New NT sleep disorder assessment tool

Doctors at Royal Darwin Hospital have created a sleep assessment tool primarily to assist in the diagnosis of sleep disorders in Aboriginal and Torres Strait Islander people.

The Top End Sleepiness Scale (TESS), a joint initiative of NT Health and Flinders University, is a culturally safe clinical daytime sleepiness assessment tool to assist in diagnosing obstructive sleep apnea (OSA), researchers say.

OSA causes breathing to repeatedly stop and start during sleep when the throat muscles intermittently relax and block the airway during sleep. A common symptom of OSA is snoring.

Dr Sam Benn, from the Royal Darwin Hospital (RDH) Respiratory and Sleep service, says the TESS questionnaire consisted of a series of pictorial representations of six items representing daily activities that would induce daytime sleepiness specific for Indigenous Australians living in predominately remote areas such as fishing, sitting under a tree or riding in a bush bus.

The picture questions were designed over a nine month period of extensive discussion with a focus group made up of traditional owners, an anthropologist, sleep physicians, remote clinical nurse consultants and Flinders University academics with in-depth knowledge in health issues facing Aboriginal and Torres Strait Islanders.

A study was conducted at the Respiratory and Sleep service at RDH and Darwin Respiratory and Sleep Health (DRSH) at Darwin Private Hospital, to test the TESS Questionnaire on patients in the Top End.

“The study included 82 patients who completed the Epworth Sleepiness Scale as well as the new TESS questionnaire prior to an overnight diagnostic sleep study. Comparing the results in this sample showed the TESS to be better at predicting problematic sleep apnoea,” Dr Benn said.

He said the study showed TESS was as effective as currently used questionnaires.

“Currently, there are no daytime sleepiness assessment tools available specifically for Indigenous patients in Australia. In the absence of a culturally appropriate sleepiness screening tool, OSA among Indigenous people is likely to be under-diagnosed, and thus not be treated. This may contribute to heightened adverse health consequences including cardiovascular disease, high blood pressure, stroke and metabolic issues.

Dr Benn said the most common current clinical assessment tool, the Epworth Sleepiness Scale (ESS) contains some questions which may not be appropriate or relevant for many Indigenous people, especially among those living in isolated regional and remote communities.

“There was a need to develop a culturally relevant sleepiness assessment tool specific for our population, which led to the development and evaluation the Top End Sleepiness Scale (TESS).

“The TESS sleepiness screening tool can potentially work alongside other existing questionnaires, to allow better assessment and referral of sleep disorders among Indigenous people to allow deeper investigation and management of their disorder,” Dr Benn said.

He said while this study found TESS to be useful among a small Indigenous sample, more studies will be required to test it further, and see a wider acceptance and use in primary health care.

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College of Medicine and Public Health