COSMIN database

A systematic review of patient-reported outcome instruments measuring sleep dysfunction in adults

Devine, E. B., Hakim, Z., and Green, J.
Sleep dysfunction can manifest in several ways, ranging from insomnia to somnolence, and from disrupted sleep to lack of restful sleep. Measuring sleep dysfunction is an area of active research and there exist a number of patient-reported outcome instruments that measure various aspects of sleep dysfunction. However, these instruments have not been evaluated systematically. We used a conceptual model of sleep that included four physical domains of general interest to patients and investigators, and cover the breadth of this disorder: sleep initiation; sleep maintenance; sleep adequacy; and somnolence. We next considered the additional health-related quality-of-life (HR-QOL) domains of psychological and social functioning, progressing along the continuum to include health perceptions and opportunity. We then conducted a literature review to identify instruments and, using criteria developed by the Medical Outcomes Trust Scientific Advisory Committee, evaluated these instruments for their potential use in measuring sleep dysfunction. Twenty-two instruments were identified. Six instruments were found to include the four physical domains defined a priori (Basic Nordic Sleep Questionnaire, Leeds Sleep Evaluation Questionnaire, Medical Outcomes Study - Sleep Problems Measures, Pittsburgh Sleep Diary, Pittsburgh Sleep Quality Index, Self-Rated Sleep Questionnaire and the Sleep Dissatisfaction Questionnaire). Several additional instruments addressed at least some of the domains and thus may be useful for specific purposes. A few instruments addressed overall HR-QOL, but did not include all four domains of interest (Functional Outcomes of Sleep Questionnaire, Quality of Life in Insomniacs and the Sleep-Wake Activity Inventory). Two instruments had undergone extensive psychometric evaluation (Medical Outcomes Study - Sleep Problems Measures and Pittsburgh Sleep Quality Index), with only the latter reporting information about interpretability. Our review indicates that measuring sleep dysfunction in adults is an area of active research and that much work still needs to be completed, specifically the study of interpretability and the application of patient preferences or item response theory. The specific research focus should dictate instrument selection.
1170-7690 (Print)
Publication year:
Symptom status:
Physical state
Functional status:
Cognitive/mental functioning
Social functioning
General health perceptions / HRQoL:
Health-related quality of life
Adults (18-65)
Seniors (65+)
External causes of morbidity and mortality
Mental and behavioural disorders and related symptoms
PRO / non-PRO:
Patient Reported Outcome
Type of measurement instrument:
1 - Questionnaires
2 - Interviews
3 - Diaries
BNSQ - Basic Nordic Sleep Questionnaire
DBAS-10 - Dysfunctional Beliefs and Attitudes about Sleep Scale-10 items
DBAS - Dysfunctional Beliefs and Attitudes about Sleep Scale
DBAS-SF - Dysfunctional Beliefs and Attitudes about Sleep Scale Short Form
ESDQ - Espie Sleep Disturbance Questionnaire
ESS - Epworth Sleepiness Scale
FOSQ - Functional Outcomes of Sleep Questionnaire
JSPS - Jenkins Sleep Problems Scale
KSD - Karolinska Sleepiness Diary
LSEQ - Leeds Sleep Evaluation Questionnaire
MOS-Sleep - Medical Outcomes Study Sleep Scale
MOS-SPI-6 - Medical Outcomes Study Sleep Problems Index – 6 Items
MOS-SPI-9 - Medical Outcomes Study Sleep Problems Index 9 Items
PSD - Pittsburgh Sleep Diary
PSQI - Pittsburgh Sleep Quality Index
QOLI - Quality of Life of Insomniacs
RSS - Resistance to Sleepiness Scale
SDQ - Sleep Disorders Questionnaire
SDQ - Sleep Dissatisfaction Questionnaire
SMHSQ - St. Mary’s Hospital Sleep Questionnaire
SQI - Sleep Quality Index
SRSQ - Self-Rated Sleep Questionnaire
SSS - Stanford Sleepiness Scale
STQ - Sleep Timing Questionnaire
SWAI - Sleep-Wake Activity Inventory
VSH Sleep Scale - Verran and Snyder-Halpern Sleep Scale