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Measurement properties of Arabic-validated sleep quality instruments: a COSMIN-based systematic review from the
Ibtissam El Harch1,2,3, Oumar Abakar Mahamed1,2,3, Hatem Elbanna4,5
1Laboratory of Epidemiology, Clinical Research and Community Health, Faculty of Medicine, Pharmacy and Dentistry, Sidi Mohamed Ben Abdellah University, Fez, Morocco.
Background:
Sleep quality is a multidimensional and inherently subjective construct that plays a fundamental role in physical and mental health. Numerous self-report instruments have been developed to assess subjective sleep quality; however, their cross-cultural validity must be established before use in different linguistic contexts.
Objective:
The objective was to systematically identify the Arabic-validated sleep quality instruments and to critically evaluate their methodological quality and psychometric properties in accordance with COSMIN standards.
Methods:
This systematic review was conducted following the PRISMA-COSMIN guidelines. PubMed/MEDLINE, Scopus, and Web of Science were searched from inception to December 2025. Studies reporting the translation, cross-cultural adaptation, or validation of sleep quality instruments in Arabic were included. Methodological quality was assessed using the COSMIN Risk of Bias checklist. Measurement properties were evaluated according to COSMIN criteria for good measurement properties.
Results:
Fifteen validation studies conducted across seven Arab countries and one general Arabic-speaking cohort were included. The Pittsburgh Sleep Quality Index was the most extensively validated instrument (n = 9 studies), demonstrating generally adequate structural validity but heterogeneous internal consistency results across populations. The Sleep Quality Scale (SQS) showed acceptable psychometric performance following structural adaptation. The Single-item SQS and the Jenkins Sleep Scale provided pragmatic, brief alternatives with acceptable construct validity, though limited structural evaluation. In intensive care settings, the Richards-Campbell Sleep Questionnaire and the Freedman Sleep Questionnaire Questionnaire demonstrated satisfactory internal consistency. Across instruments, structural validity and internal consistency were frequently evaluated, whereas measurement error, responsiveness, and cross-cultural measurement invariance were seldom examined.
Conclusion:
Multiple sleep quality instruments are available for use in Arabic-speaking populations. However, none demonstrated comprehensive evaluation across all COSMIN-recommended measurement properties. Instrument selection should be guided by both psychometric evidence and conceptual alignment with the intended context of use. Future validation studies should prioritize responsiveness, measurement error estimation, and formal cross-cultural invariance testing to strengthen the evidence base for sleep quality assessment in Arabic contexts.
Systematic Review Registration:
https://www.crd.york.ac.uk/PROSPERO/view/CRD420261328016, Identifier CRD420261328016.