The Brugmann Fatigue Scale: An Analogue to the Epworth Sleepiness Scale to Measure Behavioral Rest Propensity

Background: While often confused, fatigue (as opposed to sleepiness) mostly requires rest, not sleep, to recover from. Clinical evaluations of fatigue mainly rely on assessments of symptom intensity, however without taking into account the need to engage in behavioral countermeasures. We therefore developed an 8-item 4-point Likert scale (the Brugmann Fatigue Scale; BFS) sharing a similar conceptual background with the Epworth Sleepiness Scale (ESS), assessing mental and physical fatigue and focusing specifically on rest propensity. Methods: Out of 496 consecutive patients addressed to the sleep unit of an academic hospital, we selected a sample of 295 hypnotic-free subjects (122 females). The present study examines (a) the psychometric properties of the BFS and (b) measurement invariance regarding perceived sleep quality, in parallel with common sleepiness and fatigue scales (ESS and Fatigue Severity Scale; FSS). In addition, (c) correlations of the BFS with clinical scales and polysomnographic variables were explored descriptively. Results: Rasch analyses revealed that the BFS possesses sound psychometric characteristics (rating scale functioning, item fit, dimensionality and measurement invariance) allowing for valid, reliable, linear and unidimensional measurement of mental and physical rest propensity, irrespective of perceived sleep quality, age, or gender. In addition, the BFS was significantly correlated to periodic limb movements during sleep and inversely to REM sleep duration. For both mental and physical subscales, scores above 6 are proposed as cutoff values. Conclusion: In analogy to the ESS, the BFS shows to be a unique and precise instrument assessing symptomatic fatigue with respect to rest propensity.