Development and validation of the Tiredness Identification Index (TIDI): a combined scale for the assessment of fatigue and sleepiness, 2026, Reeve

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Development and validation of the Tiredness Identification Index (TIDI): a combined scale for the assessment of fatigue and sleepiness

Sarah Reeve1,2, Bryony Sheaves3,4, Bao Sheng Loe5, Daniel Freeman3,4

1Norwich Medical School, University of East Anglia, Norwich, UK, 2Cambridgeshire and Peterborough NHS Foundation Trust, Cambridge, UK 3Department of Experimental Psychology, University of Oxford, UK

Abstract​

Study Objectives

Tiredness is a common presentation composed of sleepiness (propensity towards sleeping) and fatigue (feelings of physiological exhaustion). Differentiating between these presentations is important for diagnosis and management. The current study reports on the development and validation of an integrated measure of tiredness (Tiredness Identification Index - TIDI) incorporating assessment of sleepiness and fatigue, and the relationship of the measure with sleep and mental health outcomes.

Method

A sample of 6706 adult participants responded to a pool of sleepiness and fatigue items. Regularised structural equation modelling and confirmatory factor analysis were used to refine the items and factor structure based on convergence against validation measures of fatigue and sleepiness. Regression analyses were then applied to test relationships of the sleepiness and fatigue factors with sleep, mental health, and wellbeing variables.

Results

An 8-item scale was developed, composed of a sleepiness (TIDI-sleepiness) and fatigue (TIDI-fatigue) factor with divergent and convergent validity, alongside a general tiredness factor. Higher TIDI-sleepiness was associated with increased apnoea risk and shorter sleep duration, whereas TIDI-fatigue was associated with increased insomnia and reduced sleep efficiency. Controlling for TIDI-sleepiness, TIDI-fatigue was associated with increased depression, anxiety, reduced well-being, and lower physical activity. Increased TIDI-sleepiness and TIDI-fatigue were both associated with paranoia and hallucinations.

Conclusions

The results indicate that the TIDI can be used as a brief scale to measure and differentiate fatigue and sleepiness, particularly in non-clinical populations and for research purposes. Assessment of its validity in discriminating fatigue and sleepiness in relevant clinical sleep, mental, and physical health populations should be a focus of future research.
 
This study demonstrated that objective sleepiness (how quickly one falls asleep when given nap opportunities throughout the day on multiple sleep latency testing) and fatigue are completely uncorrelated symptoms in OSA patients (this doesn't necessarily mean that some OSA patients with fatigue aren't more likely to actually take naps during the day than those without fatigue, but in terms of how quickly patients fall asleep, there is no correlation with fatigue):
nataliezzz

Thread 'Objective versus subjective excessive daytime sleepiness in OSA: Quantifying the impact of fatigue, 2026, Gold et al.'

Objective versus subjective excessive daytime sleepiness in OSA: Quantifying the impact of fatigue
Morris S Gold, Riccardo A Stoohs, Avram R Gold
https://www.sciencedirect.com/science/article/abs/pii/S1389945726001061

Background
In patients with obstructive sleep apnea (OSA), excessive daytime sleepiness (EDS) is typically measured either objectively with the mean sleep latency (MSL) of the multiple sleep latency test (MSLT), or subjectively with the Epworth sleepiness scale (ESS). These measures correlate only mildly with each other and differ greatly in their...
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I have not read the article, but it does seem a good thing that people are endeavouring to clarify this area where a number of the most used labels are somewhat confusing.
 
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