Validation of the Dutch translation of the Paris Arousal Disorders Severity Scale for non-REM parasomnias in a 1-year and 1-month version

Abstract

Study objectives: We created a Dutch version of the Paris Arousal Disorders Severity Scale (PADSS), which assesses non-rapid eye movement (NREM) parasomnia symptoms over the past year (PADSS-year). This questionnaire was previously validated in patients with sleep walking and/or sleep terrors (SW/ST). We validated the questionnaire in SW/ST patients, and in a broader population, including patients with confusional arousals, comorbidities, and medication users ("other NREM parasomnias"). Furthermore, we introduced a version covering the past month (PADSS-month), with the potential purpose of evaluating symptom evolution and treatment response.

Methods: We compared PADSS scores among 54 SW/ST patients, 34 age-matched controls, and 23 patients with other NREM parasomnias. We evaluated discriminative capacity, internal consistency, and construct validity. Furthermore, we assessed the test-retest reliability and treatment response of PADSS-month.

Results: Healthy controls scored significantly lower than both patient groups. We found an excellent diagnostic accuracy (area under the curve PADSS-year 0.990, PADSS-month 0.987) and an acceptable internal consistency. Exploratory factor analysis identified 3 components: "behaviors outside the bed," "behaviors in/around the bed," and "violent behaviors," with the former 2 factors reflecting the distinction between SW and ST. PADSS-month showed an acceptable test-retest reliability (0.75). Additionally, PADSS-month significantly decreased after pharmaceutical and/or behavioral treatment. This change was correlated with the clinical impression of the caregiver, implying that PADSS-month is sensitive to treatment effects.

Conclusions: The Dutch PADSS questionnaire can be used as a screening tool in a broad population of patients with NREM parasomnia, not only SW/ST. Furthermore, we validated a PADSS-month version to assess the evolution of symptoms and treatment effect.

Citation: van Mierlo P, Hermans L, Arnulf I, Pijpers A, Overeem S, van Gilst M. Validation of the Dutch translation of the Paris Arousal Disorders Severity Scale for non-REM parasomnias in a 1-year and 1-month version. J Clin Sleep Med. 2022;18(4):1135-1143.

Keywords: NREM parasomnia; sleep terror; sleepwalking.

Figure 1. Schematic representation of the study procedures.

Blue rectangles represent procedures that were part of clinical treatment; white rectangles represent time instances during which data were collected for the study. GGI-C = treatment evaluation question (reflecting change between before and after treatment) of the Clinical Global Impression Scale, PADSS = Paris Arousal Disorders Severity Scale, PSG = polysomnography,

Figure 2. Total scores for first-visit PADSS questionnaires for SW/ST patients, healthy controls, and other parasomnia patients.

NREM = non–rapid eye movement, PADSS = Paris Arousal Disorders Severity Scale, SW/ST = sleep walking/sleep terrors.

Figure 3. ROC curve for discriminating between SW/ST patients and age-matched healthy participants.

The red diagonal lines are reference lines; the blue lines represent the ROC curves. PADSS = Paris Arousal Disorders Severity Scale, ROC = receiver operating characteristic, SW/ST = sleep walking/sleep terrors.

Figure 4. Total scores for PADSS-month-1 (before treatment) and PADSS-month-3 (after treatment) for subgroups of participants stratified for type of treatment.

The 2 participants who received various other types of treatment and the 2 participants for whom the treatment was not known are not shown in this graph. CBT-p = standard lifestyle advice + cognitive behavioral therapy (n = 21), Comb = standard lifestyle advice + cognitive behavioral therapy + medication (n = 5), Lifest = only standard lifestyle advice (n = 8), Med = standard lifestyle advice + medication (n = 9), PADSS = Paris Arousal Disorders Severity Scale.