Cross-cultural Adaptation and Psychometric Assessment of the Freedman Sleep Questionnaire for Intensive Care Unit Patients in Morocco

Abstract

Background: Sleep is essential for regeneration and physiological restoration. Sleep deprivation can increase the risk of infection, cause endocrine imbalances, reduce glucose tolerance, and heighten sympathetic activity. Additionally, poor sleep quality affects the patient’s sense of safety and overall quality of stay in the intensive care unit (ICU). Objectives: The present study aimed to evaluate the psychometric properties of the Arabic for Morocco version of the Freedman Sleep Questionnaire (AM-FSQ) in critically ill ICU patients in Morocco. Methods: This psychometric evaluation included an expert review for content validity, an internal consistency assessment using Cronbach’s alpha (α = 0.816), and an exploratory factor analysis for construct validity. Test-retest reliability was assessed using an intraclass correlation coefficient (ICC) of 0.85 or greater. The study was conducted in Moroccan ICUs between May 15, 2024, and December 10, 2024, with patients completing the AM-FSQ during their ICU stay. Results: The AM-FSQ demonstrated strong content validity, with expert ratings exceeding 3 on a 4-point Likert scale. The internal consistency was high (Cronbach’s alpha = 0.816), and test-retest reliability was excellent (ICC > 0.85). Exploratory factor analysis revealed four distinct factors, supporting the construct validity of the questionnaire. Conclusions: The AM-FSQ exhibits robust psychometric properties, characterized by good content validity, high internal consistency, and excellent test-retest reliability. It is a reliable and valid tool for assessing sleep quality and environmental factors that affect sleep in critically ill patients in Moroccan ICUs.