Validity of the new 'Top End Sleepiness Scale' against the STOP-Bang tool in predicting obstructive sleep apnoea among Indigenous Australian adults.

Abstract

The validity of the newly developed sleepiness assessment tool, the 'Top End Sleepiness Scale' (TESS), against other established obstructive sleep apnoea (OSA) screening tools has not been evaluated. To compare the utility and validity of the culturally safe and clinically relevant subjective daytime sleepiness assessment tool, the 'TESS' was used among Indigenous Australians against STOP-Bang screening tool for predicting OSA in a regional and remote Indigenous Australian cohort. The TESS questionnaire, consisting of pictorial representations of six items representing daily activities that would induce daytime sleepiness specific for Indigenous Australians, was assessed for its correlation in predicting moderate to severe OSA according to Apnoea-Hypopnoea Index (AHI, ≥15) against the STOP-Bang screening tool. Eighty Indigenous Australian patients (51% male; mean age 45.1 ± 11.5 years) were included in this study with the majority (n = 70; 88%) having OSA, of which 65 (93%) had an AHI ≥ 15. Area under the curve statistics for overall scores showed no significant difference between TESS or STOP-Bang in the prediction of OSA (P = 0.16). A moderate risk score of TESS (≥3) was superior to STOP-Bang (score 3-4) in sensitivity (84% vs 33%) and specificity (39% vs 30%). The sensitivity for a high-risk score for the STOP-Bang (≥5) was superior to the TESS (≥8; 60% vs 33%), although specificity was comparable (83% vs 91% respectively). The TESS screening tool could be a useful standalone or could be adopted alongside the STOP-Bang OSA screening tools in the clinical assessment of sleep disorders among Indigenous Australians.