Ru-SATED scale and Sleep Health Index: A systematic review of two leading multidimensional sleep health measures and frameworks across the globe

1. Sleep Med Rev. 2026 Apr 18;88:102296. doi: 10.1016/j.smrv.2026.102296. Online
ahead of print.

Ru-SATED scale and Sleep Health Index: A systematic review of two leading
multidimensional sleep health measures and frameworks across the globe.

Meng R(1), BaHammam AS(2), Dzierzewski JM(3), Yang N(4), Vézina-Im LA(5), Ying
Lau EY(6), Sun IR(7), Gregory AM(8), Zeitzer JM(9), Quan SF(10), Dietch JR(11),
Szklo-Coxe M(12), Dautovich ND(13), Stranges S(14), Tahmasian M(15), Jean-Louis
G(16), Thompson MG(17), Jackson CL(18), Matricciani L(19), Tang NKY(20), Johnson
DA(21), Hale L(22), Troxel WM(23), de Batlle J(24), Manconi M(25), Tondo P(26),
Spiegelhalder K(27), Stefani A(28), Knutson KL(29), Wickwire EM(30), Feige
B(27), Bliwise DL(31), Li J(32), Furihata R(33), Poyares D(34), Khazaie H(35),
Taiar R(36), Boyer FC(37), Jahrami H(38), Coelho J(39), Fabbri M(40),
Jiménez-Correa U(41), Zaki NFW(42), Huang M(43), Ma H(44), Dong L(45), St Louis
EK(46), Stone KL(47), Spruyt K(48), Penzel T(49), Ferri R(50), Buysse DJ(51).

Author information:
(1)School of Public Health and Nursing, Hangzhou Normal University, Hangzhou,
311121, Zhejiang, China; Engineering Research Center of Mobile Health Management
System, Ministry of Education, Hangzhou, 311121, Zhejiang, China. Electronic
address: .
(2)University Sleep Disorders Center, Department of Medicine, College of
Medicine, King Saud University, Riyadh, 11324, Saudi Arabia.
(3)National Sleep Foundation, Washington, Washington DC, 20036, USA.
(4)School of Public Health and Nursing, Hangzhou Normal University, Hangzhou,
311121, Zhejiang, China.
(5)VITAM, Research Center in Sustainable Health, CIUSSS de la
Capitale-Nationale, Quebec City, Quebec, G1J 2G1, Canada.
(6)Sleep Laboratory, Department of Psychology, The Education University of Hong
Kong, Hong Kong, 999077, China; Centre for Psychosocial Health, The Education
University of Hong Kong, Hong Kong, 999077, China; AnalyticsAssessment Research
Centre, The Education University of Hong Kong, Hong Kong, 999077, China.
(7)School of Arts and Humanities, Tung Wah College, Hong Kong, 999077, China.
(8)Department of Psychology, Royal Holloway, University of London, Egham Hill,
Egham, TW20 0EX, UK.
(9)Department of Psychiatry and Behavioral Sciences, Stanford University,
Stanford, California CA, 94305, USA; Mental Illness Research Education and
Clinical Center, Veterans Affairs Palo Alto Health Care System, Palo Alto,
California CA, 94304, USA.
(10)Division of Sleep Medicine, Harvard Medical School, Boston, Massachusetts
MA, 02115, USA; Division of Sleep and Circadian Medicine, Department of
Medicine, Mass General Brigham, Boston, Massachusetts MA, 02115, USA.
(11)School of Psychological Science, Oregon State University, Corvallis, Oregon
OR, 97331, USA.
(12)Department of Health Behavior Policy, and Management, Joint School of Public
Health, Macon & Joan Brock Virginia Health Sciences, Old Dominion University,
Norfolk, Virginia VA, 23529, USA.
(13)Department of Psychology, Virginia Commonwealth University, 23284-2018,
Richmond, Virginia VA, 23220, USA.
(14)Department of Epidemiology and Biostatistics, Western University, London,
Ontario ON, N6G 2M1, Canada; Departments of Family Medicine and Medicine,
Western University, London, Ontario ON, N6G 2M1, Canada; Department of Clinical
Medicine and Surgery, University of Naples Federico II, Naples, 80131, Italy.
(15)Institute of Neuroscience and Medicine, Brain and Behavior (INM-7), Research
Center Jülich, 52428, Jülich, Germany; Institute of Systems Neuroscience,
Medical Faculty and University Hospital Düsseldorf, Heinrich Heine University,
40225, Düsseldorf, Germany; Department of Nuclear Medicine, Faculty of Medicine
and University Hospital Cologne, University of Cologne, 50937, Cologne, Germany.
(16)Department of Psychiatry and Behavioral Sciences, University of Miami Miller
School of Medicine, Miami, Florida FL, 33136, USA.
(17)Department of Community & Global Health, Lehigh College of Health, Lehigh
University, Bethlehem, Pennsylvania PA, 18015, USA.
(18)Epidemiology Branch, National Institute of Environmental Health Sciences,
National Institutes of Health, US Department of Health and Human Services,
Research Triangle Park, North Carolina NC, 27709, USA; Division of Intramural
Research, National Institute on Minority Health and Health Disparities, National
Institutes of Health, US Department of Health and Human Services, Bethesda,
Maryland MD, 20892, USA.
(19)College of Health, Adelaide University, Adelaide, South Australia SA, 5001,
Australia.
(20)Department of Psychology, University of Warwick, Coventry, CV4 7AL, UK.
(21)Department of Epidemiology, Rollins School of Public Health, Emory
University, Atlanta, Georgia GA, 30322, USA.
(22)Program in Public Health, Department of Family, Population, and Preventive
Medicine, Renaissance School of Medicine, Stony Brook University, Stony Brook,
New York NY, 11794-8338, USA.
(23)Social and Economic Well-Being Division, RAND Corporation, Pittsburgh,
Pennsylvania PA, 15213, USA.
(24)Group of Translational Research in Respiratory Medicine, Institut de Recerca
Biomèdica de Lleida – Fundació Dr. Pifarré, IRBLleida (ROR: 03mfyme49), CIBERES,
ISCIII, 25198, Lleida, Spain.
(25)Sleep Medicine Unit, Neurocenter of Southern Switzerland, EOC, Regional
Hospital of Lugano, 6900, Lugano, Switzerland; Faculty of Biomedical Sciences,
Università Della Svizzera Italiana, 6900, Lugano, Switzerland; Department of
Neurology, University of Bern, 3010, Bern, Switzerland.
(26)Department of Medical and Surgical Sciences, University of Foggia, 71122,
Foggia, Italy.
(27)Department of Psychiatry and Psychotherapy, Medical Center-University of
Freiburg, Faculty of Medicine, University of Freiburg, 79104, Freiburg, Germany.
(28)Department of Neurology, Medical University of Innsbruck, 6020, Innsbruck,
Austria.
(29)Feinberg School of Medicine, Northwestern University, Chicago, Illinois IL,
60611, USA.
(30)Division of Pulmonary, Critical Care, and Sleep Medicine, Department of
Medicine, University of Maryland School of Medicine, Baltimore, Maryland MD,
21201, USA; Department of Psychiatry, University of Maryland School of Medicine,
Baltimore, Maryland MD, 21201, USA.
(31)Department of Neurology, Emory University School of Medicine, Atlanta,
Georgia GA, 30329, USA.
(32)Johns Hopkins School of Nursing, Baltimore, Maryland MD, 21205, USA.
(33)Agency for Student Support and Disability Resources, Kyoto University,
Kyoto, 606-8501, Japan.
(34)Sleep Medicine and Biology Division, Psychobiology Department, Universidade
Federal de Sao Paulo, Sao Paulo, 04023-062, Brazil.
(35)Sleep Disorders Research Center, Health Policy and Promotion Institute,
Kermanshah University of Medical Sciences, Kermanshah, 6719851115, Iran.
(36)Université de Reims Champagne-Ardenne, MATériaux et Ingénierie Mécanique
(MATIM), 51100, Reims, France.
(37)Faculté de Médecine, Université de Reims Champagne Ardennes, UR 3797 VieFra,
51097, Reims, France; Service de Médecine Physique et de Réadaptation, Hôpital
Sébastopol, CHU de Reims, 51092, Reims, France.
(38)Government Hospitals, P.O. Box 5128, Manama, Bahrain; Department of
Psychiatry, College of Medicine and Medical Sciences, Arabian Gulf University,
P.O. Box 26671, Manama, Bahrain.
(39)Univ. Bordeaux, SANPSY, CNRS, UMR 6033, CHU de Bordeaux, Place Amélie Raba
Léon, F-33000, Bordeaux, France.
(40)Department of Psychology Renzo Canestrari, University of Bologna, 5-40127,
Bologna, Italy.
(41)Sleep Disorders Clinic, Research Division, Medicine Faculty, National
Autonomous University of Mexico (UNAM), Mexico City, 04510, Mexico.
(42)Department of Psychiatry, Faculty of Medicine, Mansoura University,
Mansoura, 35516, Egypt.
(43)The Medical Record Statistics Department, Zhejiang Hospital, Hangzhou,
310013, Zhejiang, China.
(44)School of Public Health and Nursing, Hangzhou Normal University, Hangzhou,
311121, Zhejiang, China; Engineering Research Center of Mobile Health Management
System, Ministry of Education, Hangzhou, 311121, Zhejiang, China.
(45)Department of Psychology, Stony Brook University, Stony Brook, New York NY,
11794-2500, USA; Department of Behavioral & Policy Sciences, RAND Corporation,
Santa Monica, California CA, 90401, USA.
(46)Mayo Sleep Behavior and Neurophysiology Research Laboratory, Mayo Center for
Sleep Medicine, Division of Pulmonary, Critical Care, and Sleep Medicine,
Departments of Neurology and Medicine, Mayo Clinic College of Medicine and
Science, Rochester, Minnesota MN, 55905, USA.
(47)California Pacific Medical Center Research Institute, San Francisco,
California CA, 94158, USA; Department of Epidemiology and Biostatistics,
University of California San Francisco, San Francisco, California CA, 94158,
USA.
(48)INSERM, Université Paris Cité, 75019, Paris, France.
(49)Interdisciplinary Sleep Medicine Center, Charite Universitatsmedizin Berlin,
10117, Berlin, Germany; Respiratory and Sleep Medicine Center, Binzhou Medical
University Hospital, Binzhou, 256603, Shandong, China.
(50)Sleep Research Centre, Oasi Research Institute-IRCCS, Troina, 94018, Italy.
(51)Department of Psychiatry, Center for Sleep and Circadian Science, University
of Pittsburgh, Pittsburgh, Pennsylvania PA, 15213, USA.

Research using the multidimensional sleep health (MDSH) framework has increased
globally, often relying on self-report measures. The Ru-SATED scale and Sleep
Health Index (SHI) are common self-report measures of MDSH, but comparative data
on their measurement properties and contextual characteristics remain limited.
Seven electronic databases were searched for measurement properties and uses of
the two scales over the past twelve years. This review identified 19
psychometric validation studies concerning two original and 17 cross-cultural,
and summarized contextual comparison of MDSH measures and frameworks.
Measurement properties of both measures were assessed with the COnsensus-based
Standards for the selection of health Measurement INstruments (COSMIN)
guideline, and contextual comparisons were conducted narratively. Both measures
exhibited acceptable psychometric properties across diverse cultural settings,
with the SHI findings showing greater consistency than those of the Ru-SATED
scale. Aggregating the Ru-SATED and SHI frameworks fully covered the sleep
characteristics assessed by five instruments grounded in the World Sleep Society
initiative, encompassing regularity, satisfaction, alertness, timing,
efficiency, duration, and disorder. Notably, the SHI framework incorporates
targeted sleep disorder assessment while the Ru-SATED framework specifically
excludes such assessment, highlighting the distinct focus and scope of each
tool. Instrument selection depends primarily on research purpose, study sample,
and intended use. We recommend characterizing both sleep health and sleep
disorders to fully capture the complex relationships between sleep and health
outcomes.

Copyright © 2026 Elsevier Ltd. All rights reserved.

DOI: 10.1016/j.smrv.2026.102296
PMID: 42066638

Conflict of interest statement: Conflict of interest disclosure Joseph M.
Dzierzewski served on an advisory panel for Eisai Pharmaceuticals and received
an honorarium for a presentation given for the Nevada Psychological Association;
the contents do not represent the views of the National Sleep Foundation. Alice
M. Gregory is an advisor for a project initially sponsored by Johnson’s Baby;
She was a consultant for Perrigo (2021+); She receives royalties for two books
Nodding Off (Bloomsbury Sigma, 2018) and The Sleepy Pebble (Flying Eye, 2019)
and a sleep gift (The Gift of Sleep, Lawrence King Publishers, 2023); She was
previously a CEO of Sleep Universal LTD (2022); She is a regular contributor to
BBC Focus Magazine and has contributed to other outlets (such as The
Conversation, The Guardian and Balance Magazine); She occasionally receives
sample products related to sleep (e.g. blue light blocking glasses) and has
given a paid talk to a business (Investec); She is a specialist subject editor
at JCPP (sleep) for which she receives a small honorarium; She has contributed a
paid article to Neurodiem. Stuart F. Quan has served as a consultant for
Teledoc, Bryte Foundation, Jazz Pharmaceuticals, Apnimed, Evicore, Alphasights
LTD, Guidepoint Global LLC, Summus Funding, Sultan Qaboos University, Cowen
Services and Whispersom and is the Field Chief Editor for Frontiers in Sleep and
is an Associate Editor for the Southwest Journal of Pulmonary, Critical Care and
Sleep. Natalie D. Dautovich serves as consultant to the National Sleep
Foundation. Lauren Hale receives honoraria for various speaking engagements and
has been a paid consultant for the Alliance for Sleep by Idorsia; Lauren Hale
ended her term as Editor-in-Chief of Sleep Health in 2020. Wendy M. Troxel is an
Associate Editor for the journals Psychosomatic Medicine and Sleep Health, for
which she receives honoraria; she is also on the advisory board for the National
Sleep Foundation and sleepfoundation.org. Emerson M. Wickwire has received
research funding from the AASM Foundation, Department of Defense, Merck,
NIH/NIA, ResMed, the ResMed Foundation, and the Sleep Research Society
Foundation; Emerson M. Wickwire has served as a scientific consultant to Axsome
Therapeutics, DayZz, Eisai, EnsoData, Idorsia, Merck, Nox Health, Primasun,
Purdue, and ResMed and is an equity shareholder in WellTap. Donald L. Bliwise
has served as a consultant for CliniLabs, Eisai, Ferring, Huxley, Idorsia,
Merck. Dalva Poyares has served as speaker for Takeda and Eurofarma
pharmaceuticals. Over the past 3 years, Daniel J. Buysse has served as a paid
consultant to Sleep Number; He receives book royalties as co-author of “Treating
Sleep Problems: A Transdiagnostic Approach”; Daniel Buysse is an author of the
Pittsburgh Sleep Quality Index, Ru-SATED questionnaires, and Daytime Insomnia
Symptoms Scale (copyrights held by the University of Pittsburgh), These
instruments have been licensed to commercial entities for fees; He is also
coauthor of the Consensus Sleep Diary (copyright held by Ryerson University),
which is licensed to commercial entities for a fee; Daniel J. Buysse has
received grant support from the National Institutes of Health. However, none of
these relationships are relevant to the present work. Other co-authors have no
conflicts of interest to disclose.

Auteurs Bordeaux Neurocampus