The Toronto Hospital Alertness Test scale: relationship to daytime sleepiness, fatigue, and symptoms of depression and anxiety

Abstract

ObjectiveThe Toronto Hospital Alertness Test (THAT) scale was designed to measure alertness, defined as the capacity of the mind to respond appropriately to external and internal stimuli. The present study’s aim is to determine normative values of alertness on the THAT and to explore the relationship among excessive daytime sleepiness, fatigue, depressive symptoms, and alertness.MethodsNormative data were collected from 60 healthy males and females. To explore the relationship among alertness, daytime sleepiness, fatigue, depression, and anxiety, data were collected from charts of sleep clinic patients. All study subjects completed measures for fatigue, sleepiness, depressive symptoms, and anxiety.ResultsThe average score on the THAT was 34.9±7.2 (range 22–50) for the control group. The cutoff score for the THAT, indicative of clinically significant reduced alertness, was determined to be ≤20.5 (mean −2 SD). THAT alertness scores were found to be modestly, significantly, and negatively correlated with fatigue levels (r=−0.39, P<0.001), depressive symptoms (r=−0.53, P<0.001), and anxiety symptoms (r=−0.41, P<0.001). No correlations were found between alertness levels and daytime sleepiness. Regression analyses revealed a significant model (F=19.9, P<0.001, adjusted R2=0.35) with depressive symptoms (P<0.001) and fatigue (P=0.006) emerging as the only significant predictors of scores on the THAT.ConclusionThe findings of this study support that sleepiness is not the same as poor alertness. Depressive symptoms and fatigue, but not sleepiness, were found to have a strong and significant impact on levels of alertness. This is the first study to link poor alertness to depressive symptoms.

How to Design a Relevant Corpus for Sleepiness Detection Through Voice?

“…Light green dashed boxes: neurophysiological measures; Forest green dashed boxes: neuropsychological measures; Yellow dashed boxes: psychometric questionnaires. KDT, Karolinska Drowsiness Scale ( 32 ); VIGALL, Vigilance Algorithm Leipzig ( 33 ); MSLT, Multiple Sleep Latency Test ( 34 ); PVT, Psychomotor Vigilance Task ( 35 ); SART, Sustained Attention to Response Task ( 36 ); SSS, Stanford Sleepiness Scale ( 37 ), KSS: Karolinska Sleepiness Scale ( 32 ); VAS-F, Visual Analog Scale–Fatigue ( 38 ); SIQ, Sleep Inertia Questionnaire ( 39 ); Forced Awakening, Event-related potentials during forced awakening ( 40 ); PSG, Polysomnography; ESS, Epworth Sleepiness Scale ( 41 ); MWT, Maintenance of Wakefulness Test ( 42 ); THAT, Toronto Hospital Alertness Test ( 43 ); FSS, Fatigue Severity Scale ( 44 ); FOSQ, Functional Outcomes of Sleep Questionnaire ( 45 ).…”

“…Supplementary data contains the ID, age, sex, Body mass index (BMI), diagnostic of speakers for Obstructive Sleep Apnea (OSA), and the ESS is filled by each patient. The Toronto Hospital Alertness Test ( 43 ) and the Cartoon Faces Sleepiness scale ( 58 ) have also been collected, but due to too few gathered values, they are not reported in this article. The data available on this corpus are presented in Table 4 .…”

The Psychomotor Cognition Test for Measurement of Sleepiness/Fatigue on a Touch Screen*

“…Decreased arousal caused by accumulated fatigue can be measured by questionnaires and behavioral tests. Alertness testing tools in the form of questionnaires include the Toronto Hospital Alertness Test (THAT) scale, mental alertness scale, and objective alertness scale [1][2] [3]. The behavioral test is a performance test which eventually becomes a tool to evaluate an individual's level of alertness [4] [5] [6].…”