PROMIS Sleep Disturbance
Study Notes: Disorder‑Specific Severity Measures for Adults
Focus: Level 2—Sleep Disturbance—Adult (PROMIS Sleep Disturbance—Short Form)
1. Introduction
PROMIS (Patient‑Reported Outcomes Measurement Information System) is a set of measures developed by the NIH to evaluate physical, mental, and social health.
PROMIS tools are widely used in clinical practice and research to assess patient‑reported outcomes across conditions.
The PROMIS Sleep Disturbance—Short Form (Level 2—Adult) is a validated measure specifically designed to assess sleep quality and disturbance in adults.
It provides a standardized, reliable, and efficient way to capture the severity of sleep problems, complementing diagnostic interviews and clinical judgment.
2. Understanding Sleep Disturbance
Definition
Sleep disturbance refers to difficulty initiating or maintaining sleep, poor sleep quality, or non‑restorative sleep.
It is a common complaint in both medical and psychiatric populations.
Key Symptoms
Difficulty falling asleep (sleep onset insomnia).
Waking up frequently during the night (sleep maintenance insomnia).
Early morning awakening.
Non‑restorative sleep (feeling unrefreshed).
Daytime fatigue, irritability, or cognitive impairment.
Impact
Sleep disturbance affects occupational, academic, social, and physical functioning.
Associated with depression, anxiety, cardiovascular disease, obesity, and reduced quality of life.
Chronic sleep problems increase risk for substance use, accidents, and suicide.
3. PROMIS Sleep Disturbance—Short Form
Purpose
Designed to quantify severity of sleep disturbance symptoms in adults.
Used for screening, diagnosis support, and monitoring treatment progress.
Provides a patient‑centered perspective on sleep quality.
Structure
Self‑report questionnaire aligned with DSM‑5 criteria.
Contains 8 items assessing frequency and intensity of sleep disturbance symptoms.
Response scale (5‑point Likert):
1 = Never
2 = Rarely
3 = Sometimes
4 = Often
5 = Always
Domains Assessed
Sleep quality.
Sleep initiation and maintenance.
Sleep adequacy and restfulness.
Sleep satisfaction.
Daytime consequences of poor sleep.
4. Scoring and Interpretation
Raw Scores
Each item scored 1–5; total raw score range = 8–40.
T‑Scores
Raw scores converted to T‑scores using PROMIS scoring tables.
T‑scores standardized with mean = 50, SD = 10.
Higher T‑scores = greater severity of sleep disturbance.
Clinical Interpretation
T‑Score Range Severity Level Clinical Interpretation
Within normal limits Minimal/no sleep problems
55–59 Mild Monitor; may not require treatment
60–69 Moderate Consider therapy or medication
≥ 70 Severe Active treatment recommended
5. Advantages
Brief and easy to administer (2–3 minutes).
Validated across diverse populations.
Self‑report format empowers patients.
Standardized T‑scores allow comparison across studies and populations.
Useful for monitoring treatment outcomes longitudinally.
6. Limitations
Relies on self‑report, which may be influenced by bias.
May not capture cultural variations in sleep perception.
Requires clinical judgment to interpret results.
Not a substitute for a comprehensive diagnostic interview.
7. Clinical Applications
Screening
Identifies adults at risk for sleep disorders in primary care or psychiatric settings.
Monitoring
Tracks symptom changes during psychotherapy, pharmacotherapy, or lifestyle interventions.
Research
Provides standardized data for clinical trials and epidemiological studies.
8. Integration with Value‑Based Care
Aligns with value‑based care models by providing measurable outcomes.
Supports quality improvement initiatives in sleep medicine and psychiatry.
Facilitates population health management by identifying high‑risk groups.
9. Alignment with IOM Six Aims
Safe: Identifies severe sleep disturbance early, preventing harm.
Effective: Evidence‑based tool validated in multiple studies.
Patient‑Centered: Self‑report respects patient voice.
Timely: Quick administration reduces delays in diagnosis.
Efficient: Minimizes resource use compared to lengthy interviews.
Equitable: Adaptable to diverse populations and languages.
10. Country Comparison: United States vs Kenya
United States
PROMIS measures integrated into electronic health records.
Used in primary care, psychiatry, and sleep medicine.
Supported by insurance reimbursement for screening.
Kenya
Growing recognition of sleep disturbance as a public health issue.
Challenges: limited sleep specialists, stigma, resource constraints.
PROMIS measures valuable for task‑shifting to community health workers.
Translation and cultural adaptation ongoing.
11. Case Example
Patient P: 40‑year‑old reporting difficulty falling asleep and daytime fatigue.
PROMIS Sleep Disturbance Short Form raw score = 32 → T‑score = 68 → Moderate sleep disturbance.
Intervention: CBT‑I (Cognitive Behavioral Therapy for Insomnia) + sleep hygiene education.
Follow‑up score after 8 weeks = 18 → T‑score = 55 → Mild sleep disturbance, showing improvement.
12. Future Directions
Digital administration via apps and telehealth platforms.
Integration with wearable devices for real‑time monitoring of sleep.
Use in global mental health initiatives to standardize measurement.
Expansion to cross‑cultural validation studies.
13. Conclusion
The PROMIS Sleep Disturbance—Short Form is a valuable tool for assessing and monitoring sleep problems in adults.
Its brevity, validity, and adaptability make it indispensable in clinical practice and research.
When combined with disorder‑specific severity measures, value‑based care, and IOM aims, it enhances the quality and equity of health services globally.
15‑Question Quiz: PROMIS Sleep Disturbance—Short Form
What does the PROMIS Sleep Disturbance Short Form primarily assess?
a) General anxiety symptoms
b) Sleep disturbance severity
c) Depression severity
d) Bipolar disorder symptoms
Answer: b
How many items are included in the PROMIS Sleep Disturbance Short Form?
a) 5
b) 8
c) 10
d) 20
Answer: b
What is the raw score range of the measure?
a) 0–20
b) 8–40
c) 10–50
d) 5–25
Answer: b
What statistical method is used to standardize scores?
a) Z‑scores
b) T‑scores
c) Percentiles
d) Regression coefficients
Answer: b
What is the mean and SD of PROMIS T‑scores?
a) Mean = 100, SD = 15
b) Mean = 50, SD = 10
c) Mean = 0, SD = 1
d) Mean = 75, SD = 5
Answer: b
Which T‑score range indicates severe sleep disturbance?
a) < 55
b) 55–59
c) 60–69
d) ≥ 70
Answer: d
Which domain is NOT assessed by the PROMIS Sleep Disturbance Short Form?
a) Sleep quality
b) Sleep initiation
c) Appetite changes
d) Sleep satisfaction
Answer: c
Which IOM aim does the measure support by identifying severe sleep disturbance early?
a) Efficient
b) Safe
c) Timely
d) Equitable
Answer: b
Which advantage makes the PROMIS Sleep Disturbance Short Form widely used?
a) Long administration time
b) Requires specialist only
c) Brief and validated
d) Expensive licensing
Answer: c
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