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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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“The following measures will be made at baseline and then weekly upon review a) Time and date of assessment b) Current medications c) Any intercurrent illness d) Sleepiness, using the Karolinska Sleepiness Scale (KSS),[24] a ten item scale which describes current (state) sleepiness e) Machine usage data in the CPAP tre…”
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“KAROLINSKA SLEEPINESS SCALE (KSS) In the present study, the KSS was used to measure the subjective level of sleepiness at a particular time during the day [44, 45].”
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Putilov, D. A., Verevkin, E. G., Donskaya, O. G., & Putilov, A. A. (2007) · Somnologie - Schlafforschung und Schlafmedizin · doi:10.1007/s11818-007-0304-x · Cited by 9
Missing a Meal: Effects on Alertness during Sedentary Work
Neely, G., Landström, U., Byström, M., & Lennernäs, M. A. ‐. (2004) · Nutrition and Health · doi:10.1177/026010600401800104 · Cited by 9
BLINK BEHAVIOUR BASED DROWSINESS DETECTION
Svensson, U. (2004) · Publication of: National Swedish Road & Traffic Research Institute · Cited by 9
Smith, S. S., Rossa, K. R., Soleimanloo, S. S., Pattinson, C. L., Mann, D., Edmed, S. L., Salmon, P. M., & Sullivan, K. A. (2024) · Heliyon · doi:10.1016/j.heliyon.2024.e27066 · Cited by 9
Validation of the Karolinska Sleepiness Scale in Korean
Shin, S., Lee, S., Choi, S. J., Joo, E. Y., & Suh, S. A. (2024) · Journal of Clinical Neurology · doi:10.3988/jcn.2024.0042 · Cited by 8
“…the KSS can rapidly measure the current level of sleepiness with a single question, it has been used in various contexts such as shift work, 48-51 driving ability, 52 jet lag, 53 driving performance, 52 and attention and performance, 54-56 and is widely used in research and clinical settings.”
MethodKratzel, L., Glos, M., Veauthier, C., Rekow, S., François, C., Fietze, I., & Penzel, T. (2021) · Physiological Measurement · doi:10.1088/1361-6579/abdb7e · Cited by 8
Soleimanloo, S. S., Garcia-Hansen, V., White, M. J., Huda, M. M., & Smith, S. S. (2022) · Sleep Medicine · doi:10.1016/j.sleep.2022.03.013 · Cited by 8
Trenkwalder, C., & Högl, B. (2007) · Handbook of clinical neurology · doi:10.1016/s0072-9752(07)83015-6 · Cited by 8
Kajtna, T., Štukovnik, V., & Grošelj, L. D. (2011) · Slovenian Medical Journal · Cited by 8
Schooltime subjective sleepiness and performance in Italian primary school children
Cerasuolo, M., Giganti, F., Conte, F., Costanzo, L. M., della Monica, C., Arzilli, C., Marchesano, R., Perrella, A., & Ficca, G. (2016) · Chronobiology International · doi:10.1080/07420528.2016.1178274 · Cited by 8
“Instead, we believe that this correspondence should not be taken for granted: concerning adults, for instance, in contrast to a few studies reporting moderate-to-high correlations between subjective sleepiness and objective performance (Gillberg et al., 1994; Hoddes et al., 1973), much of the research has found only l…”
ResultModeling Fatigue Degraded Performance in Artificial Agents
French, J., & Morris, C. S. (2003) · Proceedings of the Human Factors and Ergonomics Society Annual Meeting · doi:10.1177/154193120304700312 · Cited by 8
Moving Clouds on a Virtual Sky Affect Well-Being and Subjective Tiredness Positively
Stefani, O., Bues, M., Pross, A., Mebben, S., Westner, P., Dudel, H., & Rudolph, H. (2012) · Publikationsdatenbank der Fraunhofer-Gesellschaft (Fraunhofer-Gesellschaft) · Cited by 8
Long Shifts, Short Rests and Vulnerability to Shift Work
Axelsson, J. (2005) · PsycEXTRA Dataset · doi:10.1037/e529702013-001 · Cited by 8
Yancheshmeh, F. A., Mousavizadegan, S. H., Amini, A., Smith, A. P., & Kazemi, R. B. (2021) · Ergonomics · doi:10.1080/00140139.2021.1928298 · Cited by 7
“Previous studies have investigated the validity and reliability of the KSS with other subjective indicators of sleepiness, and objective measures such as electroencephalographic, and behavioral variables [53, 54].”
BackgroundMethodMelatonin Supplementation in Patients with Complete Tetraplegia and Poor Sleep
Spong, J., Kennedy, G. A., Brown, D. J., Armstrong, S. M., & Berlowitz, D. J. (2013) · Sleep Disorders · doi:10.1155/2013/128197 · Cited by 7
“The KSS measures state sleepiness on a 9-point scale where 1 indicates feeling extremely alert and 9 indicates extreme sleepiness.”
InfluentialAn Overview of Sleepiness Aspects Reflected in Balance Scale Model
van den Berg, J. (2009) · The Open Sleep Journal · doi:10.2174/1874620900902010033 · Cited by 7
“The KSS is a bipolar scale with has nine categories (1 to 9) that cover the entire wakeful/sleepy continuum [93, 98].”
BackgroundInfluence of artificial dusk on sleep
Danilenko, K. V., & Hommes, V. (2015) · Sleep and Biological Rhythms · doi:10.1007/s41105-015-0020-z · Cited by 7
“Before sleep, subjects noted in the sleep diary the time of the dusk onset, alarm set time, sleepiness score by Karolinska sleepiness scale (KSS) [28], intended falling asleep time (eyes closure).”
MethodInfluentialAn exhausted workforce increases the risk of errors.
Grissinger, M. C. (2009) · PubMed Central · Cited by 7
The Effects of Transdermal Scopolamine on Simulated Ship Navigation and Attention/Reaction Time
Howland, J., Rohsenow, D. J., Minsky, S. J., Snöberg, J., Tågerud, S., Hunt, S. K., Almeida, A. B., Greece, J. A., & Allensworth‐Davies, D. (2008) · International Journal of Occupational and Environmental Health · doi:10.1179/oeh.2008.14.4.250 · Cited by 7
Younger drivers executive functioning and the relationship with experiencing signs of sleepiness
Watling, C. N., & Watling, H. (2021) · Transportation Research Part F Traffic Psychology and Behaviour · doi:10.1016/j.trf.2021.05.003 · Cited by 6
Managing the challenge of fatigue for pilots operating ultra-long range flights
Signal, T. L., van den Berg, M. J., Zaslona, J. L., Wu, L., Hughes, M., Johnston, B., Dyer, C., Drane, M., & Glover, M. (2024) · Frontiers in Environmental Health · doi:10.3389/fenvh.2023.1329203 · Cited by 7
Béguin, E., Maranci, J., Leu‐Semenescu, S., Dodet, P., Gales, A. Z., Oudiette, D., Andrillon, T., & Arnulf, I. (2024) · SLEEP · doi:10.1093/sleep/zsae168 · Cited by 6
Azizan, M. A., Zali, Z., & Padil, H. (2018) · IOP Conference Series Materials Science and Engineering · doi:10.1088/1757-899x/370/1/012020 · Cited by 6
Jensen, M. A., Nielsen, H. B., Sallinen, M., Kristiansen, J., Hansen, Å. M., & Garde, A. H. (2022) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph191710527 · Cited by 6
“A KSS rating of 7 (“sleepy but not fighting sleep”) has been shown to be accompanied by physiological signs of sleepiness, such as occasional slow eye movements and elevated alpha and theta activity in the EEG1 [31].”
BackgroundPerformance prediction by sleepiness-related subjective symptoms during 26-hour sleep deprivation
Kaida, K., Åkerstedt, T., Takahashi, M., Vestergren, P., Gillberg, M., Löwden, A., Kecklund, G., & Portin, C. (2008) · Sleep and Biological Rhythms · doi:10.1111/j.1479-8425.2008.00367.x · Cited by 6
Self-citationBonnefond, A., Rogé, J., & Muzet, A. G. (2006) · International Journal of Occupational Safety and Ergonomics · doi:10.1080/10803548.2006.11076684 · Cited by 6
Sleepiness and hazard perception while driving
Smith, S. S., Horswill, M. S., Chambers, B. E., & Wetton, M. A. (2009) · Cited by 6
Lokförares arbetssituation med fokus på arbetstider, sömn, stress och säkerhet
Ingre, M., Söderström, M., Kecklund, G., Åkerstedt, T., & Kecklund, L. (2000) · Cited by 6
Self-citationStefani, O., Freyburger, M., Veitz, S., Basishvili, T., Meyer, M., Weibel, J., Kobayashi, K., Shirakawa, Y., & Cajochen, C. (2020) · bioRxiv (Cold Spring Harbor Laboratory) · doi:10.1101/2020.04.21.771832 · Cited by 6
COMMENT ON SHORT-TERM VARIATION IN SUBJECTIVE SLEEPINESS
Eriksen, C. A. (2005) · Perceptual and Motor Skills · doi:10.2466/pms.101.7.943-948 · Cited by 6
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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