COSMIN database

Subjective sleep measures for adolescents: a systematic review

Ji, X. and Liu, J.
BACKGROUND: Sleep disturbances in adolescents have received significant attention because of their high prevalence and the negative health outcomes. Relative to objective measures, subjective sleep instruments have been the most practical tools used to identify sleep problems and assess responses to interventions in research and clinical settings. This systematic review aims to examine the psychometric properties of subjective measures that are used to assess sleep quality and disturbances among adolescents, identify the strength and limitation of each measurement and inform recommendations for practice.

METHODS: PubMed, Embase and PsycInfo were searched from 2000 through May 2016. The reference lists of important articles were included if they met the inclusion criteria. The available measures were evaluated and classified as positive, intermediate or poor according to the quality criteria for health status questionnaires.

RESULTS: Thirteen self-reported or parent-reported sleep measures met the inclusion criteria. Of the measurements reviewed, six were generic instruments assessing overall sleep quality and disturbances; five were dimension-specific instruments measuring daytime sleepiness, sleep insufficiency and sleep hygiene; and two were condition-specific instruments for insomnia. None of the subjective sleep measures for adolescents has a psychometric profile with all essential measurement properties. Specifically, the generic sleep measurements capture multiple dimensions but face issues of participant burden and compatibility. Among the domain-specific tools, the Cleveland Adolescent Sleepiness Questionnaire and the Chronic Sleep Reduction Questionnaire have achieved good psychometric merits but need further evaluation for responsiveness. Likewise, essential measurement properties of condition-specific tools for insomnia have yet to be established.

CONCLUSIONS: Because of the limited evidence, no definite recommendations can be made at this point. However, each available measurement has its own uniqueness and strength despite the limitations. Future research on measurement development and evaluation for adolescent sleep is needed to ensure the relevance and suitability to different stages of adolescence and social contexts.
Child Care Health Dev
1365-2214 (Electronic); 0305-1862 (Linking)
Publication year:
Symptom status:
Cognitive/mental state
Emotional state
Physical state
Functional status:
Cognitive/mental functioning
Physical functioning
Children (0-18)
Codes for special purposes
Diseases of and symptoms related to the nervous system
Mental and behavioural disorders and related symptoms
PRO / non-PRO:
Non-patient Reported Outcome
Patient Reported Outcome
Type of measurement instrument:
1 - Questionnaires
AIS - Athens Insomnia Scale
ASHS - Adolescent Sleep Hygiene Scale
ASWS - Adolescent Sleep Wake Scale
CASQ - Cleveland Adolescent Sleepiness Questionnaire
CRSP - Children’s Report of Sleep Patterns
CSRQ - Chronic Sleep Reduction Questionnaire
ESS - Epworth Sleepiness Scale
ISI - Insomnia Severity Index
PDSS - Pediatric Daytime Sleepiness Scale
PSQI - Pittsburgh Sleep Quality Index
SDIS-A - Sleep Disorders Inventory for Students-Adolescents
SDSC - Sleep Disturbance Scale for Children
SSHS - School Sleep Habits Survey