Reliability and validity of the Japanese version of the Ullanlinna Narcolepsy Scale and Swiss Narcolepsy Scale for screening Japanese individuals with narcolepsy type 1

Kosuke Tanioka; Toshiyuki Hirasawa; Mariko Yanagihara; Noboru Takeuchi; Hideaki Nakayama; Akira Usui; Yuichi Inoue

doi:10.1016/j.sleep.2023.07.015

Reliability and validity of the Japanese version of the Ullanlinna Narcolepsy Scale and Swiss Narcolepsy Scale for screening Japanese individuals with narcolepsy type 1

Sleep Med. 2023 Sep:109:245-251. doi: 10.1016/j.sleep.2023.07.015. Epub 2023 Jul 19.

Authors

Kosuke Tanioka¹, Toshiyuki Hirasawa¹, Mariko Yanagihara¹, Noboru Takeuchi¹, Hideaki Nakayama¹, Akira Usui², Yuichi Inoue³

Affiliations

¹ Department of Somnology, Tokyo Medical University, SY building 5-10-10 Yoyogi, Shibuya-ku, Tokyo, 151-0053, Japan; Japan Somnology Center, Neuropsychiatric Research Institute, SY building 5-10-10 Yoyogi, Shibuya-ku, Tokyo, 151-0053, Japan.
² Japan Somnology Center, Neuropsychiatric Research Institute, SY building 5-10-10 Yoyogi, Shibuya-ku, Tokyo, 151-0053, Japan.
³ Department of Somnology, Tokyo Medical University, SY building 5-10-10 Yoyogi, Shibuya-ku, Tokyo, 151-0053, Japan; Japan Somnology Center, Neuropsychiatric Research Institute, SY building 5-10-10 Yoyogi, Shibuya-ku, Tokyo, 151-0053, Japan. Electronic address: inoue@somnology.com.

PMID: 37487277
DOI: 10.1016/j.sleep.2023.07.015

Abstract

Objective: To validate the Japanese versions of the Ullanlinna Narcolepsy Scale (J-UNS) and Swiss Narcolepsy Scale (J-SNS) for screening narcolepsy in the Japanese population and to discuss strategies for their use in hypersomniac individuals.

Methods: We selected 451 outpatients with excessive daytime sleepiness (EDS) already diagnosed according to the International Classification of Sleep Disorders third edition. They responded to both scales twice at 1-month intervals. After eliminating individuals who met the exclusion criteria, validity and reliability analyses were performed on 408 and 381 participants, respectively.

Results: Patients with narcolepsy type 1 (NT1) displayed higher J-UNS and lower J-SNS scores than those with NT2 and other sleep disorders. The intraclass correlation coefficients and weighted κ coefficient for scale scores in the total participants and patients with NT1 were ≥0.70 and ≥ 0.40, respectively, indicating high reliability. Furthermore, both the sensitivity and specificity of these scales upon using the original cut-off scores (14 for UNS and 0 for SNS) for detecting NT1 were 0.70 or ≥0.70, suggesting high validity. Additionally, the receiver operating characteristic curve analysis revealed that the best cut-off score did not change for the J-SNS but that for the J-UNS, it increased to 18. In our study, the scale's sensitivity and specificity changed from 96% to 82% and 58%-78%, respectively.

Conclusions: Both scales revealed satisfactory screening abilities for NT1 in the Japanese population. However, it may be better to use J-UNS cut-off scores of 18 for a population with EDS.

Keywords: Excessive daytime sleepiness; Narcolepsy; Reliability; Swiss Narcolepsy Scale; Ullanlinna Narcolepsy Scale; Validity.

Publication types

Validation Study
Research Support, Non-U.S. Gov't

MeSH terms

Cross-Cultural Comparison
Disorders of Excessive Somnolence* / diagnosis
East Asian People / ethnology
Humans
Narcolepsy* / diagnosis
Patient Acuity*
Reproducibility of Results