Validation of a 3-factor scoring model for the Pittsburgh sleep quality index in older adults.
ABSTRACT The Pittsburgh Sleep Quality Index (PSQI) is widely used to assess subjective sleep disturbances in psychiatric, medical, and healthy adult and older adult populations. Yet, validation of the PSQI single-factor scoring has not been carried out.
The PSQI was administered as a self-report questionnaire. Using a cross-validation approach, scores from the PSQI were analyzed with exploratory and confirmatory factor analyses.
San Diego, Denver, and Los Angeles community-based clinics.
Community-dwelling depressed and nondepressed adults older that 60 years of age (N = 417)
Results yielded a 3-factor scoring model that obtained a measure of perfect fit and was significantly better fitted than either the original single-factor model or a 2-factor model. Components of the 3 factors were characterized by the descriptors sleep efficiency, perceived sleep quality, and daily disturbances.
These findings validate the factor structure of the PSQI and demonstrate that a 3-factor score should be used to assess disturbances in three separate factors of subjective sleep reports.
SourceAvailable from: David S. Stoffer[Show abstract] [Hide abstract]
ABSTRACT: During sleep, the human body cycles through different states, and physiological activity during these states is essential to the rejuvenating properties of sleep. Researchers use polysomnography to record electrophysiological time series during sleep with the goal of characterizing sleep and elucidating the pathways through which sleep affects, and can be treated to improve, health and functioning. Important physiological information is contained in frequency patterns of many of these series, such as heart rate variability, so that the goal of an analysis of such data is to quantify associations between power spectra of time series from different sleep periods with cross-sectional clinical and behavioral variables. Such analyses are challenging as they must overcome the complex geometric structure and high dimensionality of spectral matrices. This article introduces a novel approach to analyzing such data by modeling Cholesky components of spectral matrices as bivariate functions of frequency and cross-sectional variables which, critically, preserves the poistive definite and Hermitian structure of spectral matrices while nonparametrically modeling associations. A fully automated Whittle likelihood MCMC algorithm enables inference on the association between the cross-sectional variable with the entire multivariate power spectrum and with any low-dimensional band-collapsed spectral measure. The approach not only provides inference on connections between clinical and behavioral variables and within-period spectra, but also presents the first methodology in the literature that can quantify connections with cross-period coherence, allowing for a deeper understanding of nocturnal physiology. The method is motivated by and used to analyze data from a study of poor sleep in older adults and finds a new link between autonomic nervous system activity and self-reported sleep.
[Show abstract] [Hide abstract]
ABSTRACT: Introduction. Mild traumatic brain injury (mTBI) has been widely studied and the effects of injury can be long term or even lifelong. This research aims to characterize the sleep problems of patients following acute mTBI. Methods. A total of 171 patients with mTBI within one month and 145 non-mTBI controls were recruited in this study. The questionnaire, Pittsburgh Sleep Quality Index (PSQI), was used to evaluate seven aspects of sleep problems. A propensity score method was used to generate a quasirandomized design to account for the background information, including gender, age, Beck's Anxiety Index, Beck's Depression Index, and Epworth Sleepiness Scale. The effect was evaluated via cumulative logit regression including propensity scores as a covariate. Results. Before adjustment, about 60% mTBI patients and over three quarters of control subjects had mild sleep disturbance while one third mTBI patients had moderate sleep disturbance. After adjusting by the propensity scores, the scores of sleep quality and duration were significant between mTBI and control groups. Conclusion. Our study supports that sleep problem is common in mTBI group. After adjusting the confounders by propensity score, sleep duration and subjective sleep quality are the most frequently reported problems in mTBI patients within one month after the injury.Behavioural neurology 01/2015; 2015:378726. DOI:10.1155/2015/378726 · 1.64 Impact Factor
[Show abstract] [Hide abstract]
ABSTRACT: Sleep disturbances are most prevalent among older adults and often go untreated. Treatment options for sleep disturbances remain limited, and there is a need for community-accessible programs that can improve sleep. To determine the efficacy of a mind-body medicine intervention, called mindfulness meditation, to promote sleep quality in older adults with moderate sleep disturbances. Randomized clinical trial with 2 parallel groups conducted from January 1 to December 31, 2012, at a medical research center among an older adult sample (mean [SD] age, 66.3 [7.4] years) with moderate sleep disturbances (Pittsburgh Sleep Quality Index [PSQI] >5). A standardized mindful awareness practices (MAPs) intervention (n = 24) or a sleep hygiene education (SHE) intervention (n = 25) was randomized to participants, who received a 6-week intervention (2 hours per week) with assigned homework. The study was powered to detect between-group differences in moderate sleep disturbance measured via the PSQI at postintervention. Secondary outcomes pertained to sleep-related daytime impairment and included validated measures of insomnia symptoms, depression, anxiety, stress, and fatigue, as well as inflammatory signaling via nuclear factor (NF)-κB. Using an intent-to-treat analysis, participants in the MAPs group showed significant improvement relative to those in the SHE group on the PSQI. With the MAPs intervention, the mean (SD) PSQIs were 10.2 (1.7) at baseline and 7.4 (1.9) at postintervention. With the SHE intervention, the mean (SD) PSQIs were 10.2 (1.8) at baseline and 9.1 (2.0) at postintervention. The between-group mean difference was 1.8 (95% CI, 0.6-2.9), with an effect size of 0.89. The MAPs group showed significant improvement relative to the SHE group on secondary health outcomes of insomnia symptoms, depression symptoms, fatigue interference, and fatigue severity (P < .05 for all). Between-group differences were not observed for anxiety, stress, or NF-κB, although NF-κB concentrations significantly declined over time in both groups (P < .05). The use of a community-accessible MAPs intervention resulted in improvements in sleep quality at immediate postintervention, which was superior to a highly structured SHE intervention. Formalized mindfulness-based interventions have clinical importance by possibly serving to remediate sleep problems among older adults in the short term, and this effect appears to carry over into reducing sleep-related daytime impairment that has implications for quality of life. clinicaltrials.gov Identifier: NCT01534338.JAMA Internal Medicine 02/2015; DOI:10.1001/jamainternmed.2014.8081 · 13.25 Impact Factor