Sleep quality assessment in hospitalized postoperative surgical patients: a COSMIN-based systematic review

Background: Sleep is a crucial physiological process that significantly influences recovery among hospitalized postoperative surgical patients, including those treated in intensive care units and general surgical wards. Reliable and valid instruments for assessing sleep quality are essential for guiding clinical decision-making and improving patient outcomes. However, the psychometric properties of commonly used sleep assessment tools remain inconsistent, highlighting the need for systematic evaluation. Objective: This study aimed to conduct a COSMIN-based systematic review to examine the measurement properties of sleep quality assessment instruments used in hospitalized postoperative surgical patients. Methods: A systematic literature search was conducted across PubMed, Scopus, Web of Science, CINAHL, and PsycINFO for studies published between 2010 and 2024. The methodological quality of each study was evaluated using the COSMIN Risk of Bias checklist, and a narrative synthesis was performed to summarize the psychometric evidence for each instrument. Results: Of the 210 studies initially identified, 37 met the eligibility criteria. The Pittsburgh Sleep Quality Index (PSQI) demonstrated adequate reliability and construct validity but showed limitations related to measurement error and responsiveness. The Richards-Campbell Sleep Questionnaire (RCSQ) exhibited strong reliability and construct validity, though variability was observed in interrater agreement between nurses and patients. The Epworth Sleepiness Scale (ESS) was reliable for assessing daytime sleepiness but provided limited evidence for structural validity in postoperative contexts. The Sleep Quality Questionnaire (SQQ), Verran and Snyder-Halpern Sleep Scale (VSH), and Insomnia Clinical Evaluation (ICE) showed mixed psychometric properties, indicating the need for further validation in hospitalized postoperative populations. Conclusion: The PSQI and RCSQ remain the most frequently utilized sleep assessment instruments; however, their psychometric limitations warrant cautious interpretation. This review underscores the need for further research to refine, validate, and potentially develop more robust sleep assessment tools tailored to hospitalized postoperative surgical patients.