title: The Barcelona Sleepiness Index: A New Instrument to Assess Excessive Daytime Sleepiness in Sleep Disordered Breathing.
abstract: OBJECTIVE
  To develop the Barcelona Sleepiness Index (BSI), an interviewer-administered instrument for assessing excessive daytime sleepiness (EDS) in sleep-disordered breathing (SDB) that correlates well with objective measures of EDS and which is sensitive to change with treatment.
  
  
  METHODS
  (1) Generation of a preliminary item list: Fifty-three consecutive SDB patients complaining of EDS and their bed partners were interviewed using a focus group methodology to generate a list of situations prone to cause sleepiness. Sixty different consecutive SDB patients were then evaluated using cognitive interviews to refine this list. (2) Construct validity: The maintenance of wakefulness test (MWT), the multiple sleep latency test (MSLT) and the sustained attention to response task (SART) test were used in an additional 98 consecutive SDB patients with and without EDS. The item combination that best correlated with the objective tests constituted the BSI. Cutoff values were determined to differentiate between patients with and without EDS. (3) Sensitivity to change: Thirty patients requiring continuous positive airway pressure (CPAP) were evaluated after satisfactory treatment.
  
  
  RESULTS
  A combination of two items, "in the morning, when relaxing" and "in the afternoon, standing inactive, in a public place," presented the highest correlations with the MWT (r: -0.50, p < 0.001), the MSLT (r: -0.21, p = 0.07), and the SART (r: 0.27, p < 0.02) and constituted the BSI. The BSI significantly correlated with oxyhemoglobin saturation measures (nadir SpO2: r: -0.28, p = 0.01; CT 85: r: 0.23, p = 0.04) and showed a high sensitivity to change with CPAP treatment (t: 3.4, p = 0.002). A score of 2 or more identified patients with objective EDS (sensitivity = 64.9%, specificity = 72.1%).
  
  
  CONCLUSIONS
  The Barcelona Sleepiness Index is a simple, brief instrument for measuring subjective EDS in SDB.
authors.affiliation: Multidisciplinary Sleep Disorders Unit, Hospital Clínic of Barcelona, Barcelona, Spain.|Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain.
authors.forename: Marc
authors.initials: M
authors.lastname: Guaita
authors.affiliation: Multidisciplinary Sleep Disorders Unit, Hospital Clínic of Barcelona, Barcelona, Spain.|Department of Psychiatry, Hospital Clínic of Barcelona, Barcelona, Spain.|Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain.|University of Barcelona Medical School, Barcelona, Spain.
authors.forename: Manel
authors.initials: M
authors.lastname: Salamero
authors.affiliation: Multidisciplinary Sleep Disorders Unit, Hospital Clínic of Barcelona, Barcelona, Spain.|Department of Otorhinolaryngology, Hospital Clínic of Barcelona, Barcelona, Spain.|Ciber Enfermedades Respiratorias (CIBERES), Madrid, Spain.|University of Barcelona Medical School, Barcelona, Spain.
authors.forename: Isabel
authors.initials: I
authors.lastname: Vilaseca
authors.affiliation: Multidisciplinary Sleep Disorders Unit, Hospital Clínic of Barcelona, Barcelona, Spain.|Department of Neurology, Hospital Clínic of Barcelona, Barcelona, Spain.|Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain.|Ciber Enfermedades Neurológicas (CIBERNED), Madrid, Spain.
authors.forename: Alex
authors.initials: A
authors.lastname: Iranzo
authors.affiliation: Multidisciplinary Sleep Disorders Unit, Hospital Clínic of Barcelona, Barcelona, Spain.|Department of Pneumology, Hospital Clínic of Barcelona, Barcelona, Spain.|Ciber Enfermedades Respiratorias (CIBERES), Madrid, Spain.|University of Barcelona Medical School, Barcelona, Spain.
authors.forename: Josep M
authors.initials: JM
authors.lastname: Montserrat
authors.affiliation: Multidisciplinary Sleep Disorders Unit, Hospital Clínic of Barcelona, Barcelona, Spain.|Department of Neurology, Hospital Clínic of Barcelona, Barcelona, Spain.|Ciber Enfermedades Neurológicas (CIBERNED), Madrid, Spain.
authors.forename: Carles
authors.initials: C
authors.lastname: Gaig
authors.affiliation: Multidisciplinary Sleep Disorders Unit, Hospital Clínic of Barcelona, Barcelona, Spain.|Department of Pneumology, Hospital Clínic of Barcelona, Barcelona, Spain.|Ciber Enfermedades Respiratorias (CIBERES), Madrid, Spain.
authors.forename: Cristina
authors.initials: C
authors.lastname: Embid
authors.affiliation: Multidisciplinary Sleep Disorders Unit, Hospital Clínic of Barcelona, Barcelona, Spain.|Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain.
authors.forename: Montserrat
authors.initials: M
authors.lastname: Romero
authors.affiliation: Multidisciplinary Sleep Disorders Unit, Hospital Clínic of Barcelona, Barcelona, Spain.|Fundació Clínic per a la Recerca Biomèdica, Barcelona, Spain.
authors.forename: Mònica
authors.initials: M
authors.lastname: Serradell
authors.affiliation: Multidisciplinary Sleep Disorders Unit, Hospital Clínic of Barcelona, Barcelona, Spain.|Department of Pneumology, Hospital Clínic of Barcelona, Barcelona, Spain.
authors.forename: Carme
authors.initials: C
authors.lastname: León
authors.affiliation: Multidisciplinary Sleep Disorders Unit, Hospital Clínic of Barcelona, Barcelona, Spain.|Department of Psychiatry, Hospital Clínic of Barcelona, Barcelona, Spain.|Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain.|University of Barcelona Medical School, Barcelona, Spain.
authors.forename: Joan
authors.initials: J
authors.lastname: de Pablo
authors.affiliation: Multidisciplinary Sleep Disorders Unit, Hospital Clínic of Barcelona, Barcelona, Spain.|Department of Neurology, Hospital Clínic of Barcelona, Barcelona, Spain.|Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain.|Ciber Enfermedades Neurológicas (CIBERNED), Madrid, Spain.|University of Barcelona Medical School, Barcelona, Spain.
authors.forename: Joan
authors.initials: J
authors.lastname: Santamaria
mesh_terms: D006970:Disorders of Excessive Somnolence / Q000150:complications* / Q000175:diagnosis*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015203:Reproducibility of Results; D057566:Self Report; D012680:Sensitivity and Specificity; D012891:Sleep Apnea Syndromes / Q000150:complications*; D013030:Spain; D011795:Surveys and Questionnaires / Q000592:standards*
keywords: Barcelona Sleepiness Index; MSLT; MWT; SART; excessive daytime sleepiness; focus group; sleep disordered breathing