Validation of the Behavioral Risk Factor Surveillance System Sleep Questions

Abstract

Study Objective: Sleep problems may constitute a risk for health problems, including cardiovascular disease, depression, diabetes, poor work performance, and motor vehicle accidents. The primary purpose of this study was to assess the validity of the current Behavioral Risk Factor Surveillance System (BRFSS) sleep questions by establishing the sensitivity and specificity for detection of sleep/ wake disturbance. Methods: Repeated cross-sectional assessment of 300 community dwelling adults over the age of 18 who did not wear CPAP or oxygen during sleep. Reliability and validity testing of the BRFSS sleep questions was performed comparing to BFRSS responses to data from home sleep study, actigraphy for 14 days, Insomnia Severity Index, Epworth Sleepiness Scale, and PROMIS-57. Results: Only two of the five BRFSS sleep questions were found valid and reliable in determining total sleep time and excessive daytime sleepiness. I NTRO DUCTI O NThe Behavioral Risk Factor Surveillance System (BRFSS) is an ongoing telephone health survey system conducted by the Centers for Disease Control and Prevention (CDC) in the 50 United States as well as District of Columbia, Puerto Rico, the U.S. Virgin Islands, and Guam. The purpose of the BRFSS is to track health risk behaviors, preventive health practices, and health care access primarily related to chronic disease and injury. The use of the system started in 1984 and continues monthly. More than 350,000 adults are interviewed each year. Information from the surveys is used in research and clinical practice, and is frequently used to support public health policies and health-related legislative efforts. 1In early 2000, the CDC, in collaboration with the National Sleep Foundation, facilitated a work group charged with raising awareness about, increasing the understanding of, and reducing the impact of sleep deprivation and sleep disorders. In response to the work group's recommendations, the sleep question that was initiated in the BRFSS in 1995 was expanded upon with four optional module questions to capture sleep related symptoms. The current BRFSS sleep questions are: (1) During the past 30 days for about how many days have you felt you did not get enough rest or sleep; (2) On average, how many hours of sleep do you get in a 24-hour period? Think about the time you actually spend sleeping or napping, not just the amount of sleep you think you should get; (3) Do you snore; (4) During the past 30 days, for about how many days did you find yourself unintentionally falling asleep during the day; and (5) During the past 30 days, have you ever nodded off or fallen asleep, even just for a brief moment, while driving? The questions were implemented into the state telephone surveys around 2005, but to date, evidence of their validation is lacking. Therefore, a study was performed to assess the reliability and validity of the BRFSS sleep questions to determine their sensitivity to detect sleep disorders and insufficient sleep in adults. Establishing questions that will accurately identif...

Patterns of Diet, Physical Activity, Sitting and Sleep Are Associated with Socio-Demographic, Behavioural, and Health-Risk Indicators in Adults

“…Participants were asked: “During the past 30 days, for about how many days have you felt you did not get enough rest or sleep?” Responses were categorised as none (0 days), infrequent (1–13 days), or frequent (14–30 days). This single item has demonstrated acceptable levels of test–retest reliability [20].…”

Short Sleep Duration, Obstructive Sleep Apnea, Shiftwork, and the Risk of Adverse Cardiovascular Events in Patients After an Acute Coronary Syndrome

“…At the randomization visit (median 14 days post‐ACS), each participant was to complete a short questionnaire about their sleep and shift work habits. To assess sleep duration, participants were asked, “On average, how much sleep do you get in 24 hours?” This question was very similar to the validated Behavioral Risk Factor Surveillance System question on sleep duration . The validated Berlin Questionnaire was completed and standard scoring was used to designate individuals at increased risk of OSA regardless of whether or not they had a known history of OSA .…”

“…This question was very similar to the validated Behavioral Risk Factor Surveillance System question on sleep duration. 20 The validated Berlin Questionnaire was completed and standard scoring was used to designate individuals at increased risk of OSA regardless of whether or not they had a known history of OSA. 21 The Berlin Questionnaire is scored as at risk for OSA if 2 of the 3 categories are positive (snoring and cessation of breathing, symptoms of excessive daytime sleepiness, and hypertension/body mass index [BMI] >30 kg/m 2 ; see Figure S1 for questionnaire).…”

Effect of airtime incentives on response and cooperation rates in non-communicable disease interactive voice response surveys: randomised controlled trials in Bangladesh and Uganda

“…For several decades, high-income countries have supplemented in-person data collection with telephone surveys, such as the Behavioural Risk Factor Surveillance Survey 8. These have been validated as unbiased sources of population-level data on behavioural risk factors for a number of chronic conditions 9–11. With the exponential growth of mobile phone access and ownership in LMICs, from 22.9 mobile subscriptions per 100 people in 2005 to 98.7 in 2016,12 there is an opportunity to complement traditional household surveys with more frequent surveillance through the use of mobile phone surveys (MPS).…”