Assessment tools for population sleep health surveillance in adults: A systematic review of validity and reliability

Abstract

Poor sleep health is a significant public health issue. Population health surveillance systems are important for gathering accurate data to inform public health responses but remain underdeveloped for sleep health assessment globally. We aimed to identify sleep assessment tools and to evaluate their validity and reliability for use in population surveillance. Three databases (PubMed, EMBASE, and PsycINFO) were searched resulting in 12,350 publications as of July 2025; 187 studies met the inclusion criteria and 60 sleep assessment tools were evaluated for nine measurement properties: content validity, criterion validity, construct validity, internal consistency, reliability, agreement, floor and ceiling effects, responsiveness, and interpretability. The Insomnia Severity Index had five measurement properties rated positively, the highest among all tools. Two tools assessed all sleep health domains: the Regularity, Satisfaction, Alertness, Timing, Efficiency, Duration (RU-SATED) scale and a 13-item composite measure of sleep health (13-SH). Most sleep assessment tools lacked adequate validation studies in the adult general population or lacked the ability to capture all dimensions of sleep health. Demonstrating criterion and construct validity of existing tools, developing new tools to measure multidimensional sleep health, or combining items from validated measures with strong measurement properties is warranted for effective sleep health surveillance.

Keywords: Adults; Epidemiology; Population health; Reliability; Sleep; Validity.