SYSTEMATIC REVIEW article
Front. Sleep
Sec. Sleep and Breathing
This article is part of the Research TopicNovel Technologies in the Diagnosis and Management of Sleep-disordered Breathing: Volume IVView all articles
Sleep Quality Assessment in hospitalized postoperative surgical patients: A COSMIN-Based Systematic Review
Provisionally accepted
- 1Sekolah Tinggi Ilmu Keperawatan PPNI Jawa Barat, Bandung, Indonesia
- 2Universitas Indonesia, Depok, Indonesia
- 3Universitas Islam Jakarta, East Jakarta, Indonesia
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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.
Keywords: COSMIN, postoperative surgical patients, psychometric properties, sleep quality, sleepassessment tools, Systematic review
Received: 28 Sep 2025; Accepted: 15 Dec 2025.
Copyright: © 2025 Nurhayati, Waluyo, Kariasa, Asih, Pujasari and Hayat. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Agung Waluyo
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