Elsevier

Sleep Health

Volume 3, Issue 1, February 2017, Pages 6-19
Sleep Health

National Sleep Foundation's sleep quality recommendations: first report

https://doi.org/10.1016/j.sleh.2016.11.006Get rights and content

Abstract

Objectives

To provide evidence-based recommendations and guidance to the public regarding indicators of good sleep quality across the life-span.

Methods

The National Sleep Foundation assembled a panel of experts from the sleep community and representatives appointed by stakeholder organizations (Sleep Quality Consensus Panel). A systematic literature review identified  277 studies meeting inclusion criteria. Abstracts and full-text articles were provided to the panelists for review and discussion. A modified Delphi RAND/UCLA Appropriateness Method with 3 rounds of voting was used to determine agreement.

Results

For most of the sleep continuity variables (sleep latency, number of awakenings >5 minutes, wake after sleep onset, and sleep efficiency), the panel members agreed that these measures were appropriate indicators of good sleep quality across the life-span. However, overall, there was less or no consensus regarding sleep architecture or nap-related variables as elements of good sleep quality.

Conclusions

There is consensus among experts regarding some indicators of sleep quality among otherwise healthy individuals. Education and public health initiatives regarding good sleep quality will require sustained and collaborative efforts from multiple stakeholders. Future research should explore how sleep architecture and naps relate to sleep quality. Implications and limitations of the consensus recommendations are discussed.

Introduction

Good sleep quality is a well-recognized predictor of physical and mental health, wellness, and overall vitality. Although, the term “sleep quality” is widely used by researchers, clinicians, and the public, this expression lacks definitional consensus. To date, no consistent guidance is available from the scientific community regarding what constitutes normal or optimal, healthy sleep and good sleep quality.

The Webster dictionary's simple definition of quality is “how good or bad something is.”1 Thus, a global approach for indexing sleep quality often involves soliciting a self-rating. Such indices likely reflect an individual's satisfaction with his or her sleep. An extension of this approach involves correlating self-rated sleep quality against other measures such as environmental factors, the timing of sleep, physiologically derived indices, polysomnographic parameters, behavior, pharmacologic interventions, and/or the presence of sleep disorders. One obvious limitation of relying on self-report when assessing sleep quality is the loss of consciousness during sleep, which makes individuals poor self-observers of this particular behavior.

An alternative approach to defining sleep quality involves deconstructing it into its particular objective components. Within this paradigm, “quality” is defined as a combination of constituent elements or processes judged as valuable. It is this approach that guided the current investigation. The purpose of this study was to search for a composite of objectively identifiable sleep features underlying sleep quality. Many questions related to sleep quality and its potential outcomes on health (eg, mood and cognitive performance) exist; however, those questions are outside the scope of this article.

The need for such clarity on sleep quality is of particular and timely importance given the rapid increase in public awareness of sleep as an important component of health and overall well-being. Millions of individuals are using commercially available sleep tracking devices. These devices purport to measure sleep quality and quantity. Therefore, there exists a need to define clearly both sleep quantity and quality using the best scientific evidence available. Sleep quantity recommendations were previously addressed by a National Sleep Foundation (NSF) Sleep Duration Recommendation consensus panel.2 Continuing this process, the NSF assembled a panel of experts to answer the question, “What is good sleep quality?” The overall objectives of this Sleep Quality Consensus Panel (SQCP) were to provide scientifically sound recommendations regarding indicators of good sleep quality at different ages across the life-span.

Section snippets

Participants

To ensure a wide range of perspectives regarding indicators of sleep quality, the NSF assembled an expert panel comprising sleep experts as well as experts in other areas of science and medicine. Because one objective of the SQCP was to provide interpretable recommendations to the public, it was important to include non–sleep experts from related scientific domains. The 18-member panel included representatives selected by stakeholder organizations (n = 10) as well as sleep experts selected by the

Appropriateness of possible indicators (round 0)

Among newborns, REM activity and number of awakenings were rated appropriate indicators for grading sleep quality. N3 sleep was rated uncertain. All other possible indicators were rated inappropriate and removed from future consideration. Among infants, N1 sleep and N2 sleep were rated inappropriate and removed; nap duration and nap frequency were rated uncertain and included along with all other possible indicators, which had been rated appropriate. For each remaining age category, all

Discussion

In the judgment of the consensus panel, sleep continuity measures contribute to sleep quality indicators at most ages. Shorter sleep latencies, fewer awakenings, and reduced wake after sleep onset were viewed as indicators of good sleep quality, regardless of age. Similarly, higher sleep efficiency indicates good sleep quality across all age groups, and lower sleep efficiency indicates poor sleep. In aggregate, these findings are consistent with past epidemiologic and meta-analytic findings.4

Disclosures

EMW has moderated noncommercial scientific discussion for Merck and is an equity shareholder in WellTap.

YD has received funds for seminars, board engagements, and travel to conferences by UCB Pharma, Jazz, GSK, Flamel, Theranexus, and Bioprojet.

NH has served as a consultant for the Society of Research in Human Development.

KL has served on an advisory board for Merck.

The National Sleep Foundation, a 501(c)3 charitable and scientific organization, was the sole funder of this study.

All other

References (5)

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Endorsed by National Sleep Foundation, American Association of Anatomists, American Physiological Society, Gerontological Society of America, Human Anatomy and Physiology Society, Society for Research on Biological Rhythms, Society for Research of Human Development, and Society for Women's Health Research.

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