title: A meta-analysis of diagnostic accuracy of three screening tools for insomnia.
abstract: Insomnia is a highly prevalent health complaint in the modern societies; however, insomnia remains under-diagnosed and under-treated. Although screening tools, including the Insomnia Severity Index (ISI), Athens Insomnia Scale (AIS), and Pittsburg Sleep Quality Index (PSQI), are widely used for assessing the risk of insomnia, the diagnostic properties have yet to be summarized in a systematic manner.
  
  
  
  To estimate and to compare the diagnostic accuracy of the ISI, AIS, and PSQI for insomnia screening.
  
  
  
  We systematically searched EMBASE, PubMed, PsycINFO, CINAHL and Chinese Electronic Periodic Services for data from their inception to May 20, 2015.
  
  
  
  Original articles that had assessed the sensitivity and specificity of the ISI, AIS, or PSQI against a reference standard in adult participants (age>18) were included.
  
  
  
  A total of 19 studies comprising 4693 participants were included. The pooled sensitivity for the ISI, AIS, and PSQI was 88% (95% confidence interval [CI]=0.79 to 0.93), 91% (0.87 to 0.93), and 94% (0.86 to 0.98), respectively. The pooled specificity was 85% (0.68 to 0.94), 87% (0.68 to 0.95), and 76% (0.64 to 0.85); and the pooled DORs was 41.93 (8.77 to 200.33), 67.7 (23.4 to 196.1), and 53 (15.5 to 186.2), respectively. The summary estimates did not differ significantly among the ISI, AIS and PSQI (all P>0.05).
  
  
  
  The current evidence indicates that the ISI, AIS, and PSQI yield comparable diagnostic properties for insomnia screening.
authors.affiliation: School of Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan.
authors.forename: Hsiao-Yean
authors.initials: HY
authors.lastname: Chiu
authors.affiliation: Institute of Population Health Sciences, National Health Research Institutes, Miaoli, Taiwan.
authors.forename: Ling-Yin
authors.initials: LY
authors.lastname: Chang
authors.affiliation: School of Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan.
authors.forename: Yu-Jung
authors.initials: YJ
authors.lastname: Hsieh
authors.affiliation: School of Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan; Sleep Science Center, Taipei Medical University Hospital, Taipei, Taiwan. Electronic address: ptsai@tmu.edu.tw.
authors.forename: Pei-Shan
authors.initials: PS
authors.lastname: Tsai
mesh_terms: D000328:Adult; D044466:Asian People / Q000523:psychology; D016022:Case-Control Studies; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D008297:Male; D015995:Prevalence; D012680:Sensitivity and Specificity; D007319:Sleep Initiation and Maintenance Disorders / Q000175:diagnosis* / Q000523:psychology*
keywords: Diagnostic metaanalysis; Insomnia; Insomnia screening; Instrument validation