<p>A Systematic Review of Instruments for the Assessment of Insomnia in Adults</p>

O R I G I N A L R E S E A R C H

A Systematic Review of Instruments for the

Assessment of Insomnia in Adults

This article was published in the following Dove Press journal: Nature and Science of Sleep

Raja Mahamade Ali

Monica Zolezzi

Ahmed Awaisu

College of Pharmacy, QU Health, Qatar

University, Doha 2713, Qatar

Introduction:

Self-reported sleep instruments remain the most practical methods for the

assessment of insomnia in clinical practice. This systematic review aims to identify, describe

and summarize the psychometric properties of questionnaires available for the assessment of

insomnia in the adult population. In addition, the review also aimed to identify sleep

instruments available in the Arabic language.

Methods:

A systematic literature search was conducted using the following electronic

databases: PubMed, EMBASE, ProQuest Central, SCOPUS, and Google Scholar. The quality

assessment of the instruments was conducted using two established international criteria.

Results:

One hundred and seven articles were selected for inclusion, from which 31

instruments were identi

fi

ed and categorized based on the constructs they assess as: (1)

screening for insomnia (n=14); (2) measuring the consequences of insomnia (n=8); (3)

assessing the cognitive aspects of insomnia (n= 5); and (4) assessing sleep hygiene (n= 4).

The review of the psychometric properties showed that the Insomnia Severity Index and the

Functional Outcomes of Sleep Questionnaire were the most extensively evaluated

instru-ment. Criterion validity and reliability measures were the most commonly reported

proper-ties. Only four of the identi

fi

ed instruments were available in Arabic.

Discussion:

Overall, the

fi

ndings of this study indicate ample availability of sleep

instru-ments. However, psychometric testing for several of the available sleep instruments remains

incomplete, particularly responsiveness and interpretability. Our

fi

ndings suggest that future

studies should focus on reporting more psychometric measures to ensure the trustworthiness

of these instruments.

Keywords:

insomnia, sleep hygiene, sleep quality, questionnaires, psychometric properties

Introduction

Worldwide reports suggest that around one-third of the adult population complains

of insomnia symptoms.

1–2

Insomnia is characterized by persistent sleep dif

fi

culty

despite adequate sleep opportunity and associated daytime dysfunction.

3

Insomnia

has been associated with increased rates of road accidents, lower productivity and

work absenteeism.

4,5

Several factors are known to contribute to the development or

worsening of insomnia symptoms. Current

fi

ndings from the literature suggest that

negative cognitive processes including worry, rumination and catastrophizing

thoughts are associated with worse sleep quality and insomnia.

6

These processes

have been shown to fuel anxiety and arousal resulting in delayed sleep onset and

shorter sleep duration.

7

Similarly, poor sleep hygiene, which consists of a

combina-tion of behavioral practices and environmental condicombina-tions which improves sleep, is

common among insomniacs.

8–11

Correspondence: Monica Zolezzi

College of Pharmacy, QU HealthQatar

University, PO Box 2713, Doha, Qatar

Tel +974 4403 5623

Fax +974 4403 5551

Email mzolezzi@qu.edu.qa

Nature and Science of Sleep

Dove

press

open access to scientific and medical research

Open Access Full Text Article

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Studies suggest that chronic insomnia is an

indepen-dent risk factor for developing mental illnesses in

other-wise healthy individuals.

12,13

Chronic insomnia has also

been reported to increase the probability of developing

chronic medical conditions, such as hypertension,

cardio-vascular disease and type 2 diabetes.

14,15

Therefore, early

detection and management of insomnia is important to

minimize these associated risks. Although

polysomnogra-phy (PSG) is considered the gold standard method for

evaluating insomnia, it is not routinely used as it requires

a specialized setting and equipment, and it is often labour

intensive. Wrist actigraphy is another objective tool for the

assessment of insomnia, but is limited by its lack of

speci

fi

city.

16,17

Consequently, self-reported sleep

instru-ments remain the most practical methods for the

assess-ment of insomnia in clinical practice.

16,18

There are

several systematic reviews on a range of sleep instruments

utilized for the assessment of sleep dysfunction in a

vari-ety of medical and neuropsychiatric disorders, or in

spe-cialized populations.

19–21

In these reviews, there was

insuf

fi

cient evaluation of the psychometric properties of

the instruments that were identi

fi

ed, and none of them

included instruments which assess sleep hygiene practices

in the adult population. Therefore, the main objective of

this study is to present an updated systematic review of the

literature on validated self-reported instruments used for

the assessment of different dimensions of sleep in the adult

population. In addition, the review also aimed to identify

sleep instruments available in Arabic language.

Methods

Search methods

Data Sources and Search Strategy

A comprehensive systematic search was conducted to

identify studies reporting the development and/or

valida-tion of instruments for the assessment of self-reported

sleep and sleep hygiene in the adult population. The

fi

ve

databases and search engines utilized included PubMed

(1966 - April 2018), EMBASE (1980 - April 2018),

ProQuest Central (1947

–

2018), SCOPUS (1966 - April

2018), and Google Scholar (till April 2018). Grey

litera-ture was also searched by reviewing conference

proceed-ings and abstracts of the Canadian Sleep Society and the

American Academy of Sleep Medicine published in the

period

from

January

2014

to

December

2017.

Additionally, a hand search of the bibliographies of the

articles identi

fi

ed through the electronic databases search

was undertaken. Search terms used in the electronic

data-bases search were classi

fi

ed into three categories related

to: sleep dysfunction (Category A), the instrument for

assessment (Category B), and validation and psychometric

properties (Category C). Terms from Category C were not

used in databases such as PubMed which offered

“

valida-tion studies

”

as one of the limits or

fi

lters. Publication

language was limited to English and no limits were

imposed on the publication year. Examples of full search

strategies for two of the electronic databases can be found

under the

supplementary material

. In addition to the

English search, two separate searches were conducted to

identify sleep instruments developed in Arabic language or

translated into Arabic. The

fi

rst used the same search terms

as those used in the original search, in addition to the word

“

Arabic

”

. The second was conducted in Arabic language

in the following databases: PubMed, Google Scholar and

Dar Al-mandumah using the same search terms as those

used in the original search.

Inclusion Criteria

Articles selected for full review were those providing

results of validation studies or reporting psychometric

properties of instruments and questionnaires assessing

characteristics of sleep (quality, quantity, nocturnal

awa-kenings), daytime consequences of poor sleep, or sleep

hygiene in the adult population. The inclusion criteria

were limited to instruments completed by self-report and

to instruments written in English or Arabic.

Exclusion Criteria

Studies were excluded from the review if they included

evaluating instruments designed to measure sleep

disor-ders other than insomnia (eg obstructive sleep apnea,

rest-less leg syndrome, etc.), those using sleep items as

subdomains of an instrument assessing a condition other

than insomnia, studies which focused on pediatric/geriatric

populations, studies describing instruments designed to be

completed by clinician or caregiver and not by the patient,

using instruments developed in languages other than

English or Arabic, or describing instruments not

psycho-metrically validated.

Data Collection and Analysis

Data Collection Process and Data Extraction

Duplicate citations were removed after obtaining the initial

records of relevant articles from different databases. Titles

and abstracts of the articles were then screened for

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relevance. Full-text of eligible articles were obtained and

screened against the inclusion and exclusion criteria. Data

were extracted from the eligible studies according to eight

key attributes, as established by the Scienti

fi

c Advisory

Committee, Medical Outcomes Trust (SAC-MOT).

22

The

extraction tool used in this study included the following

elements: instrument

’

s name, authors, conceptual

frame-work (domains and purpose), psychometric properties,

validation population, general description of the

instru-ment (number of items, scale, scoring, response format,

burden), and cultural and linguistic adaptation. The

psy-chometric properties were extracted from studies

describ-ing the validation of the original (English or Arabic)

version of the instruments. The psychometric properties

extracted from the validation studies included validity,

reliability, responsiveness, and interpretability. In addition,

instruments

’

attributes related to the validation sample

were extracted. Data extraction was done by one reviewer

(RA) and reviewed by a second author (MZ). The

psycho-metric properties for instruments validated in speci

fi

c

populations were not extracted.

Quality Assessment

A modi

fi

ed version of the criteria developed by Terwee

et al

23

was used to assess the quality of the sleep

instru-ments. The Terwee at al. criteria evaluates 8 psychometric

properties including validity (content, construct and

criter-ion), reliability (internal consistency and reproducibility),

responsiveness, interpretability and

fl

oor and ceiling

effects.

23

For the purposes of this study, the criteria for

the

fl

oor and ceiling effects and the agreement component

of the reproducibility were not used, primarily because, for

the most part, these measures were not reported in the

validation studies included in this review. In addition,

Pearson

’

s Correlation Coef

fi

cient was used for rating the

reliability, responsiveness, criterion and construct validity.

Results

As illustrated in

Figure 1

, a total of 4453 citations were

retrieved from the search. One hundred and seven articles

were deemed suitable for inclusion in the review. These

articles included 31 distinct sleep instruments. Of the 107

articles included, 47 discussed the validation process of

the instruments in English, while the remaining 60 articles

reviewed the translation and cultural adaptation of these

instruments into a variety of languages and populations.

The two additional searches to identify sleep instruments

in the Arabic language did not identify any additional

results than those derived from the original search.

Table 1

summarizes the results of the validation studies

(n=47) related to the 31 sleep instruments included in this

review. The table also describes the psychometric

proper-ties of the instruments and the characteristics of the

popu-lations in which they were validated.

Table 2

provides a

detailed description of the characteristics of the 31

instruments.

As summarized in

Tables 1

and

2

, the majority of the

instruments identi

fi

ed contain less than 20 items. The

longest of these instruments is the Sleep Practices and

Attitudes Questionnaire (SPAQ), which contains 151

questions divided into 16 different domains.

75

While the

Karolinska Sleepiness Scale (KSS),

24

the Minimal

Insomnia Symptoms Scale (MISS),

25,26

and the Jenkins

Sleep Scale (JSS)

27–73

are the shortest instruments

iden-ti

fi

ed, consisting of one, three, and four questions,

respectively. Some of the instruments have multiple

ver-sions, each consisting of a different number of questions

[eg, the Functional Outcomes of Sleep Questionnaire

(FOSQ)-30 and the FOSQ-10 have 30 and 10 questions,

respectively].

74,28

The majority of the instruments use

Likert-type scales as response options to generate scores.

The time needed to complete an instrument was not

reported in the majority of the studies reviewed.

However, the response burden, wherever reported, did

not exceed 10 minutes. The recall period for the majority

of the instruments was one month, except for the

Insomnia Severity Index (ISI)

29,30

and the the Sleep

Functional Impact Scale (SFIS)

31

which had a recall

period of 2 weeks and 1 week, respectively. Only four

of the identi

fi

ed instruments were available in Arabic,

three of which (PSQI,

32

ISI,

33

and ESS

34

) were originally

developed in English, but translated and validated in

Arabic-speaking populations. The Arabic Scale of

Insomnia (ASI)

35

is the only instrument which was

ori-ginally developed in Arabic.

The instruments were classi

fi

ed into four categories

based on the outcomes that were assessed in the 107

studies, as follows: (1) instruments screening for insomnia

symptoms (n=14); (2) instruments assessing consequences

of poor sleep (n=8); (3) instruments assessing the

cogni-tive aspect of insomnia (n=5) and; (4) instruments

evalu-ating sleep hygiene (n=4). A detailed description of the

reported psychometric properties for the four categories of

sleep instruments retrieved from the studies included in

this review is provided in

Table 3

.

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Instruments Screening for Insomnia

Symptoms

From the 14 instruments screening for insomnia

symp-toms, two [the Women

’

s Health Initiative Insomnia

Rating Scale (WHIIRS)

36,37

and the Restorative Sleep

Questionnaire (RSQ)

38

] were dimension-speci

fi

c and

focus on evaluating the sleep quality through assessing

problems with initiation and maintenance of sleep. The

remaining 12 instruments were multidimensional,

asses-sing sleep quality and consequences of poor sleep. Some

of the identi

fi

ed instruments also measure other speci

fi

c

dimensions such as satisfaction with sleep in the Bergen

Insomnia Scale (BIS)

39

and sleep environment in the

Insomnia Screening Scale (ISS).

40

While the Daily

Cognitive-Communication

and

Sleep

Pro

fi

le

(DCCASP)

41

measures the daily

fl

uctuation in sleep

qual-ity and evaluates the impact of these

fl

uctuations on the

individual

’

s cognitive functioning and communication,

while the General Sleep Disturbance Scale (GSDS)

42,43

assesses sleeping patterns and the use of sleep aids during

the past month.

Instruments Assessing Consequences of

Poor Sleep

These instruments measure an individual

’

s functioning

and daytime performance. Two of these instruments

[the Epworth Sleepiness Scale (ESS

44–46

and the

KSS)

24,47

focus on assessing sleepiness only, whereas

Records identified through

database searching

(n = 6,020)

Records identified through Grey

literature search

(n = 0)

Records after duplicates removed

(n = 4,453)

Records screened

(n = 4,453)

Records excluded

(n = 4,349)

Articles assessed for

eligibility

(n = 104)

Articles excluded

(n =30)

Reasons for exclusion:

Full text not

available

Article is not in

English

The tool is assessing

a different construct

The tool focuses on

other disorders

Not a validation

study

The article describes

the validation of

item banks

The tool is for a

specialized

population

English version not

validated

Additional full

text articles

identified

through hand

search

(n = 33)

Studies included in

qualitative synthesis

(n = 107)

Figure 1Flow chart of the systematic review process.

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T

able

1

Studies

T

esting

the

Psychometric

Pr

oper

ties

of

Extracted

Sleep

Instruments

Author

,

y

ear

Instruments

Sample

V

alidity

Reliability

Responsiveness

and

Interpr

etability

Pallesen

et

al,

2008

39

The

Bergen

insomnia

scale

(BIS)

Univer

sity

students:

(n=320)

Community sample: (n=5,000) Patient

sample:

(n=225)

Con

verg

ent

and

discriminant

:

BIS

signi

fi

cantly

associated

with

Athens

Insomnia

scale

(r=0.79)

and

the

PSQI

(r=0.73).

BIS

had

lower

corr

elation

with

Beck

depr

ession

and

anxiety

in

ventories

(r=0.55

and

0.32

respectiv

ely).

-Internal

consistenc

y

:

Students:

α

=

0.79

Community:

α

=

0.87

Patient

sample:

α

=

0.80

-Test

retest

(after

2

week

s)

Students

(n=200):

r

=

0.77

NR

Y

eh

et

al,

2012

40

The

Insomnia

Scr

eening

Scale

(ISS)

Study

1:

(n=162)

-Primar

y

insomniacs -Health

y

participants Study

2:

(n=262)

Community sample (paediatrics, adults

and

elderly)

Concurrent/criter

ion

validity

:

-ISS

signi

fi

cantly

corr

elated

with

Insomnia

se

verity

index

(ISI)

and

PSQI

(PSQI):

(r

=0.87

and

r

=0.85

respectiv

ely).

-Da

ytime

functioning

domain

signi

fi

cantly

corr

elated

with

ISI

and

PSQI

(r

=0.63

and

0.68

respectiv

ely).

-Sleep

en

vir

onment

domain

negativ

ely

corr

elated

with

PSQI

and

ISI:

(r

=

-0.31

and

-0.25

respectiv

ely).

-Sleep

opportunity

negativ

ely

corr

elated

with

ISI

and

PSQI:

(r

=

–

0.37

and

r

=

–

0.41,

respectiv

ely).

-External

validity

:

Community

sample:

13.36%

(inadequate

sleep

opportunity

and

sleep

envir

onment),

and

37.02%

met

the

criteria

of

insomnia

and

da

ytime

function.

Internal

consistenc

y

:

-Insomnia

symptoms:

α

=0.98

-Da

ytime

function:

α

=0.94

-Sleep

en

vir

onment:

α

=

0.90

-Sleep

opportunity:

α

=0.87

Interpr

etability:

ISS

demonstrated

sensitivity

and

speci

fi

city

of

0.89

and

0.59

respectiv

ely

Cut-off

scores:

-Sum

of

sleep

en

vir

onment

and

opportunity

subscales

scores=

27

-Sum

of

insomnia

symptoms

and

da

ytime

functioning

subscales

scores=42

Kato

T

.,

2013

70

Sleep

Quality

Questionnair

e

(SQQ)

Full-time emplo

yees

and

college

students

Content

validity

:

con

fi

rmed

by

tw

o

Japanese

experts

in

str

ess

re

sear

ch.

Con

verg

ent

validity

:

(n=370)

SQQ

subscales

(Sleep

dif

fi

culty

and

da

ytime

sleepiness)

with

MOS

sleep

scale

(

r

s

=

0.37

and

0.43,

p<

0.001). The

Da

ytime

Sleepiness

subscale

score

with

Epw

orth

Sleepiness

Scale

(ESS)

score

(r

=

0.47,

p

<

0.001). Incremental

validity

:

(n=

346

)

SQQ

subscales

with

the

GHQ-12,

CES-D

Scale,

FSS,

and

SWLS

scor

es

signi

fi

cant

Δ

R

scor

es

(0.403,

0.313,

0.408

and

0.054

respectiv

ely)

with

p<

0.001.

Internal

consistenc

y

:

Da

ytime

sleepiness

subscale:

-Student

sample:

α

=

0.83

-Emplo

yees

sample:

α

=0.84

Sleep

Dif

fi

culty

subscale:

-Students

sample:

α

=0.74

-Emplo

yees

sample:

α

=0.77

Test-retest

(ov

er

8

w

eeks)

Da

ytime

Sleepiness

subscale:

(r

=0.76)

Sleep

Dif

fi

culty

subscale:(r

=0.79)

NR

(

Continued

)

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T

able

1

(Continued).

Author

,

y

ear

Instruments

Sample

V

alidity

Reliability

Responsiveness

and

Interpr

etability

Le

vine

et

al,

2003

(study

a)

36

Le

vine

et

al,

2003

(study

b)

37

W

omen

’

s

Health

Initiative Insomnia

Rating

Scale

(WHIIRS)

P

ostmenopausal _women

Content

analysis

:

The

WHIIRS

items

corr

esponded

to

most

of

insomnia

characteristics

noted

in

the

nosologies

(eg

International

Classi

fi

cation

of

Sleep

Disord

ers)

and

the

literature.

Construct

validity

:

-Small

corr

elation

betwe

en

the

CES-D

and

the

WHIIRS:

r

=0.29

-The

WHIIRS

mean

in

the

largest

CES-D

categor

y

(

M

=10.3

for

Categor

y

12)

was

1.8

times

that

in

the

smallest

depr

ession

categor

y

(ie,

M

=5.7

for

Categor

y

0)

-The

SF-36

subscales

w

er

e

linearly

corr

elated

with

the

WHIIRS:

Cohen

’

s

f

value

was

0.273,

(p

<

0.0001). -Fo

r

night

swe

ats

and

hot

fl

ushes

with

WHIIRS,

the

values

of

Cohen

’

s

f

w

er

e,

re

spectiv

ely

,

0.205

and

0.157.

Internal

consistenc

y

:

α

=

0.786.

●

89.3%

of

the

samples

had

reliability

coef

fi

cients

≥

0.75

Test-retest

:

Same

da

y

administration

(r

=0.96)

Tests

after

>1

year

(r

=0.66)

NR

Drak

e

et

al,

2014

38

Restorativ

e

sleep questionnair

e

(RSQ)

Community based

sample

Patients

with

primar

y

insomnia

Non-r

efres

hed

sleepers

(NRS)

Content

validity

:

-K

ey

concepts

dev

eloped

thr

ough

patient

focus

gr

oups

and

patient

inter

vie

ws.

Concepts

rev

ie

w

ed

by

two

expert

panels.

Con

verg

ent/divergent

:

-RSQ-Daily

(RSQ-D)

with

Leeds

Sleep

Evaluation

Questionnair

e

scor

es:

positive

and

signi

fi

cant

corr

elation

with

all

domains

(r

≥

0.40,

p

≤

0.006)

except

for

Getting

to

Sleep

scores

(r

=

0.27;

p=

0.079). -RSQ-D

with

Subjective

Sleep

questionnaire:

Sleep

quality

(r

=

0.59;

p

<

0.001);

TST

(r

=

0.32;

p=

0.036)

-RSQ-D

with

vitality

questionnair

e:

(r

=

0.61;

p

<

0.001)

-RSQ

with

PSG:

Latency

to

persistent

sleep

(r

≥

0.20),

TST

and

sleep

ef

fi

ciency

(r

≥

0.26),

W

ASO

(r

≤

0.020)

and

total

wak

e

time

(r

≤

0.26)

signi

fi

cant

p-value.

Internal

consistenc

y

:

RSQ-D:

α

=

0.91

RSQ-W:

α

=

0.90

Test-retest

(r

esponses

on

consecutiv

e

da

ys

measur

es)

RSQ-D

and

RSQ-W:

r

>0.80

NR

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Buysse et al, 1989 67 Grandner et al, 2006 68 Backhaus et al, 2002 69 Pittsburgh sleep quality index (PSQI) -Gr oup I: health y contr ol subjects

(n=52) -Gr

oup 2: patients with major depr essiv e disor der (n=34). -Gr oup 3: Clinical sample ph ysician-referr ed outpatients at the Sleep

Evaluation Center (n

=

45)

-Non-clinical sample (younger

and

older

adults)

-Primar

y

insomniacs -Health

y contr ols Discriminating between patients and contr ols : -Global PSQI scores differ ed signi fi cantly betw een subject gr oups and contr ol gr oup subjects differ ed fr om all patient gr oups. -Patients with DIMS had signi fi cantly higher scores than patients with DOES patients. A signi fi cant differ ence in PSQI components ’ scor es we re found between the contr ol gr oup and both DIMS and depr essed gr oups. PSQI scores also differ ed on 3 components (sleep disturbances, da ytime dysfunction, and sleep quality) with DOES patients. -A signi fi cant differ ence in all PSQI component scores except sleep disturbance w er e identi fi ed between DOES and DIMS patients. While DOES and depr essed patients differ ed on all components ’ scores except sleep disturbance and da ytime dysfunction. Diagnostic validity : (Buysse et al, 1989) A cutoff score of 5 corr ectly determined the sleep quality for 88.5 of all part icipants (kappa = 0.75, p < 0.001) re por ting a sensitivity of 89.6% and a speci fi city of 86.5%. (Backhaus et al, 2002) -PSQI global score > 5 resulted in a sensitivity of 98.7% and speci fi city of 84.4% Criter ion/concurrent validity : (Buysse et al, 1989) PSQI scores and PSG: -Signi fi cant positiv e corr elation betw een PSG and PSQI only for sleep latency (r =0.33, p <0.001) PSQI global scor e and PSG: -Objectiv e sleep latency (r = 0.20, p< 0.01), w eak corr elation -The global PSQI score corr elated only with REM% in contr ols (r = 0.34, p <0.006) and number of ar ousals in depr essiv es (r = 0.47, p< 0.002). (Backhaus et al, 2002) -PSQI was highly corr elated with sleep log data (r =0.81, p< 0.001 for sleep duration and r =0.71, p= 0.000 for sleep onset latency . -The corr elations betw een PSQI and PSG data was signi fi cant and low er ranging between r = ( − 0.32 to − 0.33). Construct validity : -PSQI scores did not corr elate signi fi cantly with actigraphic measur es of sleep (r ≤ 0.13). PSQI with sleep diar y: (signi fi cant correlation) -Sleep ef fi ciency (r = − 0.562, p< 0.01), TST (r = − 0.307, p< 0.01), W ASO: (r = 0.262, p< 0.01). -Sleep latency: r = 0.480, p <0.01 -CESD: r = 0.305, p <0.01 Internal consistenc y : Ov erall: α = 0.83 (Buysse et al, 1989) Ov erall: α = 0.85 (Backhaus et al, 2002) Test-retest : (Buysse et al, 1989) -T est retest (28 da ys apart): The corr elation betwee n the PSQI scores was r = 0.85 (p <0.001). -Component scores: r = 0.84 – 0.65 (p< 0.001 for each component scor e). Test retest : (Backhaus et al, 2002) Ov erall: (r =0.87, p <0.001) -Short inter val (2 da ys): r =0.90, p=0.00 -Longer inter val (45.6 ± 18 da ys): r =0.86, p <0.001 Interpr etability: Can distinguish between “ good ” and “ poor ” sleepers. The cut-off point is 5.

(

Continued

)

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T

able

1

(Continued).

Author , y ear Instruments Sample V alidity Reliability Responsiveness and Interpr etability Bastien et al, 2001 29 Morin et al, 2011 30

Insomnia severity

index (ISI) Study 1: Patients with

insomnia complaint (n=145). Study

2: (n=78) Insomnia patient in volved in a study assessing the ef fi cacy of cognitiv e beha vioral therap y. Morin et al, 2011

●

Community sample (n=

959)

●

Clinical sample (n=183) Criter ion/concurrent validity : ISI items with sleep diar y variables: -Sleep onset latency (r = 0.38), W ASO (r = 0.35) and Early morning awak ening (r =0.35) -T otal ISI score and the sleep ef fi ciency variable (r = -0.19)

●

ISI and sleep diar y components r = 0.32 – 0.55 at baseline and r = 0.50 to 0.91 post-therap y (all p values < 0.05).

●

ISI variables with PSG variable: Corr elation ranged betwe en r = 0.07 to 0.45 at pr etre atment, and fr om 0.23 to 0.45 at post-trea tment. Only the corr elation for SOL was signi fi cant at pr etr eatment, wher eas all corr elations, but one (EMA) w er e signi fi cant at post-tr eatment (p< 0.05). -T h e co rr e lat io ns b e tw e en the p at ien t’ s an d the clinicia n ’ s ve rs io n s o f th e IS I at th e tw o as ses sm en t p er iod s w er e al ls ign i fi can t (p val u es < 0 .0 1 ). Fu rt h er mo re, th e co rr el at io n s b et w ee n th e pa ti en t ’ sa n d the sig n i fi ca n t oth e r ve rs ions of the IS I w e re al so sig n i fi can t at th e tw o as ses sm en t pe ri o d s (p val u es <0 .0 1) . Pr ed ic ti ve va lid ity : Th e clin icia n ’ s rat in gs p red ic ted b e st the pa ti en t’ s IS I tota l scor e at ba se line , w hile at post-tr e atme n t, bo th the clinicia n an d the sle e p dia ry d ata w e re re lia b le p re d icto rs of th e pa ti e n t ’ s to tal ISI sc o re. R2 = 0 .3 7 (p< 0.05) at p re tre at me nt , clinicia n : (β = 0 .52) R2 = 0 .6 1 (p< 0.05) at p ost -t re at m en t , clinic ia n : ( β = -0 .52 ) Sl e ep di ary: ( β = -0.34) Con te n t va lid ity: A p ri n ci p al co m p on en t an al ys is ,u si n g va ri m ax ro tat io n ,e x pl o red th e IS Ic o nt e nt val id it y an d th e ex ten t to wh ic h it s co m po n en ts co rr es p o nd ed to in so mn ia ’ s d ia gnostic cr ite ri a. D ia gn os tic va lidi ty : M or in et al , 20 1 1 -Sub thr es ho ld in so mn ia : A cutoff scor e of 8 : S e n sitivity of 9 5 .8% an d 9 9.4% in th e Co m munity an d Clinica lsa m p le s re spe ctiv e ly ,a n d w ith spe ci fi city of 78.3% an d 91.8% . -M ode rat e to se ver e in so mn ia : -A cu to ff sc o re o f 15 : Sp ec i fi city of 9 8 .3% an d 1 0 0% in th e Com munity an d Clinica lsa mple s, re sp e ctiv e ly ,w ith a se n sitivity of 4 7. 7 % an d 78 .1 % res p ec ti vel y. -Com munity sa m p le : cut-p oint of 1 0 (86.1% se n sitivity and 87.7% spe ci fi city). -Cl inical sample :cut-point of 1 1 w as as sociate d w ith 97. 2 % sensit ivity and a p erfect 100% sp eci fi city . Con str uct va lid ity (c onver ge nt ) : -Insomnia se verity o n the IS I w as posit iv e ly corr elated w it h the corr e sponding diar y var ia ble . -The ISI tota ls cor e wa s sig ni fi cantl y corr el ated w ith the P SQ I tota ls cor e ,r = 0 .80, p< 0. 0 5 . -S ig n i fi cant re lat ionships w er e found wit h meas ur es of anxiety and de pr essi on ,d iff er e nt dime nsions of fa tigue .Si gni fi cant corr ela tions w e re als o d iscov er ed with the SF -12, with a str onge r associ ation ide nti fi ed with the M ental components of the measur e than w ith the Ph ys ical Healt h component. Study 1: Internal consistency: α = 0.74. Study 2: Internal consistency: The internal reliability coef fi cients did not change signi fi cantly fr om baseline to follow up (0.76 to 0.78, respectiv ely). Morin et al, 2011 Community (Cr onbach α = 0.90) Clinical samples (Cr onbach α = 0.91). Responsiveness: A signi fi cant reduction in ISI score was detected post-tr eatment in patients ’ (8.9 vs 15.4) and clinician ’ s ve rsions (7.7 vs 17.7). ISI sensitivity to detect clinical impro vement (n=146) -Moderate impr ovemen t in insomnia was identi fi ed as a reduction in ISI score by > 7 points (60% sensitivity , 70% speci fi city). -Mark ed/higher impr ov ement in sleep was identi fi ed as a decrease in ISI score by > 8 points (64% sensitivity , 80% speci fi city). Interpr etability: The scores of the ISI represent the

following: 0–

7: lack of insomnia, 8 – 14: Subthr eshold insomnia 15 – 21: Moderate insomnia 22 – 28: Se ver e insomnia. Morin et al (2011) suggested clinically signi fi cant insomnia could be identi fi ed by ISI scores >10 in community samples and scores >11 in clinical settings.

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Jenkin

s

et

al,

1988

27

Nassermoaddeli et

al,

2005

73

Jerl

ock

et

al,

2006

72

The

Jenkin

s

Sleep

Scale

(JSS)

-Air

traf

fi

c

contr

ollers

(n=250

men;

25

–

49

years

old)

-Patients recoveri

ng

after

fr

om

cardi

ac

surger

y

(n=500

patients).

Construct

validity

:

Spielberger

’

s

state

anxiety:

r

=0.37

POMS-Depre

ssion:

r

=0.35

POMS-Hostility:

r

=0.29

POMS-Vigor

:

r

=

-0.24

POMS-Fatigue:

r

=

0.46

P

ositiv

e

w

ell-being:

r

=

-0.22

Internal

consistenc

y

:

α

=

0.79

Test-retest

reliability

:

r

=0.59

Nassermoaddeli

et

al,

2005

Internal

consistency:

α

=

0.77

Jerlock

et

al,

2006

Internal

consistency:

α

=

0.80

NR

Soldatos

et

al,

2000

65

Soldatos

et

al,

2001

65

Athens

Insomnia

Scale

(AIS)

299

subjects

Consisting

of:

1-Primar

y

insomniacs

2-Psychiatric

patients

(both

inpatients

and

outpatients) 3-Health

y

subjects

External

validity

:

Sleep

pr

oblems

scale

with:

AIS-8:

r

=

0.90,

p

<0.001

AIS-5:

r

=

0.85,

p

<0.001

Soldatos

et

al,

2001

Diagnostic

validity

:

-AIS

in

general

population,

for

a

Cut-off

score

of

6

only

1%

of

those

respo

nders

with

insomnia

ar

e

misdiagnosed

(ie

NPV=

99%)

and

(PPV=41%).

-Psychiatric

population:

8%

(NPV=92%)

and

(PPV=86%).

-A

total

score

of

6

or

higher

in

the

AIS

was

shown

to

corr

ectly

identify

90%

of

the

study

subjects

as

suffering

or

not

fr

om

“

nonorganic

insomnia

”

according

to

ICD-10.

-the

AIS

in

overall

case

identi

fi

cation

corr

esponded

to

high

indices

of

both

sensitivity

(93%)

and

speci

fi

city

(85%).

Internal

consistenc

y

:

AIS-8:

α

=

0.89,

AIS-5:

α

=0.87

Test

retest

(n=194;

within

one

w

eek):

AIS-8:

r

=

0.89,

p<0.001

AIS-5:

r

=

0.88,

p<0.001

Interpr

etability:

Cut-off

score

of

6

General

population

(NPV=

99%,

PPV=41%) Psychiatric

population

(NPV=92%,

PPV=86%)

with

sensitivity

(93%)

and

speci

fi

city

(85%).

-A

total

score

of

6

or

higher

in

the

AIS

was

shown

to

corr

ectly

identify

90%

of

the

subjects

’

sleep

quality

.

Br

oman

et

al,

2008

25

W

estergren

et

al,

2015

26

Minimal Insomnia Symptom

Scale

(MISS)

Subjects

selected

randomly (n=1379) Age

range:

20

–

64

(Sw

eden).

Criter

ion

validity

:

The

corr

elation

between

BNSQ

question

about

sleep

quality

and

MISS

total

scor

e

was

high

with

r

=0.76. W

estergren

et

al,

2015

The

differ

ence

between

the

adult

and

elderly

samples

was

lower

for

the

originally

recom

mended

≥

6

points

cut-off

(0.09

logits).

Internal

consistenc

y

:

Total:

α

=0.73

Test

retest

reliability

:

(6

months

apart)

High

corr

elation

was

found

with

an

ICC

of

0.79.

Responsiveness: Sensitivity

to

change

Paired

t

tests

re

vealed

that

there

was

a

str

ong

tr

end

for

incr

ease

in

score

in

subjects

who

deteriorated

(m=+0.80;

t=2.0;

p=0.053). There

was

also

a

signi

fi

cant

decrease

in

MISS

scores

among

subjects

who

impr

ov

ed

(m

=

−

1.06;

t

=2.9;

p<

0.01).

Interpr

etability:

A

cut-off

score

of

≥

6

on

the

MISS

identify

insomniacs

in

the

general

adult

population

(sensitivity

0.82;

speci

fi

city

0.86),

PPV

0.44;

NPV

0.97.

(

Continued

)

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T

able

1

(Continued).

Author , y ear Instruments Sample V alidity Reliability Responsiveness and Interpr etability Espie et al, 2014 64 Sleep Condition Indicator (SCI) Samples fr om 5 validation studies: -The Gr eat British Sleep Sur ve y (GBSS): adults > 18 -The GBSS+ -TV sample -Glasgow Science Centr e data

(n=256) -A

randomized contr olled trial (RCT) sample (n=164) recruited into a placebo- contr olled ev aluation of CBT Content validation :

●

The DSM-5 was used to de velop the questionnair e, consultations w er e conducted, and a draft was published on the American psychiatric association w ebsite. Concurrent/criter ion validity :

●

SCI was negatively associated with the score of sleep quality questionnaires including PSQI (r = − 0.734) and the ISI (r = − 0.793).

●

Sleep condition was signi fi cantly associated with ph ysical and mental health (r =0.222 and r =0.335 respectiv ely).

●

Using the HADS scale, SCI was negative ly corr elated with symptoms of depr ession (r = − 0.426) and anxiety (r = − 0.400). But was higher than the associated detected in the RCT sample study (depr ession (r = − 0.267), anxiety (r = − 0.236) and str ess (r = − 0.263)). Concurrent and diagnostic validity :

●

A cut-off score ≤ 16 was diagnostic for 89% of individuals who w er e identi fi ed as insomniacs on the ISI scale (scor es of ≥ 15), with a capacity of corre ctly classifying 82% of non-insomniacs.

●

These fi ndings support the concurr ent validity for the SCI and con fi rming that a score of ≤ 16 on the SCI could identify insomniac patients. Internal consistenc y :

●

Cr onbach ’ s α = 0.857 (the GBSS

●

(range of α -if-item-deleted 0.822 – 0.860).

●

GBSS+ sample

●

( α =0 .86 5). Th e me an co rre cte d ite m-tot al cor rel ati on wa s mo der ate (r =0 .62 0) . Interpr etability: A cut-off ≤ 16, was able to identify 89% of patients who had insomnia (ISI scores of ≥ 15). How ev er , an SCI score of >16 was able to exclude 82% of individuals without insomnia Lee, 1992 41 Lee, 2007 42 General Sleep Disturbance Scale (GSDS) Fem ale nurses in differ ent shifts (permanent da y shift, permanent night shift and rotating shifts) N=760 Paren ts of hospitalized infants in the intensiv e car e unit n=44 Lee, 2007 Content validity : Evaluated by multidisciplinar y rev ie w ers. Criter ion/concurrent validity : 1 -Sleep diar y: Fo r both the Chinese and English versions, higher GSDS scores w er e corr elated with self-r eported lower sleep quality in sleep logs (r = 0.41), higher morning fatigue le vels (Chinese version: r = 0.42, p= 0.05; English version: r = 0.56, p = 0.006). 2-Wrist actigraph y: less sleep ef fi ciency (Chinese version: r = -0.26; English version: r = -0.42). Criter ion/predictive validity : The participants ’ GSDS mean scores w er e positiv ely corr elated with their morning fatigue le vels (Chinese version, r = 0.42, p = 0.05; English version, r = 0.56, p = 0.006), supporting the pr edictiv e validity of the GSDS. Lee, 1992 Internal consistenc y : -Ov erall: α = 0.88 -Subscales of quality of sleep , da ytime sleepiness, and use of sleep aids w er e 0.62, 0.79, and 0.82, re spectiv ely . Lee, 2007 Internal consistencies : Ov erall: Chinese version ( α = 0.81) English version ( α = 0.85) NR

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Fung

et

al,

2014

41

Daily

Cognitiv

e

Communication and

Sleep

Pr

o

fi

le

(DCC

ASP)

Univer

sity

students

’

univ

ersity

of

T

or

onto

(n=59).

Criter

ion

validity

:

DCC

ASP

and

PSQI:

-Adequate

criterion

validity

for

the

Sleep

Quality

domain

of

the

DCC

ASP

was

established

by

comparing

it

to

the

Sleep

Quality

domain

of

the

PSQI,

with

rs

=

0.398

(p<

0.001).

-P

ositiv

e

corr

elation

betw

een

sleep

quality

and

each

of

the

DCCA

SP

domains:

rs

(0.38

–

0.55)

(p<0.0001).

-Internal

consistenc

y

:

Cr

onbach

’

s

α

ranged

betw

een

0.864

and

0.938

acr

oss

the

se

ven

domains

of

the

DCCA

SP

.

-Test-retest

(r

epeated

after

2

w

eeks)

Concor

dance

Corr

elation

Coef

fi

cient

(CCC)

of

each

domain

of

the

DCC

ASP

was

moderate,

ranging

fr

om

r

=

0.548

to

0.742.

NR

Abdel-khalek, 2008

35

The

Arabic

Scale

of

insomnia

(ASI)

Students

and

emplo

yees

Content

validity

:

The

initial

draft

of

the

ASI

was

rev

ie

w

ed

by

PhD

holding

faculty

members

and

master

students. Construct

:

Conv

ergent

validity:

AIS

was

signi

fi

cantly

corr

elated

with

Arabic

sleep

disor

ders

scale

and

Jenkins

sleep

scale

a

corr

elation

range

of

(r=

0.56

–

0.94,

p<0.001).

Internal

consistenc

y

:

α

=

0.84

–

0.87

Test-retest

reliability

(1

w

eek

apart):

α

=

0.70

–

0.83

NR

Morr

one

et

al,

2017

52

Maugeri

Sleep

Quality

and

Distress Inv

entory

(MaSQuDI-17)

Outpatients evaluated

for

sleep

disorders

in

sleep

centers

of

Northern

Italy

Con

verg

ent

validity

and

discriminant

:(p

<0.001

for

all)

r2

=

0.5

with

the

PSQI

r2

=

0.15

with

ESS

r2

=

0.39

with

anxiety

as

measur

ed

by

A-D

schedule

r2

=

0.52

with

depr

ession

as

measur

ed

by

A-D

schedule

-Discriminating

capacity

:

The

differ

ence

in

mean

scor

e

between

the

health

y

gr

oup

and

patients

(9.31

and

14.15

respect

iv

ely)

was

statistically

signi

fi

cant

(p<

0.001).

-Differen

ces

w

er

e

consistent

with

the

type

of

pathological

condition

pre

sent

(normal

subject

vs

OSAS

or

INS

or

BSD

gr

oup

of

subjects

p

<

0.001).

Internal

consistenc

y

:

α

=

0.896

NR

(

Continued

)

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T

able

1

(Continued).

Author , y ear Instruments Sample V alidity Reliability Responsiveness and Interpr etability Joh ns M., 1991 44 Joh ns M., 1992 45 Joh ns M., 1994 46 Epw orth Sleepiness scale (ESS) -Contr ol (n=30) -Individuals with sleep disorders (n=150) -Thir d year medical students (n=104) -OSA patients tr eated with CP AP -Patients who had MSL T (n=44) -Spouses of participants who completed ESS (n=50) Discriminating capacity : -Signi fi cant differe nces in ESS scores between the se ven diagnostic gr oups wer e detected (F= 50.00; df= 6,173; p< 0.0001). -Scor es for OSA, nar colepsy and idiopathic h ypersomnia w er e signi fi cantly higher than for contr ols (p <0.001) or primar y snor ers (p< 0.001). -The insomniacs had signi fi cantly low er scores (p< 0.01) than all gr oups except contr ols. -Criter ion validity : ESS (total score) with MSL T : -Mean Sleep latency (SL): (rho = − 0.42, p< 0.01). [Signi fi cant negativ e corr elation] -When the corr elation betwee n mean SL with ESS individual item scores was assessed only 3 items w ere signi fi cantly corr elated (p <0.05) which w ere :

●

The lik elihood of dosing off “ when sitting, inactiv e in a public place ” (rho= − 0.44), when “ sitting quietly after lunch without alcohol ” (rho= − 0.34) and when “ in a car , stopped for a fe w minutes in the traf fi c ” (rho= − 0.41). Predictive validity : -All eight item score s as pred ictors of the mean SL in the MSL T w er e statistically signi fi cant (r = 0.639, p = 0.01). -Items 3 (r = − 0.44, p <0.01) and 8 (r = − 0.41, p= 0.01) w er e signi fi cant independent pred ictors. Internal consistenc y : α = 0.88 (patients) α = 0.73 (students) Test-retest reliability : (5 months apart) -F or 87 students: r = 0.822 (p< 0.001). -Patient-Spouse paired item corr elation: (mean rho = 0.57, p< 0.001). -The pair ed (patient-Spouse) total ESS scor es corr elation (high) (rho = 0.74, n = 50, p< 0.001). Responsiveness: After 3 months of tr eatment with CP AP . T reatment with nasal CP AP in 54 individuals with OSAS was associated with a change in ESS scores by 7.0 ± 5.2 (SD) following therap y, which was statistically signi fi cant (t = − 9 .59, df = 53, p< 0.001). Ak erstedt et al, 1990 24 Re yner , et al, 1998 47 Kar olinska sleepiness scale (KSS) 8 male subjects Criter ion validity : KSS with V AS: -The maximum score on the KSS scale corr esponds with the verbal anchor “ extrem ely sleep y, fi ghting sleep ,” while the minimum value corr esponds with the rating “ alert. ” -The association between subjectiv e sleepiness and the EEG/EOG variables was signi fi cant: (r =0.29 – 0.65, p<0.05). -Signi fi cant differ ences in various le vels of subjective sleepiness w er e identi fi ed for all variables, except theta activity-during the test conducted under ambulator y conditions. A signi fi cant differ ence between maximum and minimum sleepiness was detected (Wilcoxon , z > 2.20, p<0.05). -No changes w er e identi fi ed in the EEG/EOG befor e le vel 7 was re ached on the KSS scale. Fo r the test session with closed ey es, a signi fi cant variation was identi fi ed only with slow rolling ey e movem ent (x2 = 13.6, p<0.01). -Increasin g KSS le vels w er e highly signi fi cantly corr elated with an incr eased lik elihood of falling asleep (P earson ’ s r = 0.78; d = 1043; p= 0.001). NR NR

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W ea ver et al, 1997 74 W ea ver et al, 2009 28 Functional outcomes of sleep questionnair e (FOSQ) FOSQ-30 : Sample 1 (n = 153) Health y individuals presen ting with sleep complaint Samples 2 (n = 24) and 3 (n = 51): Patients with OSA FOSQ-10 : Sample 1: (n=155) Participants with moderate to se ver e OSA on CP AP Sample 2: (n = 51) CP AP-treated OSA patients Normal subjects FOSQ-30: Face validity : Se ven judges with expertise in the ar eas of functional status instrument de velopment and sleep pr oblems rated the clinical relev ance of each item and the instrument to DOES. Content validity : Determined by the pr oportion of items receiving a rating of at least three or four acr oss all judges. Construct validity : -Subscale-to-subscale corr elations range: r = 0.52 – 0.86 -Subscale-to-global FOSQ score inter corr elations ranged fr om r = 0.78 – 0.86. Concurrent/criter ion validity : -FOSQ-30 global score with SIP total score (n=24): (r = − 0.50, p ≤ 0.05) -FOSQ-30 global with SF-36 sub-scales (n=51): no signi fi cant corr elation -FOSQ-30 global score with SF36 role emotional functioning subscale (r =0.46, p ≤ 0.01) -FOSQ activity le vel subscale signi fi cantly corr elated with SF36 ph ysical functioning subscale. -The FOSQ social outcome subscale was signi fi cantly corr elated with the SF-36 social function subscale (r =0.36, p ≤ 0.05) and SF36 mental health subscale (r =0.38, p ≤ 0.01). -Discriminant validity : -Mean of FOSQ global score discriminated between normal sleepers and those with sleeping pr oblems: (68.05 ± 21.24 and 89.59 ± 8.64 respectiv ely with p= 0.0004) (T157 = − 5.88, p= 0.0001). FOSQ-10: Criter ion validity : Global scor es comparison: -Before treatm ent with CP AP the FOSQ-10 global score was robustly associated with the FOSQ-30 T otal score (r = 0.96, p< 0.0001). -The corr elation between the post-treatmen t total scores of FOSQ-10 and the FOSQ-30 was r =0.97 (p< 0.0001). Know n gro up validity : -Baseline total score on the FOSQ-10 for the OSA gr oup (mean = 12.48 ± 3.23) statistically differ ed ( t = 8.65, p< 0.0001) fr om the normal values (mean = 17.81 ± 3.10). FOSQ-30: Internal consistenc y( n=153): -T otal: α = 0.95 -Subscales (α = 0.86 to α = 0.91) -Item to total corr elation range: 0.35 – 0.73 Test retest reliability (n=32): (Within 1 w eek) -Global score: r = 0.90 -Individual subscales ranged fr om r = 0.81 to r = 0.90 FOSQ-10: Internal consistenc y : α = 0.87 Responsiveness: Fo llowing CP AP treatm ent, both the FOSQ-30 and the FOSQ-10 detected a large clinically meaningful change in the total score (p< 0.0001). Da vid, 2008 50 Occupational impact of sleep questionnair e (OISQ) Community sample of 86 participants (age: 25 – 50 years)

●

43 meeting DSM IV cri-teria for pri-mar y insomnia (26 w omen & 17 men)

●

43 contr ols Criter ion : -At each time point OISQ scores positiv ely corr elate with PSQI (mean r = 0.59, p<0.001). -Sleep diar y variable: W ork assessment scores negatively corr elated with mean TST (r = − 0.47, p<0.001) and mean SE (r = − 0.56, p<0.001), and signi fi cantly and positiv ely with mean W ASO (r =0.66, p<0.001). -Signi fi cant negative corr elation with SF-36 subscales ranging fr om r =-0.21 to − 0.62, p< 0.001. Internal consistenc y : α = 0.93 Test-retest : A mean differ ence of 10.82 betw een gr oups was found resulting in a signi fi cant main gr oup effect (F = 12.52, p< 0.001). A consistent decrease of 10% is seen in insomniacs compared to contr ol. NR

(

Continued

)

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T

able

1

(Continued).

Author

,

y

ear

Instruments

Sample

V

alidity

Reliability

Responsiveness

and

Interpr

etability

Bell

et

al,

2011

31

The

Sleep

Functional Impact

Scale

(SFIS)

Primar

y

insomniacs Health

y

volunteers

Content

validity

:

W

as

assessed

though

face

to

face

inter

vie

ws

with

patients.

Con

verg

ent/divergent

validity

:

(p

<0.001)

-SFIS

with

ISI

composite

score:

(r

=0.82),

SFIS

with

PSQI

composite:

(r

=0.78),

SFIS

with

FOSQ

composite:

(r

=

−

0.69),

SFIS

with

ESS

total:

(r

=0.46),

SFIS

with

MOS-sleep

pr

oblems

indices

(I

and

II):

(r

≥

0.74),

SFIS

with

MOS

bre

athing

and

Snoring

subscales:

(r

=0.26

and

0.27

respectiv

ely)

and

with

WP

AI

–

GH

Subscales

(r

≥

0.31).

Know

n

gro

up

validity

(n=430):

-Higher

SFIS

score

in

the

insomnia

gr

oup

compar

ed

to

contr

ol

(t=19.36,

p<

0.0001),

effect

size=2.05

-Lower

SFIS

scores

for

those

reporting

good

sleep

compar

ed

not

reporting

good

sleep

.

(t

=

−

12.18,

p<

0.001)

(effect

size

=

−

1.04).

-Higher

SFIS

score

for

parti

cipants

reporting

wor

se

sleep

quality

on

PSQI

(t

=17.06,

p<

0.0001)

(effect

size

=

2.33).

Internal

consistenc

y

:

All

the

sample:

α

=

0.97

Insomniacs=

α

=

0.95

NR

Espie

et

al,

2000

51

Sleep Disturbance Questionnair

e

(SDQ)

Chr

onic

insomniacs

The

factors

score

of

SDQ

corr

elated

with

the

SDQ

total

(0.31

to

0.88).

Internal

consistenc

y

:

α

=

0.67

NR

Regestein

et

al,

1993

49

Pa

vlova

et

al,

2001

47

Hyperar

ousal

Scale

(H-scale)

-Primar

y

insomnia

patients

-Hypersomnia -Dela

yed

sleep

syndr

ome

-Normal

subjects

-Patients

with

refractor

y

insomnia

Criter

ion

validity

:

-H-Scale

with

neur

oticism

scale

and

extr

ove

rsion-intr

oversi

on

scale:

no

signi

fi

cant

corr

elation

-Higher

EEG

activity

in

insomniacs

compar

ed

to

normal

subjects

(p

<0.05).

-Signi

fi

cant

corr

elation

betwee

n

h

yperar

ousal

score

with

alpha

and

non-alpha

EEG

activity:

(r

≥

0.38,

p

≤

0.03).

Discriminating

capacity:

(

Pa

vlovaa

et

al,

2001)

-The

insomnia

gr

oup

had

a

mean

Hyperar

ousal

total

scor

e

signi

fi

cantly

higher

than

the

normal

gr

oup

(F

=

20.7;

p

<0.001).

NR

NR

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Espie et al, 2000 51 Edinger et al, 2001 58 Chung et al, 2016 59 Dysfunctional Beliefs and Attitudes about Sleep Scale (DBAS) Chr onic insomniacs Normal subjects Insomniacs Individuals with insomnia deriv ed for a randomized contr olled trial of self-help CBT -I. Construct validity : -DBAS 10 with DBAS-30: good corr elation (r =0.826). -T otal score: DBAS-10 and SDQ (r = 0.28) Construct/converg ent validity : Edinger et al, 2001 -DBAS with DBAS-10: Normal sleepers: r =0.84, Insomniacs: r ≥ 0.80 Discriminative validity : Insomniac subjects had signi fi cantly higher scores on the full-length DB AS scale (F (1, 136) = 28.2, p< 0:0001) with mean of (mean DBAS 35.5, SD 10.5) as compar ed to normal sleepers (mean DBAS 26.4, SD 9.7). -DBAS-10 scores of our insomnia suffer ers (mean DBAS-10 43.3, SD 15.0) wer e signi fi cantly (F (1,136) = 15.9, p< 0:0001) higher than those shown by our normal sleepers (mean DBAS-10= 33.5, SD 14.0). Criter ion/concurrent validity : Chung et al, 2016

●

DBAS total scor e signi fi cantly corr elated with se veral subscale scores of the ISI, PSQI total scor es and HADS-anxiety and HADS-depr ession subscale scores.

●

The DBAS-10 “ immediate consequences ” subscale had signi fi cant corre lation with ISI and HADS-anxiety subscale but was not related to HADS-depr ession subscale. The DBAS-30 and DBAS-16 “ sleep expectation ” subscales w er e only signi fi cantly corr elated with ISI total score. DBAS 30: Internal consistenc y : -Ov erall: α = 0.72 -Only tw o subscales achie ved signi fi cance: 1) “ misattributions or ampli fi cations of the consequences of insomnia ” ; α = 0.77 2)Subscale 4: “ diminished per ceptions of contr ol and pred ictability of sleep; ” α =

0.41. DBAS-10: -Internal

consistenc y : α = 0.69 -Internal consistenc y for factors I and II w er e 0.73 and 0.60. Edinger et al, 2001 Internal consistenc y : DBAS 30: Normal subjects: α = 0.81 Insomniacs; α ≥ 0.71 DBAS-10: Normal subjects: α = 0.70, Insomniacs: α ≥ 0.53 Chung et al, 2016 Internal consistenc y : DBAS-30, DBAS-16, and DBAS-10 with Cr onbach α of 0.81, 0.80, and 0.73, respectiv ely . Responsiveness: -Changes in DBAS scor e following trea tment we re statistically comparable (F (2,68) = 2.33, p< 0.10) for all three tr eatment gr oups CBT , relaxation training (R T) or placebo contr ol (PC). -DBAS-10 changes did differ statistically acr oss the three trea tment gr oups (F (2, 68) = 4.69, p< 0.025). -P ost hoc comparisons, show ed that the CBT -tr eated insomniacs show ed signi fi cantly gr eater decreases on the DBAS-10. -Signi fi cantly gr eater reduction in DBAS score s was found in participants allocated to CBT -I, except the DBAS-30 “ attributions ” subscale and DBAS-16 “ medication ” -Impr ov ement in ISI scor es by ≥ 8 points was associated with signi fi cant changes in DBAS total scores and on DBAS-30 and DBAS-10 subscale scores. Kallestad et al, 2010 5 8

Insomnia daytime

wor ry scale (ID WS) Undergraduate students and senior high school students (Norwa y) Predictive validity : The ID WS pred icted insomnia se verity ov er and abov e the other variables, accounting for an additional 12% of the variance. -In ID WS factor 1 (lack of energy) and ID WS factor 2 (danger) both pred icted insomnia se verity . The internal consistenc y : Total scale α =0.93 lack of energy subscale: α = 0.94 Danger subscale: α =0.75. NR

(

Continued

)

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