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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.
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“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]
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Azizan, M. A., Fard, M., Azari, M. F., & Jazar, R. N. (2017) · Applied Ergonomics · doi:10.1016/j.apergo.2016.12.020 · Cited by 34
A Unified Model of Performance: Validation of its Predictions across Different Sleep/Wake Schedules
Ramakrishnan, S., Wesensten, N. J., Balkin, T. J., & Jaques Reifman, A. (2015) · SLEEP · doi:10.5665/sleep.5358 · Cited by 34
Yang, C., Lin, F.-W., & Spielman, A. J. (2004) · SLEEP · doi:10.1093/sleep/27.2.329 · Cited by 34
The alerting effect of the wake maintenance zone during 40 hours of sleep deprivation
de Zeeuw, J., Wisniewski, S., Papakonstantinou, A., Bes, F., Wahnschaffe, A., Zaleska, M., Kunz, D., & Münch, M. Y. (2018) · Scientific Reports · doi:10.1038/s41598-018-29380-z · Cited by 34
Laboratory Studies of a Sound System that Maintains Wakefulness
Landström, U., Englund, K., Nordström, B., & Åström, A. (1998) · Perceptual and Motor Skills · doi:10.2466/pms.1998.86.1.147 · Cited by 33
Self reported sleep quality and cognitive performance in ecstasy users
Montgomery, C., Fisk, J. E., Wareing, M., & Murphy, P. N. (2007) · Human Psychopharmacology Clinical and Experimental · doi:10.1002/hup.879 · Cited by 32
Electroencephalography and subjective ratings of sleep deprivation
van den Berg, J., Neely, G., Nilsson, L., Knutsson, A., & Landström, U. (2005) · Sleep Medicine · doi:10.1016/j.sleep.2004.11.012 · Cited by 32
“The KSS has been validated previously [21]; however, this is the first time that the CR-10 has been shown to measure ratings of sleepiness as effectively as other established measures.”
MethodCajochen, C., & Dijk, D. (2003) · Sleep and Biological Rhythms · doi:10.1046/j.1446-9235.2003.00041.x · Cited by 32
Sleep Restriction, Sleep Hygiene, and Driving Safety
Philip, P., Taillard, J., & Micoulaud‐Franchi, J. (2019) · Sleep Medicine Clinics · doi:10.1016/j.jsmc.2019.07.002 · Cited by 31
Perceived fatique related to work
Åhsberg, E. (1998) · Cited by 31
Meesters, Y., Winthorst, W. H., Duijzer, W. B., & Hommes, V. (2016) · BMC Psychiatry · doi:10.1186/s12888-016-0729-5 · Cited by 32
Prolonged Eyelid Closure Episodes during Sleep Deprivation in Professional Drivers
Alvaro, P. K., Jackson, M. L., Berlowitz, D. J., Swann, P., & Howard, M. E. (2016) · Journal of Clinical Sleep Medicine · doi:10.5664/jcsm.6044 · Cited by 31
“3,23 Consequently, while the results support the pursuit of simple automated methods for measuring ocular movements to assess and monitor drowsiness, they suggest that averaged data are influenced by a large range of eyelid closure episode length, particularly during extended sleep deprivation.”
Graco, M., Schembri, R., Cross, S., Thiyagarajan, C., Shafazand, S., Ayas, N., Nash, M. S., Vu, V. H., Ruehland, W. R., Chai‐Coetzer, C. L., et al. (2018) · Thorax · doi:10.1136/thoraxjnl-2017-211131 · Cited by 30
Excessive daytime sleepiness in obstructive sleep apnea: implications for driving licenses
Garbarino, S. (2019) · Sleep and Breathing · doi:10.1007/s11325-019-01903-6 · Cited by 27
“assessed at pseudo-random intervals ranging from 2 to 10 s [120, 121].”
BackgroundDoes Subjective Sleepiness Predict Objective Sleep Propensity?
Short, M. A., Lack, L. C., & Wright, H. (2010) · SLEEP · doi:10.1093/sleep/33.1.123 · Cited by 30
Sagaspe, P., Charles, A., Taillard, J., Bioulac, B. H., & Philip, P. (2003) · Canadian Journal of Experimental Psychology/Revue canadienne de psychologie expérimentale · doi:10.1037/h0087430 · Cited by 30
“L’épreuve de temps de réaction simple durait 10 min pendant lesquelles 176 carrés noirs se succédaient sur l’écran d’un agenda de poche électronique à intervalles aléatoires de 2 à 7 s (Gillberg et al., 1994; Philip et al., 2003; Philip et al., 1999).”
Blink behaviour based drowsiness detection - method development and validation
Svensson, U. (2004) · KTH Publication Database DiVA (KTH Royal Institute of Technology) · Cited by 29
Age-related neuroendocrine and alerting responses to light
Chellappa, S. L., Bromundt, V., Frey, S., & Cajochen, C. (2021) · GeroScience · doi:10.1007/s11357-021-00333-1 · Cited by 27
Everyday and prospective memory deficits in ecstasy/polydrug users
Hadjiefthyvoulou, F., Fisk, J. E., Montgomery, C., & Bridges, N. (2010) · Journal of Psychopharmacology · doi:10.1177/0269881109359101 · Cited by 28
“Prospective memory fatigue test: At the beginning of the test session, participants were told that they should provide an indication of their level of fatigue (using the Karolinska Sleepiness Scale; see Gillberg et al., 1994) every 20 minutes throughout the experiment.”
MethodForberg, K., Waage, S., Moen, B. E., & Bjorvatn, B. (2010) · Sleep Medicine · doi:10.1016/j.sleep.2009.07.015 · Cited by 28
“Subjective ratings of sleepiness were obtained using a shortened version of the Accumulated Time with Sleepiness (ATS) scale [26].”
MethodDeep Physiological Arousal Detection in a Driving Simulator Using Wearable Sensors
Saeed, A., Trajanovski, S., van Keulen, M., & van Erp, J. B. F. (2017) · IEEE ... International Conference on Data Mining workshops · doi:10.1109/icdmw.2017.69 · Cited by 31
“The KSS appears to be most widely used a sensitive and reliable measure of sleepiness [29].”
BackgroundGarcía‐Gea, C., Martínez, J., Ballester, M. R., Gich, I. J., Valiente, R., & Antonijoan, R. M. (2014) · Human Psychopharmacology Clinical and Experimental · doi:10.1002/hup.2378 · Cited by 27
“Several studies have shown that self-assessed measures of sedation may be reliable predictors of psychomotor impairment, at least under drug-free conditions (Gillberg et al., 1994; Dorrian et al., 2000).”
BackgroundPerceived sleep quality among edentulous elders
Emami, E., Lavigne, G. J., de Grandmont, P., Rompre, P. H., & Feine, J. S. (2010) · Gerodontology · doi:10.1111/j.1741-2358.2010.00426.x · Cited by 27
Berlowitz, D. J., Schembri, R., Graco, M., Ross, J. M., Ayas, N., Gordon, I., Lee, B. B., Graham, A., Cross, S., McClelland, M., et al. (2018) · Thorax · doi:10.1136/thoraxjnl-2018-212319 · Cited by 26
Sleepiness does not Modulate Experimental Joint Pain in Healthy Volunteers
Drewes, A. M., Rössel, P., Arendt‐Nielsen, L., Dremstrup, K., Hansen, L. M., Birket‐Smith, L., & Stengaard‐Pedersen, K. (1997) · Scandinavian Journal of Rheumatology · doi:10.3109/03009749709065709 · Cited by 26
Now You Hear Me, Now You Don't: Eyelid Closures as an Indicator of Auditory Task Disengagement
Ong, J. L., Asplund, C. L., Chia, T. T. Y., & Chee, M. W. L. (2013) · SLEEP · doi:10.5665/sleep.3218 · Cited by 25
Chronotype differences in cortical thickness: grey matter reflects when you go to bed
Rosenberg, J., Jacobs, H. I. L., Maximov, I. I., Reske, M., & Shah, N. J. (2018) · Brain Structure and Function · doi:10.1007/s00429-018-1697-y · Cited by 25
Efficacy and Tolerability of Armodafinil
Erman, M. K., Seiden, D., Yang, R., & Dammerman, R. S. (2011) · Journal of Occupational and Environmental Medicine · doi:10.1097/jom.0b013e318237a17e · Cited by 24
“Health care practitioner and technical 31 (16) 25 (13) 56 (15)”
BackgroundCircadian adaptation of airline pilots during extended duration operations between the USA and Asia
Gander, P. H., van den Berg, M. J., Mulrine, H. M., Signal, T. L., & Mangie, J. (2013) · Chronobiology International · doi:10.3109/07420528.2013.790042 · Cited by 25
“Sleepiness was rated on the Karolinska Sleepiness Scale, from 11⁄4 ‘‘extremely alert’’ to 91⁄4 ‘‘extremely sleepy, fighting sleep’’ (Akerstedt & Gillberg, 1990; Gillberg et al., 1994; Reyner & Horne, 1998).”
MethodAssociations of waking EEG structure with chronotype and trototype of 130 sleep deprived individuals
Putilov, A. A., Donskaya, O. G., Verevkin, E. G., & Putilov, D. A. (2009) · Biological Rhythm Research · doi:10.1080/09291010903018057 · Cited by 25
“After each EEG recording, the participants were asked to determine their selfperceived sleepiness/alertness on a nine-point Karolinska Sleepiness Scale (KSS; Åkerstedt and Gillberg 1990; Gillberg et al. 1994).”
MethodWang, D., Bai, X. X., Williams, S. C., Hua, S. C., Kim, J.-W., Marshall, N. S., D'Rozario, A. L., & Grunstein, R. R. (2015) · SLEEP · doi:10.5665/sleep.4912 · Cited by 26
Kretzschmar, U., Werth, E., Sturzenegger, C., Khatami, R., Bassetti, C., & Baumann, C. (2016) · Journal of Sleep Research · doi:10.1111/jsr.12383 · Cited by 24
Does the Circadian Modulation of Dream Recall Modify with Age?
Laxhmi, C. S., Münch, M., Blatter, K., Knoblauch, V., & Cajochen, C. (2009) · SLEEP · doi:10.1093/sleep/32.9.1201 · Cited by 24
Howard, M. E., Jackson, M. L., Swann, P., Berlowitz, D. J., Grunstein, R. R., & Pierce, R. J. (2013) · Traffic Injury Prevention · doi:10.1080/15389588.2013.800637 · Cited by 24
“A ceiling effect was observed after this time (from 20 to 23 hours awake), despite further deterioration in performance being evident, which has also been found previously in professional drivers after 19 to 21 hours awake (Gillberg et al. 1994).”
BackgroundMethodBerlowitz, D. J., Spong, J., Pierce, R. J., Ross, J. M., Barnes, M., & Brown, D. J. (2009) · Spinal Cord · doi:10.1038/sc.2009.56 · Cited by 24
Occupational safety: The role of workplace sleepiness
DeArmond, S. E., & Chen, P. Y. (2009) · Accident Analysis & Prevention · doi:10.1016/j.aap.2009.06.018 · Cited by 24
LED‐backlit computer screens influence our biological clock and keep us more awake
Bues, M., Pross, A., Stefani, O., Frey, S., Anders, D., Späti, J., Wirz‐Justice, A., Mager, R., & Cajochen, C. (2012) · Journal of the Society for Information Display · doi:10.1889/jsid20.5.266 · Cited by 24
Comment on Short-Term Variation in Subjective Sleepiness
Eriksen, C. A., Åkerstedt, T., Kecklund, G., & Miley-Åkerstedt, A. (2005) · Perceptual and Motor Skills · doi:10.2466/pms.101.3.943-948 · Cited by 24
Self-citationCajochen, C., Biase, R. D., & Imai, M. (2008) · American Journal of Physiology-Regulatory, Integrative and Comparative Physiology · doi:10.1152/ajpregu.00747.2007 · Cited by 24
“Subjective sleepiness was assessed with the Karolinska sleepiness scale (KSS) (1) and with the Karolinska drowsiness test (KDT) (1, 18), which was scheduled once during the first dim light episode, twice during the light exposure episode, and once during the second dim light episode before sleep.”
MethodInfluential
Metadata
- 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
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