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SUMMARY T w o assumptions underlying the Stanford Sleepiness Scale (SSS) were evaluated:
that the descriptors defining each level of the scale are equivalent ways of
characterizing a particular level of sleepiness; and that sleepiness, thus measured, is
an unidimensional construct. Twenty-four True/False items were derived from t h e
descriptors at each level of the SSS. This revised scale was administered to 340
undergraduates in a questionnaire which also included: t h e SSS; four visual
analogue scales; items identifying the subjects age, sex, a n d circadian type; and the
time of administration. Analyses of the responses indicated that endorsement of
items o n the revised scale was not consistent with the SSS level endorsed, indicating
that the descriptors at each scale level a r e not equivalent. A principal components
analysis revealed two components, tentatively identified as activation and sleepiness,
accounting, respectively, for 24.2 and 20.6% of the variance. It was concluded that
sleepiness is not a n unidimensional construct. Further studies a r e necessary t o
elucidate the nature of its components.
KEYWORDS psychometric evaluation, Stanford Sleepiness Scale, sleepiness
35
36 A . MacLean et al.
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Figure 1. Proportion of subjects who Item number
respond True to each of the derived items 80
in relation to their score on the Stanford
Sleepiness Scale (SSS). The level of the SSS 60
endorsed by the subjects is shown in the
upper left corner of each part of the figure, 40
the number of the subjects making the
endorsement in the upper right, while the 20
solid bars indicate those items that are
derived from the level of the SSS. Note: 0
only one subject responded to SSS scale 4 8 12 16 20 24
point 7. Item number
often than the relevant items. Similar patterns were also of the SSS selected the one that would be predicted from the
obtained for subjects rating themselves at levels 1 , 2 , 4 , 5 derivation of the item. For ten items it differs by one
and 6 of the SSS. Note that the data for level 7 are based on position; for four items by two positions; on three items by
the responses of only one individual. three positions; and on one item by four positions.
Another measure of the consistency of the individual From neither of these analyses can the component items
components of the SSS is the modal level of the SSS which is of the SSS levels b e judged t o be consistent with the level of
selected by individuals who endorse a particular item as the scale from which they are derived.
true. Again, if the component items of the SSS are
consistent with the level of the scale from which they are
Dimensionality of the scale
derived, subjects who endorse, for example, item 19 as
True should all rate themselves at level 6 of the SSS. In To explore the dimensionality of the SSS, we carried out a
fact, the majority of individuals who endorse item 19 as Principal Components Analysis of the 24 items derived from
True select levels 3 of the SSS. When considering all of the the scale descriptors. Two components were extracted,
24 items of the questionnaire, in only six is the modal level which were based on the examination of a scree plot (Cattell
38 A . MacLean et al.
Table 2 Principal Components Analysis of
Factor revised Sleep Scale items
Item ~~~
no. 1 2 Item
1966) and they were rotated to a Varimax Criterion: factor Table 3 Pearson product-moment correlations between Visual
loadings greater than 0.320 (representing a minimum of 10 Analogue Scales and Sleepiness Scales
percent of shared variance between the items and the factor) Measure sss Factor 1 Factor 2
were interpreted.
The results of the analysis are shown in Table 2 . The first sss 0.500*** 0.62 1* * *
Age -0.113 -0.055 -0.150
factor, accounting for 24.2 percent of the variance, appears Circadian type 0.113 0.147 0.109
to be an energic or activation factor which is characterized
Calm-Irritable 0.351 * * * 0.269** * 0.321 * * *
at one extreme by the statements I feel slowed down and Energetic-Sluggish 0.668* * * 0.671*** 0.436***
I am not at full alertness and at the other by I feel Happy-Sad 0.36S** * 0.342** 0.291***
active and I feel wide awake. The second factor, which Relaxed-Tense 0.228** 0.219** 0.188*
accounts for 20.6 percent of the variance, seems to be more ~
DISCUSSION
Analogue scales The results of the present study indicate that items derived
To investigate further the interpretation of the two factors, from the descriptors defining each level of the SSS are not
Pearson product-moment correlations were calculated homogeneous. Furthermore, it was shown that sleepiness, as
between the visual analogue scales, the SSS and the factor defined by these items, is not an unidimensional construct;
scores of the two factors (Table 3). T h e two largest two independent dimensions are present. If one considers
correlations, 0.668 and 0.671, respectively, are those the items that load on each component and their
between the Energetic-Sluggish scale us the SSS, and the relationship to visual analogue scale ratings, then these can
Energetic-Sluggish scale us Factor 1. Otherwise, however, be identified provisionally as activation and sleepiness.
Evaluation of Stanford Sleepiness Scale 39
The multifaceted nature of subjective states related to psychometric instrument for the assessment of subjective
sleepiness, and of sleepiness itself, has been recognized by a sleepiness.
number of writers. Although Dement (1976) maintained
that sleepiness was an independent feeling state, he drew ACKNOWLEDGEMENT
attention to some overlap between sleepiness, physical
The support of the Medical Research Council of Canada
tiredness, and depression and lack of initiative. Carskadon
(Grant No. MA-6937) is gratefully acknowledged.
and Dement (1982), in providing a theoretical framework
for the Multiple Sleep Latency Test, distinguished between
physiological and manifest sleepiness o r sleep tendency. The REFERENCES
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