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A Two-Continua Model of Sleep Health and Sleep Disorders: Why Framework Proliferation Is a Feature
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DOI：10.1016/j.smrv.2026.102320.png)
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Abstract
En 中文
Multi-dimensional sleep health (MDSH) frameworks emerged in the 2010s to articulate positive sleep health beyond the absence of sleep disorders. Meng et al. [1] provide the first systematic review directly comparing the two leading instruments, the Ru-SATED scale [2], [7] and the Sleep Health Index (SHI) [4], and surface two unresolved tensions: a conceptual question (what is the relationship between sleep health and sleep disorders?) and an operational question (will sleep science converge on a single MDSH framework?). This perspective elaborates Meng et al’s brief observation that MDSH is orthogonal to sleep disorders into a Two-Continua Model (TCM), drawing on the dual-continua model of mental health. The TCM defines a sleep disorder continuum (X-axis) and an orthogonal sleep health continuum (Y-axis), generating a four-quadrant typology. Implications: the typology identifies under-attended populations for surveillance; MDSH complements rather than replaces disorder-focused science; joint-axis modeling integrating disorder and health information yields more powerfully predictive frameworks; and a proliferation of tailored MDSH frameworks is a feature of a maturing research program, not a defect.
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