Network models of subjective sleep health: a systematic review and statistical evaluation

Given the increased use of network analysis in sleep studies, this systematic review and statistical evaluation aimed to aggregate network studies to identify the most central symptoms in composite network models of sleep-related symptoms.

A systematic search of cross-sectional network studies focused exclusively on sleep within community or clinical samples was conducted across PubMed, Web of Science (WOS), PsycINFO, and EMBASE databases up to March 5, 2025. Studies were categorized by topic and measurement instruments. Statistical evaluations extracted the most central symptoms across network models.

The review included 23 studies of 84,510 participants and 29 network models. Explored topics included insomnia/sleep disturbances, sleep quality, sleep attitudes and behaviors, daytime function, and dream content. Regarding main analyses, key central symptoms in network models of insomnia were "Difficulty staying asleep" [median rank:1.5, Interquartile range (IQR): 1-2], "Distress caused by the sleep difficulties" (median rank:2, IQR: 2-3) and "Interference with daytime functioning" (median rank:3.5, IQR: 2.25-4). For sleep quality, "Subjective sleep quality" (median rank:1, IQR: 1-1), "Daytime dysfunction" (median rank:3, IQR: 2-5.25) and "Sleep disturbance" (median rank:3.5, IQR: 2-4.5) were the most central experiences.

Identified central symptoms offer plausible targets for intervention across populations and guide future research directions.