance on a Simple Reaction Time Task While Sleep Deprived
van den Berg, J., & Neely, G. (2006) · Perceptual and Motor Skills · doi:10.2466/pms.102.2.589-599 · Cited by 74 · see citing works
Paavilainen, P., Korhonen, I., Lötjönen, J. M. P., Cluitmans, L., Jylhä, M. K., Särelä, A., & Partinen, M. (2005) · Journal of Sleep Research · doi:10.1111/j.1365-2869.2004.00433.x · Cited by 73 · see citing works
Gander, P. H., Signal, T. L., van den Berg, M. J., Mulrine, H. M., Jay, S. M., & Jim Mangie, C. (2013) · Journal of Sleep Research · doi:10.1111/jsr.12071 · Cited by 73 · see citing works
Putilov, A. A., & Donskaya, O. G. (2013) · Clinical Neurophysiology · doi:10.1016/j.clinph.2013.01.018 · Cited by 70 · see citing works
“In fact, each EEG recording session might be regarded as a modified Karolinska drowsiness test (Åkerstedt and Gillberg, 1990; Gillberg et al., 1994) that, however, originally required 5-min rather than 2-min interval of eyes open recording.”
- Authors
- Gillberg, M., Kecklund, G., & Åkerstedt, T.
- Affiliations
- Karolinska Institutet (SE)
- Corresponding author
- Gillberg, Mats
- Venue
- Sleep
- Publisher
- Oxford University Press (OUP)
- Published
- 1994-05
- Volume
- 17
- Issue
- 3
- Pages
- 236-241
- ISSN
- 0161-8105 (ISSN-L)
- 1550-9109
- OpenAlex
- W254030361
- Cited by
- 423
- References
- 0
- Citations by year
- 2026: 10 · 2025: 5 · 2024: 12 · 2023: 9 · 2022: 12 · 2021: 12 · 2020: 9 · 2019: 13 · 2018: 16 · 2017: 11 · 2016: 16 · 2015: 16 · 2014: 18 · 2013: 22 · 2012: 18
- FWCI
- 6.99
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- SLEEP (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Sleep and Work-Related Fatigue
- Life Sciences › Neuroscience › Cognitive Neuroscience › Sleep and Wakefulness Research
- Life Sciences › Neuroscience › Cognitive Neuroscience › Mind wandering and attention
- Keywords
- sleepiness, Karolinska Sleepiness Scale, visual vigilance task, reaction time, sleep deprivation, scale validation, visual analogue scale, performance degradation
- MeSH terms
- Adult, Arousal, Female, Humans, Male, Middle Aged, Self-Assessment, Sleep Deprivation, Task Performance and Analysis, Wakefulness
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
Are you an author, or do you see a problem with this page? Request a review
