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

PharmacoEconomics volume 23, pages 889–912 (2005)Cite this article

Abstract

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 patientreported 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.

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Acknowledgements

This work was supported by Roche Pharmaceuticals. At the time this work was completed, EB Devine was a post-doctoral fellow with Roche Global Health Economics and Strategic Pricing Group. The authors have no conflicts of interest relevant to this review.

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Affiliations

  1. Pharmaceutical Outcomes Research and Policy Program, Department of Pharmacy, University of Washington, Box 357630, Seattle, Washington, 98195-7630, USA

    Emily Beth Devine

  2. Roche Global Health Economics and Strategic Pricing, Nutley, New Jersey, USA

    Zafar Hakim & Jesse Green

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  1. Emily Beth Devine
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  2. Zafar Hakim
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Devine, E.B., Hakim, Z. & Green, J. A systematic review of patient-reported outcome instruments measuring sleep dysfunction in adults. Pharmacoeconomics 23, 889–912 (2005). https://doi.org/10.2165/00019053-200523090-00003

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  • DOI: https://doi.org/10.2165/00019053-200523090-00003

Keywords

  • Item Response Theory
  • Epworth Sleepiness Scale
  • Pittsburgh Sleep Quality Index
  • Sleep Adequacy
  • Sleep Dysfunction