Abstract
Study objectives:We conceptualized sleep quality judgment as a decision-making process and examined the relative importance of 17 parameters of sleep quality using a choice-based conjoint analysis.Methods:One hundred participants (50 good sleepers; 50 poor sleepers) were asked to choose between 2 written scenarios to answer 1 of 2 questions: “Which describes a better (or worse) night of sleep?”. Each scenario described a self-reported experience of sleep, stringing together 17 possible determinants of sleep quality that occur at different times of the day (day before, pre-sleep, during sleep, upon waking, day after). Each participant answered 48 questions. Logistic regression models were fit to their choice data.Results:Eleven of the 17 sleep quality parameters had a significant impact on the participants’ choices. The top 3 determinants of sleep quality were: Total sleep time, feeling refreshed (upon waking), and mood (day after). Sleep quality judgments were most influenced by factors that occur during sleep, followed by feelings and activities upon waking and the day after. There was a significant interaction between wake after sleep onset and feeling refreshed (upon waking) and between feeling refreshed (upon waking) and question type (better or worse night of sleep). Type of sleeper (good vs poor sleepers) did not significantly influence the judgments.Conclusions:Sleep quality judgments appear to be determined by not only what happened during sleep, but also what happened after the sleep period. Interventions that improve mood and functioning during the day may inadvertently also improve people’s self-reported evaluation of sleep quality.
Highlights
Sleep quality is an important indicator of health and wellbeing in both healthy and clinical populations.[1,2,3,4] In the context of sleep treatment, it is an important patient-reported outcome used to reflect treatment progress or to determine treatment success.[5,6,7,8]sleep quality is an elusive construct that is difficult to measure
The present study aimed to extend our understanding of the factors influencing our sleep quality judgment, by examining the relative weights they carry in the sleep quality judging process
Effects of Individual Parameters on Sleep Quality Judgment The multiple parameters of sleep quality covered the experience of the day before sleep, during the pre-sleep period, during sleep, upon waking, and the day after
Summary
Sleep quality is an important indicator of health and wellbeing in both healthy and clinical populations.[1,2,3,4] In the context of sleep treatment, it is an important patient-reported outcome used to reflect treatment progress or to determine treatment success.[5,6,7,8]sleep quality is an elusive construct that is difficult to measure. Multi-item questionnaires such as the Pittsburgh Sleep Quality Index (PSQI),[14] and Medical Outcomes Study (MOS) sleep scale[15] are well-validated measures of sleep quality and commonly used in research and clinical settings In these instruments, sleep quality is represented by a composite score encompassing various aspects of (1) sleep experience during the night (e.g., sleep latency, sleep duration), (2) reports of sleep disturbances (e.g., waking up in the middle of the night, having to get up and use the bathroom, coughing or snoring loudly, having pain), (3) self-reported evaluation of sleep quality (e.g., good or bad, quiet or restless, feeling rested upon waking or not), (4) the bedroom environment (e.g., sleep disturbance from a bed partner or roommate, too hot or too cold), and (5) sleep-related behavior during the day (e.g., trouble staying awake, having to take sleep medication, having to take naps). These measures assume that the respondents would put equal emphasis on each predefined factor while forming their overall judgment of sleep quality, which is at odds with the suggestion that different individuals tend to have different interpretations of what sleep quality is.[16]
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