What sleep clinicians should know about the National Sleep Foundation’s Sleep Health Index

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Seven days of national focus on sleep health

As we covered in our earlier blog posting this month, The National Sleep Foundation (NSF) is dedicated to improving health and well-being through sleep education and advocacy, and as part of that goal they have instituted National Sleep Awareness Week®—March 14-20, 2021.2 One of the many helpful programs of the NSF is the campaign coincides with the beginning of Daylight Savings Time, when many Americans lose an hour of sleep. Losing an hour of sleep during that time in combination with reported negative sleep health symptoms that could be a sign of sleep apnea could serve as a conversation starter for many types of physicians with patients who find this time of year especially difficult to feel rested and get through their routine easily or with little issue. 

The NSF has a focus on research in sleep, and began in 2013 to develop a “a survey instrument to assess general sleep health.”1This became the Sleep Health Index (SHI). 

The development of the SHI involved “assembling a task force, identifying specific topic areas, developing and testing questions, surveying a beta version of the instrument, refining the instrument, and developing and testing the index.”1 This SHI is in addition to their annual National Sleep in America Poll where more specific symptom-related questions and patient response to symptom questions are a part of the study. 

These focused on disturbed sleep or daytime sleepiness—worthy topics to be sure, but not the specific benchmark of trends desired by the NSF to assess sleep health or sleep disorders like sleep apnea in the general population.2 Those allude to sleep apnea and other disorders, but do not provide definitive answers or indicators that point to a definite diagnosis or an immediate screening need. Part of the problem, is that sleep health is so broad that many patients do not view any symptoms they may be having as part of any disorder like sleep apnea, but merely a feeling they must manage their way through without medical intervention.3 

What is sleep health? 

Surprisingly, no uniform or accepted definition of “sleep health” exists (although the NSF is working on developing its own).1 Sleep health is “not merely the absence of a sleep disorder or problem.”1 Overall sleep health may include the quantity, quality, and impact of sleep—which are all essential, especially for the large portion of the population that does not suffer from sleep pathologies.1 Because of that fact, the burden of communication and awareness around sleep apnea and its effects on not only cardiac health but overall health and wellness is on you as the clinician. 

How did America do?

In simple terms, the SHI measures three separate but related elements of sleep health—duration, quality, and disorders. Americans earned an overall score of 76/100 (higher score reflects better sleep heath). The sub-index scores were 81/100 in disordered sleep, 79/100 in sleep duration, and 68/100 in sleep quality.1 The strongest independent predictors of sleep health were self-reported stress and overall health, which were also the strongest predictors of sleep quality.1 

How sleep clinicians can use this information in relation to sleep apnea

According to the NSF: “Research consistently demonstrates that sleep is a significant component of physical and mental health, as well as overall well-being.”1 The importance placed in the Sleep Health Index on self-reported stress and overall health for both sleep quality and sleep health emphasizes the need to include general practitioners, cardiologists, sleep clinicians and doctors of all other specialties in the discussion around sleep and sleep health. 


A huge start toward seeing improvements in the findings from the NSF’s SHI is to normalize the consideration of regularly screening for possible sleep disorders like sleep apnea with patients who are not viewing sleep as a part of their overall health considerations. Further fine-tuning of who to ask, what to ask and when to ask is evident with just these three predictors from the index alone. Furthermore, with up to 80% of moderate cases of sleep apnea still remaining undiagnosed, interest in sleep studies of this nature continues to be important across specialty. These studies and surveys are a way to open lines of communication with patients and justify clinical opinions or recommendations of running a sleep study even if the patient remains on the fence that they have a problem. 

Luckily, with the advent and the growing usage of home sleep test options, these recommendations for a sleep study are a lot less burdensome than they have been in previous years where an in-lab sleep study was needed just to scratch the surface in terms of exploring the implications of less than perfect sleep patterns in patients. Screening for disorders like sleep apnea can now be done with the help of a home sleep apnea test where a patient can easily follow the instructions and administer their own test in their own home. 

Every survey or study on sleep health, whether done by the NSF or another organization, is likely welcome to our community of medical professionals, especially those who specialize in sleep and have a deeper understanding of how a patients’ sleep patterns may lead down a road to more serious conditions like hypertension, narrowing or arteries, atrial fibrillation, or even heart failure. In summary, while the NSF’s SHI is eye opening for many types of clinicians to get the conversation started about the importance of screening and the possible implications of the symptoms of sleep disorders like sleep apnea. Knowledge is power, and more knowledge on how our patients are sleeping and responding to their poor sleep is more power. And that is a plus for the patients being treated as a result of these studies.

References: 

1. Sleep Health Journal,  The National Sleep Foundation’s Sleep Health Index. https://www.sleephealthjournal.org/article/S2352-7218(17)30102-X/fulltext#secst0005  Kristen L. Knutson, PhD  Julie Phelan, PhD (co-primary authors) Michael J. Paskow, MPH  Anita Roach, MS  Kaitlyn Whiton, MHS  Gary Langer, BA  Sunshine Hillygus, PhD. Michael Mokrzycki, BS  William Broughton, MD  Sudhansu Chokroverty, MD, FRCP. Kenneth Lichstein, PhD  Terri E. Weaver, PhD, RN, FAAN  Max Hirshkowitz, PhD, DABSM. June 19, 2017.

2. The National Sleep Foundation, Press Release. “National Sleep Foundation prepares for Sleep Awareness Week 2012” https://www.thensf.org/national-sleep-foundation-prepares-for-sleep-awareness-week-2021/  February 19, 2021.

3.   American Academy of Sleep Medicine. Press Release. https://aasm.org/aasm-response-to-screening-for-obstructive-sleep-apnea-in-adults-evidence-report-and-systematic-review-for-the-us-preventive-services-task-force/ February 24, 2021.