Patient-Reported Outcome Measures to Determine Sleep Problems in Adults With Chronic Kidney Disease: A Systematic Review

Abstract

Background: Adults with chronic kidney disease are prone to sleep problems, which can impact sleep quality and harm physical and mental wellbeing. Subjective sleep instruments help assess sleep quality and symptom severity. Evaluating the characteristics and psychometric properties of these instruments aids health practitioners in selecting suitable tools. Objective: To identify optimal patient-reported outcome measures for assessing sleep quality and/or problems in the chronic kidney disease population. Design: Systematic review. Participants: Adults with chronic kidney disease. Measurements: A comprehensive search was conducted in CINAHL, MEDLINE, Embase, the Cochrane Library, PsycINFO, and JBI for studies published between January 2010 and December 2023. Methodological quality was evaluated using COSMIN-COMIT guidelines. Results: Nineteen instruments were identified. The Pittsburgh Sleep Quality Index, assessing both sleep quality and problems, was used in 73.8% of studies and has only been validated in kidney transplant populations. The Athens Insomnia Scale and Epworth Sleepiness Scale, while useful for insomnia and daytime sleepiness, provide narrower coverage, and the STOP-BANG and Berlin Questionnaire target sleep apnoea risk but are less practical for broad sleep assessment. These limitations may explain their less frequent use compared with the Pittsburgh Sleep Quality Index. Conclusion: Future research should validate sleep instruments in non-transplant chronic kidney disease populations through comprehensive psychometric testing. Clinicians and researchers should carefully select multiple instruments to assess both overall sleep quality and sleep disorder-specific symptoms.