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Nature and science of sleep
2016;8 41-5.

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

Azmeh Shahid, Sharon A Chung, Lance Maresky, Affan Danish, Arina Bingeliene, Jianhua Shen, Colin M Shapiro
Author Information
  1. Azmeh Shahid: Sleep Research Laboratory, Department of Psychiatry, University Health Network, University of Toronto, Toronto, ON, Canada; Youthdale Treatment Centres, University of Toronto, Toronto, ON, Canada; Youthdale Child and Adolescent Sleep Centre, University of Toronto, Toronto, ON, Canada; Department of Psychiatry, University of Toronto, Toronto, ON, Canada; Department of Psychiatry, Toronto Western Hospital, University Health Network, Toronto, ON, Canada.
  2. Sharon A Chung: Sleep Research Laboratory, Department of Psychiatry, University Health Network, University of Toronto, Toronto, ON, Canada; Youthdale Treatment Centres, University of Toronto, Toronto, ON, Canada; Department of Psychiatry, Toronto Western Hospital, University Health Network, Toronto, ON, Canada.
  3. Lance Maresky: Sleep Research Laboratory, Department of Psychiatry, University Health Network, University of Toronto, Toronto, ON, Canada.
  4. Affan Danish: Sleep Research Laboratory, Department of Psychiatry, University Health Network, University of Toronto, Toronto, ON, Canada.
  5. Arina Bingeliene: Sleep Research Laboratory, Department of Psychiatry, University Health Network, University of Toronto, Toronto, ON, Canada; Department of Psychiatry, University of Toronto, Toronto, ON, Canada; Department of Psychiatry, Toronto Western Hospital, University Health Network, Toronto, ON, Canada.
  6. Jianhua Shen: Sleep Research Laboratory, Department of Psychiatry, University Health Network, University of Toronto, Toronto, ON, Canada.
  7. Colin M Shapiro: Sleep Research Laboratory, Department of Psychiatry, University Health Network, University of Toronto, Toronto, ON, Canada; Youthdale Treatment Centres, University of Toronto, Toronto, ON, Canada; Youthdale Child and Adolescent Sleep Centre, University of Toronto, Toronto, ON, Canada; Department of Psychiatry, University of Toronto, Toronto, ON, Canada; Department of Psychiatry, Toronto Western Hospital, University Health Network, Toronto, ON, Canada.
PMID: 26855603 DOI: 10.2147/NSS.S91928

Abstract

OBJECTIVE: The 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.
METHODS: Normative 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.
RESULTS: The 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 R (2)=0.35) with depressive symptoms (P<0.001) and fatigue (P=0.006) emerging as the only significant predictors of scores on the THAT.
CONCLUSION: The 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.

Keywords

alertness anxiety depression fatigue sleepiness

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Journal Article
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Word Cloud

Created with Highcharts 10.0.0alertnesssleepinessfatiguesymptomsTHATdepressiveanxietyP<0001daytimesignificantrelationshipdepressionstudyfoundlevelsr=-0TorontoHospitalAlertnessTestexploreamongdatacollectedscore2scorespoorOBJECTIVE:scaledesignedmeasuredefinedcapacitymindrespondappropriatelyexternalinternalstimulipresentstudy'saimdeterminenormativevaluesexcessiveMETHODS:Normative60healthymalesfemaleschartssleepclinicpatientssubjectscompletedmeasuresRESULTS:average349±7range22-50controlgroupcutoffindicativeclinicallyreduceddetermined≤205mean-2SDmodestlysignificantlynegativelycorrelated395341correlationsRegressionanalysesrevealedmodelF=199adjustedR=035P=0006emergingpredictorsCONCLUSION:findingssupportDepressivestrongimpactfirstlinkscale:

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