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Validation of the Portuguese version of the Pittsburgh Sleep Quality Index (PSQI-PT)
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- ... Relatedly, analysis of the instrument using a Portuguese sample (João et al., 2017) found poor reliability (Cronbach's alpha). As demonstrated by Mollayeva et al. (2016), most studies using factor analysis achieved better results with a model with two or three factors. ...The present study examined the factor structure of the Pittsburgh Sleep Quality Index (PSQI) in a sample of older Portuguese adults using a cross-validation approach. Design is a cross-sectional. A convenience sample of 204 community-dwelling older adults (M=70.05, SD=7.15) were included. The global sleep quality (GSQ) score ranged from 0 to 18 with a mean of 5.98 (SD ±3.45). The distribution showed that gender and perception of oneself as healthy influences GSQ in this sample. Cronbach's α was 0.69, but increased to 0.70 if the “use of sleep medication” component was deleted. Exploratory factor analysis (EFA) demonstrated two factor model is better than one factor, and a model fit with good indices (chi-square=8.649, df=8, p=0.373). Confirmatory factor analysis (CFA) was performed on the single factor, two factor, and three factor models, with and without the “use of sleep medications” component. The best model was the 3-factor model without the “use of sleep medications” component (chi-square=1.214, df=6, GFI=0.997, AGFI=0.918, CFI=0.986, RMSEA=0.046). The adaptation of the model is similar to the original model, with the only change being the exclusion of the "use of medications to sleep" component. We suggest using that component as a complementary qualitative assessment of health.
- ... for a healthy normalized Portuguese population, where the mean global score was 1.20 (SD = 0.46), which shows a significantly impaired sleep quality.(11) However, this value is similar to the results of other populations of caregivers of patients with severe psychomotor development (the sample (72.4%) obtained global scores greater than or equal to 5, which indicates the presence of difficulties in, at least, two components of the questionnaire, showing a higher risk for sleep disturbance.(11) ...Background The role caregivers of children with complex chronic disease play may be linked to important sleep disturbances, which may threaten the long-term quality care to their children. Aim Evaluation of the sleep quality of the caregivers of children with complex chronic disease under home mechanical ventilation. Design Observational and analytic study (October 2018 – January 2019). Setting/Participants We assessed 33 caregivers of patients with complex chronic disease under home mechanical ventilation for ≥3 months, followed in the Pneumology Clinic of a tertiary paediatric hospital. Evaluation instrument: Pittsburgh Sleep Quality Index (Portuguese version). Results Most of the caregivers were mothers (88%), median age of 40 years. Most of the children were male (70%), median age of 11 years. The main diagnostic group was genetic/polymorphic syndrome (46%); 52% belonged to group 2 (Association for Children with Life-Threatening or Terminal Conditions). There was a discrepancy between the subjective sleep quality ("Good" in 64%) and the Pittsburgh Sleep Quality Index score ("Poor" in 72%), with significant percentage of daytime sleepiness/dysfunction (75%). The increase in daily hours of ventilation seems to lead to a lower sleep quality (p = 0.669). Caregivers with sleep disorder had lower sleep quality values. Conclusions The sleep quality of the caregivers of children under home mechanical ventilation has similar values to specific groups described in literature, but lower than that of the healthy Portuguese population. It is essential to raise the professionals’ awareness for the evaluation of sleep quality of caregivers, since it may not be adequately perceived by them.
- ... On the contrary, Ho et al. [17] described that a revised onefactor model, with a residual covariance between sleep duration and habitual sleep efficiency, was the best solution, supporting the original unidimensional structure of the PSQI. Two studies evaluated the psychometric properties of the PSQI in Portuguese populations [18,19]; one reported preliminary data from a sample of undergraduates and master degree students [19], and the other evaluated a sample of communitydwelling adults [18], yielding values of internal consistency for the unidimensional solution (Cronbach's alpha) of 0.65 and 0.70, respectively. However, the factor structure of the PSQI or its test-reliability was not addressed in any of these previous studies, and none of them investigated its construct validity using an objective measure of sleep (e.g., actigraphy or polysomnography). ...Purpose: We aimed to assess the factor structure, internal consistency, test-retest reliability, and construct validity of the European Portuguese version of the Pittsburgh Sleep Quality Index (PSQI) in breast cancer patients. Methods: This study was based on a cohort of breast cancer patients, among whom the PSQI was used to measure sleep quality three years after cancer diagnosis (N = 474). A sample of 62 participants underwent additional PSQI testing, wore a wrist actigraph for five consecutive days, and was reevaluated with the PSQI after one month. A confirmatory factor analysis, considering the components suggested by the principal component analysis (PCA), was performed to determine model fit. To evaluate internal consistency and test-retest reliability, Cronbach's alpha and intraclass correlation coefficient (ICC) were calculated, respectively. To assess construct validity, Spearman's correlation coefficients were computed between PSQI scores and actigraphy measures and other theoretical related constructs. Results: PCA suggested one or two components. The latter showed better fit to the data, though the two factors were strongly correlated (r = 0.76) and internal consistency was not satisfactory for one of the factors. Regarding the one-factor model, internal consistency (Cronbach's alpha = 0.70) and test-retest reliability (ICC = 0.76) were adequate. Sleep duration, habitual sleep efficiency, and sleep disturbance dimensions were significantly correlated with the corresponding actigraphy measures; the PSQI global score derived from the one-factor model was more strongly correlated with subjective sleep complaints (r ≥ 0.60). Conclusions: The unidimensional construct of the European Portuguese version of the PSQI showed adequate reliability and validity among breast cancer patients.
- ... Sleep is important for optimal cognitive performance and physiological processes, emotional regulation and quality of life (O'Leary et al., 2017). Thus, sleep can be considered a complex and dynamic behavioral state that greatly influences our waking hours and contributes to the body's physical and mental recovery (João et al., 2017). Sleep can be assessed across self-report, behavioral, physiological, circuit, cellular, and genetic levels of analysis. ...Sleep health is a new and important concept. Considering the need to expand the research on sleep from the health perspective, this research proposes to validate a Sleep Health Scale (SHS) for use with the Portuguese adult population. A sample of 540 community-dwelling adults aged 18–90 years old was included. The SHS scores ranged from 0 to 30 with a mean of 19.09 (SD ± 6.49). The distribution indicated that all socio demographic variables (age, gender, and literacy) influenced sleep health. Exploratory factor analysis (EFA) demonstrated one factor for this measurement model with poor indices (Chi-square (df) = 55.02(9), p < 0.001). Confirmatory factor analysis (CFA) was performed on the single factor and showed a well-adjusted model except for question 5 (Chi-square (df) = 11.443(4), p = 0.022; RMSEA = 0.084; CFI=0.99; GFI = 0.98; AGFI = 0.94), the convergent validity (AVE = 0.55) and reliability values (α = 0.85 /CR = 0.86) were good. In conclusion, the Sleep Health Scale (SHS) is valid and reliable for the assessment of the several sleep health indicators of Portuguese adults. An investigation on the relationship between sleep health and well-being in promoting quality of life with this scale is recommended for future research.
- ... Sociodemographic variables included age (in years), gender (male/female), highest level of education completed (primary or secondary education, graduate, postgraduate, master's, or PhD), household (live alone or in cohabitation), sports activities (play or not play sports), health (consider themselves as healthy), and retirement status. Sleep quality was evaluated by the Portuguese version of the Pittsburgh Sleep Quality Index (PSQI-PT; João, Becker, Jesus, & Martins, 2017). This index is comprised by 19 items grouped into seven dimensions graded from 0 (No difficulty) to 3 (Difficulties). ...Background/Objective: Sleep insufficiency, which affects more than 45% of the world's population, has a great importance when considering older adults. Thus, this research tested a mediation hypothesis, through a path analysis, which explains how depression relates to the quality of life considering the effects of sleep quality in older adults. Method: A sample of 187 community-dwelling Portuguese older adults answered questionnaires about sociodemographic status (age, gender, highest level of education completed, family status, sports activities, health, and retirement status), quality of life, sleep quality, and depression. Descriptive and path analysis statistics were performed considering the results of the normality test. Results: The sample has health characteristics and presents adequate sleep duration. Sleep quality acted as a mediator between depression and the quality of life in older adults, considering the variation of gender and health. This suggests that it is important to establish self-care practices, namely sleep quality, to intervene in the ageing process. Conclusions: It is important to consider sleep quality associated with depression for older adults and to test interventions to minimize health impacts. Also, more researches are needed about the primary prevention in sleep quality relating to depression.
- ... However, their study was the only validation test of the Korean version of the PSQI. The cut-off point of the PSQI translated into various languages was 5 [20][21][22] and the study using the Korean version of the PSQI still sets the standard for poor sleep quality to 5. Therefore, we applied two cut-off scores in this study [23,24]. ...Objective Poor sleep quality has a number of significant negative effects on daytime function. However, few studies have examined sleep quality in patients with dizziness. Here, we investigated the potential association between sleep quality and various types of dizziness. Subjects and methods We examined dizziness and sleep disturbance in 237 patients experiencing dizziness using Korean versions of the Pittsburgh Sleep Quality Index (PSQI), the Insomnia Severity Index (ISI), and Dizziness Handicap Inventory (DHI). All participants were classified as having benign paroxysmal positional vertigo (BPPV), Ménière’s disease (MD), vestibular neuritis (VN), vestibular migraine (VM), psychogenic dizziness (PD), or Other. Results The mean PSQI and ISI scores were highest in the PD group. The rate of sleep disturbance was highest in the Other group when the cut-off score for each questionnaire was set differently, except ISI ≥ 15. The correlation between DHI and sleep disturbance indices was highest in the VM group. Multivariate regression showed that PSQI score and DHI-E score were significantly related to the PD and Other groups, while the Other group was significantly related to the ISI score. Conclusion The findings of this study strongly suggest that there are associations between sleep quality and some disease subtypes associated with dizziness. Therefore, it is important to consider sleep disturbance in patients with psychogenic dizziness, such as phobic postural vertigo and chronic subjective dizziness, or nonspecific dizziness.
- ... The validated Portuguese version of PSQI-PT [27] was applied to the Portuguese sample, similarly a validated version of the PSQI-BR was administered to the Brazilian sample [28], and the Spanish participants answered to the validated version of the PSQI-ES [29]. ...Introduction Sleep quality relates to mental health in clinical and non-clinical populations. However, there is more evidence of this relationship in clinical populations. Therefore, there is lack of evidence on how these variables relate and on which sociodemographic factors influence this relationship in non-clinical populations. In this study we hypothesize that in a non-clinical population sleep quality predicts mental health indicators and that age, country and gender moderate this relationship. Methods In a sample of 1552 subjects from Portugal, Spain and Brazil, self-reported sleep quality and mental health indicators were assessed through the Pittsburgh Sleep Quality Index and the Depression, Anxiety and Stress Scale-21, respectively. A multivariate linear regression model was used to test the research hypotheses. Results This adjusted model explained 10.1%, 12.3% and 13.1% of the variability of Depression, Anxiety and Stress, respectively, suggesting multiple sources of variance. Conclusions Our results confirmed that sleep quality predicts mental health in non-clinical populations, and that the variable country is a significant moderator of this relationship.
- ... The Pittsburgh Sleep Quality Index (PSQI) [1] is one of the most used self-report scales for measuring sleep quality worldwide, both in clinical and healthy samples [2,3]. It appears that only recently psychometric data from European Portuguese versions 1 have been published (in abstract form: [4]; as full-length article: [5,6]). Marques et al. [4] reported on its reliability, its validity against self-report tools, and its cut-off point suitability in higher education students in abstract form. ...To assess the reliability and validity concerning the formal European Portuguese version of the Pittsburgh Sleep Quality Index [PSQI (EP)], its accuracy, and optimal cut-off point. N = 564 volunteers (18–80 years old) recruited in several settings (e.g., university campuses; work place; home; sleep consultations), agreed to complete the PSQI (EP). Subgroups completed additional measures: Insomnia Severity Index (ISI), STOP-Bang, Glasgow Sleep Effort Scale, or responded to a supplementary question about perceived sleep problems. As to internal consistency, Cronbach’s α = 0.75. Principal component analysis revealed a unidimensional structure. Six PSQI (EP) components and total scores were able to discriminate individuals who did versus did not describe having any sleep problem; all PSQI (EP) scores were significantly higher (denoting poorer quality) in participants suffering from a sleep disorder. Most Cohen’s d values showed large magnitude associations. PSQI (EP) and ISI scores were highly correlated, but no significant correlations were found considering STOP-Bang. ROC analysis confirmed an optimal cut-off point > 5 of the PSQI (EP) to detect self-reported poor/good sleepers in non-clinical settings. To discriminate non-clinical from clinical sleep patients, the optimal cutoff was > 7, and AUC = 0.94. The European Portuguese version of the PSQI performs as a reliable, valid, and accurate measure of overall sleep quality in Portuguese participants. Furthermore, results suggest that PSQI (EP) can discriminate poor sleepers in non-clinical settings, in addition to demonstrating high clinical accuracy in signaling potential sleep-disorder cases. In conclusion, the PSQI (EP) is a suitable tool to assess general sleep quality in Portuguese participants, both for clinical or non-clinical applications. [Full-text view: https://rdcu.be/R9I1]
- ... All participants were asked, in a structured interview format given participants' age and educational status, about the following information: sociodemographic; subjective sleep quality (Pittsburgh Sleep Quality Index, PSQI) (Buysse et al., 1989;Del Rio João et al., 2017); depressive symptoms (Geriatric Depression Scale, GDS) (Yesavage et al., 1982); sleepiness (Epworth Sleepiness Scale, ESS) (Johns, 1991;Santos, 2001). In the questionnaires used, the higher the score, the poorer the outcome. ...Sleep is a ubiquitous phenomenon, essential to the organism homeostasis. Notwithstanding, there has been an increasing concern with its disruption, not only within the context of pathological conditions, such as neurologic and psychiatric diseases, but also in health. In fact, sleep complaints are becoming particularly common, especially in middle-aged and older adults, which may suggest an underlying susceptibility to sleep quality loss and/or its consequences. Thus, a whole-brain modeling approach to study the shifts in the system can cast broader light on sleep quality mechanisms and its associated morbidities. Following this line, we sought to determine the association between the standard self-reported measure of sleep quality, the Pittsburgh Sleep Quality Index (PSQI) and brain correlates in a normative aging cohort. To this purpose, 86 participants (age range 52–87 years) provided information regarding sociodemographic parameters, subjective sleep quality and associated psychological variables. A multimodal magnetic resonance imaging (MRI) approach was used, with whole-brain functional and structural connectomes being derived from resting-state functional connectivity (FC) and probabilistic white matter tractography (structural connectivity, SC). Brain regional volumes and white matter properties associations were also explored. Results show that poor sleep quality was associated with a decrease in FC and SC of distinct networks, overlapping in right superior temporal pole, left middle temporal and left inferior occipital regions. Age displayed important associations with volumetric changes in the cerebellum cortex and white matter, thalamus, hippocampus, right putamen, left supramarginal and left lingual regions. Overall, results suggest that not only the PSQI global score may act as a proxy of changes in FC/SC in middle-aged and older individuals, but also that the age-related regional volumetric changes may be associated to an adjustment of brain connectivity. These findings may also represent a step further in the comprehension of the role of sleep disturbance in disease, since the networks found share regions that have been shown to be affected in pathologies, such as depression and Alzheimer's disease.
- ... A global PSQI score greater than 5 indicates major difficulties in, at least, two components or moderate difficulties in more than three components. [12] The validity and reliability of the PSQI were carried out in several studies. In the study of Ghavami and Akyolcu, Cronbach's alpha reliability coefficient of the Persian version of the PSQI scale (a) in the first measurement was calculated as 0.746 and it was 0.783 in the last measurement. ...Background: This study aims to evaluate the effect of self-care interventions based on sleep hygiene practices, nutrition, and physical activity on sleep quality in post-coronary artery bypass grafting patients. Methods: This randomized-controlled study included a total of 146 patients (109 males, 37 females; mean age 55.31 years; range, 41 to 65 years) who underwent isolated coronary artery bypass grafting at Seyyed Al- Shohada Hospital of Urmia Medical Sciences University, between September 2017 and May 2018. The patients were divided into two groups as the self-care intervention group (n=73) and as the control group (n=73). The self-care intervention group received six educational courses on sleep hygiene, nutrition, and physical activity. Then they received individualized consulting weekly for three months. The control group was instructed to continue their normal life and routine care and received no education. The Demographic Information Form and the Pittsburgh Sleep Quality Index were used for data collection. Results: The mean Pittsburgh Sleep Quality Index scores in the self-care intervention group decreased to 7.1±2.3 after the intervention, while it increased to 9.5±2.1 in the control group. There was no significant difference between the two groups in terms of the mean global Pittsburgh Sleep Quality Index scores before the study (p=0.91); however, the scores were statistically significantly higher after the self-care intervention (p=0.001). Conclusion: Patients undergoing coronary artery bypass grafting may benefit from self-care interventions based on sleep hygiene, nutrition, and physical activity to improve the quality of sleep.
- ... [2] Sleep is a dynamic behavior state that seriously influences waking periods and contributes to the mental and physical health status. [3] Poor quality of sleep can disturb motivation, thoughts, and emotions. ...Background: Many patients on maintenance hemodialysis experience sleep disorders. This problem is related to depression, anxiety, hospitalizations, chronic medical conditions, decreased quality of life, and increasing mortality rate in patients on maintenance hemodialysis. The objective of this research is to determine the impact of massage therapy by hot stone on quality of sleep in patients on maintenance hemodialysis. Materials and methods: This was a randomized controlled trial conducted on 60 patients on maintenance hemodialysis. They were assigned via random allocation process into two groups of study: intervention group (n = 30), or control group (n = 30). Patients in the experimental group received massage therapy by hot basalt stone for 12 séances. During the massage therapy, each of five basalt stones were placed at the sites of the fifth, fourth, third, second, and first chakra. Control group received their treatment as usual without any massage therapy. Using Pittsburgh Sleep Quality Index (PSQI), the global score and its components were computed in both groups of study, two times (before the intervention and 1 month after the intervention). Results: Although there were not any baseline differences between the two groups of study for the mean of global PSQI score (P = 0.92) before the study, the mean of global PSQI score in the intervention group, after the intervention decreased to 5.7 ± 3.06, but in the control group sleep quality increased to 10.7 ± 3.6. The difference between the mean of global score of PSQI among two groups of study after the massage therapy was statistically significant (P < 0.001). Conclusion: Applying massage therapy by hot stone in hemodialysis patients may contribute in enhancing their quality of sleep.
- ... It is an instrument authored by Buysse et al. (1989), whose Portuguese version for research was developed by Del Rio et al. (2017) and its translation into Portuguese was done by Bertolazi et al. (2011). ...
- ... For the ESS results at or above 10 indicate abnormal or pathological sleepiness and results at or above 17 indicate severe sleepiness 24 . For the PSQI higher scores represent worse sleep quality; "bad" sleep quality is a total score ≥ 5 25 . ...Objective/Background: Delayed sleep-wake phase disorder (DSWPD) is defined by a delay in the major sleep episode relative to desired or required sleep and wake times. The objectives of this study were to evaluate DSWPD in our population and to compare it with similar clinical data, to analyse gender differences, and to identify possible subpopulations based on circadian timing and alignment. Patients/Methods: 162 consecutive DSWPD patients from a sleep clinic with a median age of 35.5 (24.0) years, 85 (52.5%) males were studied. Patient data were obtained from a clinical interview composed of socio-demographic, life events, daily habits, consumptions, and comorbidities data; and from diaries, actimetry, melatonin and PSG T1. The Dim Light Melatonin Onset (DLMO) was used to define circadian alignment or misalignment. Results: In our DSWPD cohort, there were gender differences for different age groups (p=0.028). Men were more likely to be single and women more likely to be married (p=0.034). In students, school failure was higher for women (p
- The sleep quality of patients with osteosarcoma (OS) was poorly understood. We aimed to evaluate the prevalence of sleep dysfunction in adolescent patients with OS using the Pittsburgh Sleep Quality Index (PSQI) and to further investigate the psychometric properties of the PSQI in this cohort of patients. Fifty four adolescent patients with OS who underwent chemotherapy treatment in our clinic centre were included. Sleep quality was assessed with the Chinese PSQI. Cronbach's alpha was calculated to evaluate the internal consistency. The confirmatory factor analysis (CFA) was used to determine the fitness of a two‐factor structure. Sleep disturbance was observed in 57.4% (31/54) of the patients. Patients with the presence of metastasis or more than 2 cycles of chemotherapy were found to have remarkably higher median global score. The overall Cronbach's alpha was 0.87. The CFA showed an overall comparative fit index of 0.97, a root mean square error of approximation of 0.06 and a standardised root mean square residual of 0.07 respectively. PSQI was a reliable instrument to evaluate the sleep quality of adolescent patients with OS. Over half of the patients may experience sleep disturbance during the treatment. Early psychological interventions were recommended to improve the sleep quality of the patients.
- Background: The Pittsburgh Sleep Quality Index (PSQI) dimensionality is much debated, with the greatest number of reported factor structures. Therefore, this review appraised the methodologies of studies investigating the factor structure of the PSQI. Material and methods: MEDLINE, PsycInfo, AJOL, BASE, Cochrane Library, Directory of Open Access Journals (Lund University), CINAHL, and Embase were searched systematically to include articles published till 23rd March, 2018. The articles with the objective of factor analysis of the PSQI (20 articles) or with a major section on the same subject (25 articles) were included. There was no limitation about participant characteristics. Descriptive analysis of articles for measures of the suitability of the data for factor analysis, details of the exploratory factor analysis (EFA) and details of the confirmatory factor analysis (CFA) was performed. Results: The analysis used by the majority did not employ the simplest scheme for interpreting the observed data: the parsimony principle. Other shortcomings included under- or non-reporting of sample adequacy measures (11 out of 45 articles), non-use of EFA (20 out of 45 articles), use of EFA without relevant details, non-use of CFA (11 out of 45 articles), and use of CFA without relevant details. Overall, 31 out of 45 articles did not use either EFA or CFA. Conclusion: We conclude that the various PSQI factor structures for standard sleep assessment in research and clinical settings may need further validation. Trial registration: Not applicable because this was a review of existing literature. Keywords: Confirmatory factor analysis, Dimensionality, Exploratory factor analysis, Model fit, Systematic review, Sleep
- Background and Aim: Sleep is fundamental for the development of the individual, arousing interest in investigating the quality of sleep in higher education students. The aim of this study was to characterize the components of subjective quality of sleep and excessive daytime sleepiness in a sample of higher education students. Method: The Portuguese versions of the Quality Sleep Index (PSQI-PT) and of the Epworth Sleepiness Scale (ESS) were applied to 257 college students in seven higher education institutions. Results: Participants subjectively reported poor sleep quality and sleeping more than seven hours during the week, but at the weekend the value was higher. The perception of sleep latency and dysfunction during the day differed according to the participants' gender. The Working College students showed to perceive bad Subjective Sleep Quality and a smaller Sleep Duration. It was found a small statistically significant correlation between subjective sleep quality (PSQI-PT) and daytime sleepiness (ESS). Although most of the participants of the sample perceived bad sleep quality, the majority also revealed a sleep efficiency higher than 85.0%. Conclusions: Study participants subjectively assessed sleep quality as poor. Future studies should explore possible prevention programs (i.e., diet, ICT, physical exercise) to improve subjective sleep quality.
- Objective: Sleep quality and risk of sleep apnea in smokers and nonsmokers living in Kermanshah province-Iran were compared. Methods: Based on the statistics available at Kermanshah Health Center, 50 different clusters of the city were selected randomly. Then, eight to 13 subjects in age range of 20 to 60 were selected from each cluster according to the inclusion criteria of the study (n = 390, two groups of 195 subjects). The subjects were assessed using the Pittsburgh sleep quality index (PSQI) and the Berlin questionnaire (BQ). Results: There was a significant difference in terms of mental sleep quality, sleep problems, taking sleeping pills, and low performance throughout the day between the smokers and nonsmokers (P < .05). Sleep quality was not good in smokers, and they had a significantly higher snoring and drowsiness in comparison with nonsmokers (P < .05). Furthermore, sleep apnea was significantly higher in the smokers (P < .05). The findings also revealed that consuming more than 10 cigarettes in a day reduced sleep quality and increased obstructive sleep apnea (P < .05). Conclusion: The results showed that cigarette smoking leads to respiratory problems and lower sleep quality.
- Objectives We aimed to compare three variants of the Pittsburgh Sleep Quality Index (PSQI usual, work- and work-free days: PSQIu, PSQIw, PSQIf) and to assess whether chronotype (MSFsc)/social jetlag (SJL) are associated to sleep quality in patients with sleep disorders (SD). Methods 431 SD patients and 338 subjects from the general population (GP) were included. Participants filled in three variants of the PSQI and the Munich ChronoType Questionnaire. We used Generalized Estimating Equations (GEE) to investigate effects of group (GP, SD), PSQI (usual, work or free) and their interaction (group*PSQI) on scores. To investigate associations between MSFsc/SJL and the difference between PSQIw and PSQIf (PSQIdiff) in patients with SD we used linear regressions (N=352). We used Sobel to test whether there was a mediation effect of SJL on the association between MSFsc and PSQIdiff. Results PSQI scores differed between groups (p<0.001). Post-hoc analysis revealed a significant difference between PSQIuvs. PSQIf and PSQIwvs. PSQIf with PSQIf presenting lower scores, while PSQIuvs. PSQIw did not differ in any group. In line with previous findings, SJL was associated to PSQIdiff in SD patients. Conclusions PSQIu mainly represents sleep quality on workdays also in SD patients. Being a late chronotype seems to be associated with higher differences in sleep quality on work-vs. free days mostly when it coincides with societal time constraints. Since sleep quality is poorer on workdays even in SD patients, we suggest that treatment strategies should address social aspects affecting sleep, including ways of minimizing SJL.
- The impact of sleep deprivation on muscular strength and power remains poorly understood. We aimed to determine the acute effects of 24 hr of sleep deprivation on H‐reflex and V‐wave excitability. Fourteen healthy young adults (eight men, six women) were included. Participants visited the laboratory on two different occasions, without and with 24 hr of sleep deprivation. In each session, participants were tested for maximal voluntary contraction (MVC) of the plantar flexors and dorsiflexors, soleus H‐ and M‐recruitment curves, and evoked V wave, as well as tibialis anterior/soleus electromyographic co‐activation. Twenty‐four hours of sleep deprivation did not affect either plantarflexion MVC or soleus electromyographic normalized amplitude (p > .05). Moreover, H‐reflex and V‐wave peak‐to‐peak normalized amplitude did not change with sleep deprivation (p > .05). Conversely, we obtained a significant increase in antagonist/agonist level of co‐activation during MVC post‐sleep deprivation (6.2 ± 5.2%, p < .01). In conclusion, we found that H‐reflex and V‐wave responses are well preserved after 24 hr of sleep deprivation, revealing that descending neural drive and/or modulation in Ia afferent input remains largely unaffected under these circumstances. Yet, sleep deprivation affects motor control by exacerbating the magnitude of antagonist/agonist co‐activation during forceful muscle contractions and this is novel.
- Insomnia. In: Sleep Disorders and Psychiatry
- D J Buysse
- A Germain
- D Moul
Buysse, D.J., Germain, A., Moul, D., 2005. Insomnia. In: Sleep Disorders and Psychiatry. American Psychiatric Publishing, Arlington, VA, 29–75. - This review appraises the process of development and the measurement properties of the Pittsburgh sleep quality index (PSQI), gauging it’s potential as a screening tool for sleep dysfunction in non-clinical and clinical populations; it also compares non-clinical and clinical populations in terms of PSQI scores. MEDLINE, EMBASE, PsycINFO, and HAPI databases were searched. Critical appraisal of measurement properties was performed using COSMIN. Of 37 reviewed studies, 22 examined construct validity, 19 - known-group validity, 15 - internal consistency, and three - test-retest reliability. Study quality ranged from poor to excellent, with the majority designated fair. Internal consistency, based on Cronbach’s alpha, was good. Discrepancies were observed in factor analytic studies. In non-clinical and clinical samples with known differences in sleep quality, the PSQI global scores and all subscale scores, with the exception of sleep disturbance, differed significantly. The best evidence synthesis for the PSQI showed strong reliability and validity, and moderate structural validity in a variety of samples, suggesting the tool fulfills its intended utility. A taxonometric analysis can contribute to better understanding of sleep dysfunction as either a dichotomous or continuous construct.
- • Data for this report come from a nationally representative probability sample survey of noninstitutionalized adults, aged 18 to 79 years. The survey, conducted in 1979, found that insomnia afflicts 35% of all adults during the course of a year; about half of these persons experience the problem as serious. Those with serious insomnia tend to be women and older, and they are more likely than others to display high levels of psychic distress and somatic anxiety, symptoms resembling major depression, and multiple health problems. During the year prior to the survey, 2.6% of adults had used a medically prescribed hypnotic. Typically, use occurred on brief occasions, one or two days at a time, or for short durations of regular use lasting less than two weeks. The survey also found a small group of hypnotic users (11% of all users; 0.3% of all adults) who reported using the medication regularly for a year or longer. If we include anxiolytics and antidepressants, 4.3% of adults had used a medically prescribed psychotherapeutic drug that was prescribed for sleep; 3.1% had used an over-the-counter sleeping pill. The majority of serious insomniacs (85%) were untreated by either prescribed or over-the-counter medications.
- This review appraises the process of development and the measurement properties of the Pittsburgh sleep quality index (PSQI), gauging its potential as a screening tool for sleep dysfunction in non-clinical and clinical samples; it also compares non-clinical and clinical populations in terms of PSQI scores. MEDLINE, Embase, PsycINFO, and HAPI databases were searched. Critical appraisal of studies of measurement properties was performed using COSMIN. Of 37 reviewed studies, 22 examined construct validity, 19 - known-group validity, 15 - internal consistency, and three - test-retest reliability. Study quality ranged from poor to excellent, with the majority designated fair. Internal consistency, based on Cronbach's alpha, was good. Discrepancies were observed in factor analytic studies. In non-clinical and clinical samples with known differences in sleep quality, the PSQI global scores and all subscale scores, with the exception of sleep disturbance, differed significantly. The best evidence synthesis for the PSQI showed strong reliability and validity, and moderate structural validity in a variety of samples, suggesting the tool fulfills its intended utility. A taxonometric analysis can contribute to better understanding of sleep dysfunction as either a dichotomous or continuous construct. Copyright © 2015 Elsevier Ltd. All rights reserved.
- ABSTRACT The aim of this work was to translate the Jenkins Sleep Scale into Portuguese, to culturally adapt it to the Portuguese culture and to assess its stability, internal consistency and convergent validity among a group of shift workers (airline pilots). The scale was validated in a random sample of 456 airline pilots. The original Jenkins Sleep Scale was translated and culturally adapted to the Portuguese Culture using recommended procedures. The psychometric methods used were confirmatory factor analysis using structural equation modeling, Cronbach’s α coefficients, and intra-class correlation coefficients. The results confirmed the JSS-PT has a single factor model, like the original version, with the Comparative Fit Index and the Tucker-Lewis Index suggesting a very good fit. Cronbach’s α coefficient was .84 for the extracted factor. Pearson bivariate correlations were performed on 75 participants, with an interval of 1 week for test-retest purposes with intra-class correlation of .99. Convergent validation showed significant correlations (r = .57). The validity and reliability of this scale was established, enabling it to be used within the Portuguese language speakers. Nevertheless, this study should be replicated in other samples, with other forms of validity being be explored.
- As part of the National Institute of Mental Health Epidemiologic Catchment Area study, 7954 respondents were questioned at baseline and 1 year later about sleep complaints and psychiatric symptoms using the Diagnostic Interview Schedule. Of this community sample, 10.2% and 3.2% noted insomnia and hypersomnia, respectively, at the first interview. Forty percent of those with insomnia and 46.5% of those with hypersomnia had a psychiatric disorder compared with 16.4% of those with no sleep complaints. The risk of developing new major depression was much higher in those who had insomnia at both interviews compared with those without insomnia (odds ratio, 39.8; 95% confidence interval, 19.8 to 80.0). The risk of developing new major depression was much less for those who had insomnia that had resolved by the second visit (odds ratio, 1.6; 95% confidence interval, 0.5 to 5.3). Further research is needed to determine if early recognition and treatment of sleep disturbances can prevent future psychiatric disorders. (JAMA. 1989;262:1479-1484)
- Study Objectives: Alterations in emotional reactivity may play a key role in the pathophysiology of insomnia disorder (ID). However, only few supporting experimental data are currently available. We evaluated in a hypothesis-driven design whether patients with ID present altered amygdala responses to emotional stimuli related and unrelated to the experience of insomnia and, because of chronic hyperarousal, less habituation of amygdala responses. Design: Case-control study. Setting: Departments of Psychiatry and Psychotherapy and of Radiology of the University of Freiburg Medical Center. Participants: There were 22 patients with ID (15 females; 7 males; age 40.7 +/- 12.6 y) and 38 healthy good sleepers (HGS, 21 females; 17 males; age 39.6 +/- 8.9 y). Interventions: N/A. Measurements and Results: In a functional magnetic resonance imaging session, five different blocks of pictures with varying emotional arousal, valence, and content (insomnia-relatedness) were presented. Pictures were presented twice to test for habituation processes. Results showed that patients with ID, compared to HGS, presented heightened amygdala responses to insomnia-related stimuli. Moreover, habituation of amygdala responses was observed only in HGS, but not in patients with ID who showed a mixed pattern of amygdala responses to the second presentation of the stimuli. Conclusions: The results provide evidence for an insomnia-related emotional bias in patients with insomnia disorder. Cognitive behavior treatment for the disorder could benefit from strategies dealing with the emotional charge associated with the disorder. Further studies should clarify the role of insomnia disorder with respect to habituation of amygdala responses.
- Fibromyalgia (FM) is recognized as a common condition, characterized by widespread pain and associated with sleep disturbances and poor-quality sleep. The Pittsburgh Sleep Questionnaire Index (PSQI) is one of the most recommended instruments to measure sleep quality and sleep disorders. The purpose of our study was to translate the questionnaire into Spanish and to assess the psychometric properties of the Spanish version of the PSQI. A total of 138 women with FM belonging to a FM association (AFIXA, Andalusia, Spain) completed the study. Internal consistency and test-retest reliability were analyzed. Factorial analysis was performed for the PSQI components. Convergent validity of the PSQI was evaluated using Spearman's rank correlation coefficient with the Spanish versions of the Fibromyalgia Impact Questionnaire (FIQ) and the health survey short form-36 (SF-36). In our analysis, the Spanish version of the PSQI has shown a good internal consistency of the total score, with a Cronbach's alpha of 0.805, and an acceptable test-retest reliability, with a Spearman's correlation coefficient of 0.773 (p < 0.001), for the total score. A two-factor structure was generated by exploratory factor analysis, with a Cronbach's alpha of 0.866 for factor 1 and of 0.712 for factor 2. In convergent validity analysis, the PSQI total score showed a significant correlation (p < 0.01) with the FIQ total score and with the mental and physical health summaries scores of the SF-36. Our results show that the Spanish version of the PSQI provides a reliable instrument, with a good convergent validity for measuring sleep quality among Spanish FM patients.
- Good sleep is essential to good health. Yet for most of its history, sleep medicine has focused on the definition, identification, and treatment of sleep problems. Sleep health is a term that is infrequently used and even less frequently defined. It is time for us to change this. Indeed, pressures in the research, clinical, and regulatory environments require that we do so. The health of populations is increasingly defined by positive attributes such as wellness, performance, and adaptation, and not merely by the absence of disease. Sleep health can be defined in such terms. Empirical data demonstrate several dimensions of sleep that are related to health outcomes, and that can be measured with self-report and objective methods. One suggested definition of sleep health and a description of self-report items for measuring it are provided as examples. The concept of sleep health synergizes with other health care agendas, such as empowering individuals and communities, improving population health, and reducing health care costs. Promoting sleep health also offers the field of sleep medicine new research and clinical opportunities. In this sense, defining sleep health is vital not only to the health of populations and individuals, but also to the health of sleep medicine itself. Buysse DJ. Sleep health: can we define it? Does it matter? SLEEP 2014;37(1):9-17.
- This study assessed the dimensional structure of sleep quality with the Pittsburgh Sleep Quality Index (PSQI) and investigated its psychometric properties in cases with temporomandibular disorders (TMD). A convenience sample of 609 TMD cases (age: 37.1 + 13.1 yrs, 18-67 yrs, 85% female) of the multi-center Validation Project meeting Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD) and with sufficient PSQI data were included in this study. To investigate PSQI scores' dimensionality, exploratory factor analysis was used. Factors were identified using the Scree plot. To investigate internal consistency, Cronbach's alpha was calculated. Analyses were separately performed for TMD cases with (N = 496) and TMD cases without a pain-related diagnosis (N = 113). The mean PSQI score for all TMD cases was 7.1 + 4.0 units, range: 0-19. The exploratory factor analysis identified one factor for cases with at least one pain-related TMD diagnosis as well as one factor for cases with a pain-free TMD diagnosis that explained 41% of the variance in cases with pain-related TMD and 37% in cases with pain-free TMD. Internal consistency for PSQI scores was alpha of 0.75 in cases with pain-related TMD, alpha of 0.66 in cases with pain-free TMD and alpha = 0.75 for all TMD cases. Sleep quality in TMD patients is a unidimensional construct and can therefore be represented by one summary score; a finding that is in line with previous reports in TMD patients.
- Sleep is an effective factor in the process recovery from diseases. Many variables affect the sleep quality of hospitalized older patients. This study was conducted to evaluate the quality of sleep and its related risk factors in hospitalized older patients in Kashan's hospitals, Iran 2009. Settings and design: a cross-sectional study was carried out on a sample of 400 hospitalized older adults in the hospital of Kashan, Iran. The Farsi Pittsburgh Sleep Quality Index (FPSQI) was used for gathering data. A global sum of 6 or greater indicates a poor quality of sleep. Statistical analysis used: data were analyzed using the Chi-square test, t-test, ANOVA, and binary logistic regression at the multivariate model. The overall quality of sleep of the patients in this study was poor. In the final regression model, sex (OR = 0.342), level of education (OR = 0.470), type of ward (OR = 0.592), previous hospitalization experience (OR = 2.336), and use of hypnotics in hospital (OR = 3.633) were the most important predictors of sleep quality. The most prevalent sleep disturbing factors were worries and anxiety, environmental noises and pain. However, the most negative effects on the PSQI mean score were reported to be from dyspnea, environmental lights, and changes in the sleep habits. Quality of sleep also had significant relationship with sleep latency (P = 0.001) and having a respiratory disorder. The knowledge of sleep disturbing factors in hospitalized older adults might help in planning preventive strategies to improve quality of sleep.
- Guidelines for translating educational and psychological assessments for use across different languages and cultures have been developed by the International Test Commission and the Joint Committee on Standards for Educational and Psychological Testing. Common themes in these guidelines and standards are when translating items both judgmental and statistical techniques should be used to ensure item comparability across languages, and rigorous quality-control steps should be included in the translation process. In this study, the authors use differential item functioning methodology to evaluate the comparability of translated items at two different points in time—after the initial translation and 4 years later after the translations were revisited using a more rigorous translation model. The results indicated that the revised translations led to improvements in some but not all items. Improvements in the process of translating survey items, even when based on accepted professional standards, should be statistically evaluated. This methodology illustrates how evaluations can be conducted on translated survey items.
- OBJECTIVE To examine whether chronotype and daily caloric distribution are associated with glycemic control in patients with type 2 diabetes independently of sleep disturbances.RESEARCH DESIGN AND METHODS Patients with type 2 diabetes had a structured interview and completed questionnaires to collect information on diabetes history and habitual sleep duration, quality, and timing. Shift workers were excluded. A recently validated construct derived from mid-sleep time on weekends was used as an indicator of chronotype. One-day food recall was used to compute the temporal distribution of caloric intake. Hierarchical linear regression analyses controlling for demographic and sleep variables were computed to determine whether chronotype was associated with HbA1c values and whether this association was mediated by a higher proportion of caloric intake at dinner.RESULTSWe analyzed 194 completed questionnaires. Multiple regression analyses adjusting for age, sex, race, BMI, insulin use, depressed mood, diabetes complications, and perceived sleep debt found that chronotype was significantly associated with glycemic control (P = 0.001). This association was partially mediated by a greater percentage of total daily calories consumed at dinner.CONCLUSIONS Later chronotype and larger dinner were associated with poorer glycemic control in patients with type 2 diabetes independently of sleep disturbances. These results suggest that chronotype may be predictive of disease outcomes and lend further support to the role of the circadian system in metabolic regulation.
- Statistical procedures for missing data have vastly improved, yet misconception and unsound practice still abound. The authors frame the missing-data problem, review methods, offer advice, and raise issues that remain unresolved. They clear up common misunderstandings regarding the missing at random (MAR) concept. They summarize the evidence against older procedures and, with few exceptions, discourage their use. They present, in both technical and practical language, 2 general approaches that come highly recommended: maximum likelihood (ML) and Bayesian multiple imputation (MI). Newer developments are discussed, including some for dealing with missing data that are not MAR. Although not yet in the mainstream, these procedures may eventually extend the ML and MI methods that currently represent the state of the art. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
- The purpose of this research was to evaluate the factor structure of the Pittsburgh Sleep Quality Index (PSQI) in rheumatoid arthritis (RA). The sample included 107 patients with RA, 88 females and seven males, with an average age of 56.09 years, recruited from the greater Southern California area. Confirmatory factor analysis evaluated single, two- and three-factor models. The single factor solution yielded a poor fit to the data. While the three-factor solution had the best fit, the two-factor solution, comprised of sleep efficiency and perceived sleep quality factors, was optimal because it had very good fit, and acceptable reliability for its individual factors. Clinical indices were consistently correlated with the sleep quality factor, but not with the sleep efficiency factor.
- The current study investigated the factor structure of the Pittsburgh Sleep Quality Index (PSQI) among English speaking non-Hispanic whites (NHW) and English and Spanish speaking Hispanics of Mexican descent (HMD). The PSQI was administered during a telephone interview. In order to test the factor structure of the PSQI structure across ethnic/language groups, multiple group confirmatory analysis with covariates (MIMIC) was employed. The 1- and 3-factor versions of the PSQI previously reported in the literature were examined. San Diego County. Community-dwelling English speaking, NHW (n = 1,698) and English (n = 654) and Spanish (n = 792) speaking HMD. A single-factor scoring model fit across language/ethnic groups; however, a 3-factor model provided a better than the 1-factor model in all language/ethnic groups. The subscale sleep medications loaded poorly and was removed from all models. Across groups, a 3-factor model of the PSQI more reliably assessed sleep quality than a single-factor global score. Results indicate that the 3-factor structure of the PSQI was uniform across English speaking NHW and English and Spanish speaking HMD. CITATION: Tomfohr LM; Schweizer CA; Dimsdale JE; Loredo JS. Psychometric characteristics of the Pittsburgh Sleep Quality Index in English speaking non-Hispanic whites and English and Spanish speaking Hispanics of Mexican descent. J Clin Sleep Med 2013;9(1):61-66.
- Poor sleep quality among individuals with posttraumatic stress disorder (PTSD) is associated with poorer prognosis and outcomes. The factor structure of the most commonly employed measure of self-reported sleep quality, the Pittsburgh Sleep Quality Index (PSQI), has yet to be evaluated among individuals with PTSD. The current study sought to fill this gap among a sample of 226 U.S. military veterans with PTSD (90% with co-occurring mood disorders, 73.5% with substance use disorders). We evaluated the factor structure of the PSQI by conducting an exploratory factor analysis (EFA) in approximately half of the sample (n = 111). We then conducted a second EFA in the other split half (n = 115). Lastly, we conducted a path analysis to investigate the relations between sleep factors and PTSD symptom severity, after accounting for the relation with depression. Results suggested sleep quality can best be conceptualized, among those with PTSD, as a multidimensional construct consisting of 2 factors, Perceived Sleep Quality and Efficiency/Duration. After accounting for the association between both factors and depression, only the Perceived Sleep Quality factor was associated with PTSD (β = .51). The results provide a recommended structure that improves precision in measuring sleep quality among veterans with PTSD.
- The Pittsburgh Sleep Quality Index (PSQI) is widely used to assess subjective sleep quality in clinical and non-clinical settings. Although the PSQI is routinely scored to provide a single sleep quality factor, two recent studies suggest that multiple factor scoring methods could be more appropriate. As a consequence, the present study investigated for the dimensionality and factor structure of the PSQI in 364 Australian adults aged 18 to 59 years. The results demonstrate that two factor and three factor scoring models were favored statistically over the single factor model. These results add to recent findings and suggest that scoring the PSQI in relation to multiple factors could facilitate the assessment of sleep problems, which are increasingly common in society.
- The objective of this study was to investigate the reliability and validity of the Pittsburgh Sleep Quality Index (PSQI) in a non-clinical sample consisting of younger and older adults. There has been little research validating the PSQI with respect to multinight recording as with actigraphy, and more validation is needed in samples not specifically selected for clinical disturbance. Also, the degree to which the PSQI scores may reflect depressive symptoms versus actual sleep disturbance remains unclear. One-hundred and twelve volunteers (53 younger and 59 older) were screened for their ability to perform treadmill exercises; inclusion was not based on sleep disturbance or depression. Internal homogeneity was evaluated by correlating PSQI component scores with the global score. Global and component scores were correlated with a sleep diary, actigraphy, and centers for epidemiological studies - depression scale scores to investigate criterion validity. Results showed high internal homogeneity. PSQI global score correlated appreciably with sleep diary variables and the depression scale, but not with any actigraphic sleep variables. These results suggest that the PSQI has good internal homogeneity, but may be less reflective of actual sleep parameters than a negative cognitive viewpoint or pessimistic thinking. The sleep complaints measured may often be more indicative of general dissatisfaction than of any specifically sleep-related disturbance.
- Sleep problems are treatable causes of morbidity and mortality, but little is known about how often the history fundamental to diagnosis is obtained. We recorded the frequency of sleep histories during encounters with simulated patients by 20 experienced primary care practitioners, 23 uninstructed medical interns, and 22 interns who had previous instruction about sleep disorders. Sleep histories were uncommonly obtained by uninstructed physicians (0% of practitioners, 13% of interns), but trained interns more often (81.8%) asked about sleep. If sleep problems are to be prioritized, major changes in physician education and behaviors are essential. Focused instruction about sleep influences physician behavior.
- Epidemiological studies link short sleep duration and circadian disruption with higher risk of metabolic syndrome and diabetes. We tested the hypotheses that prolonged sleep restriction with concurrent circadian disruption, as can occur in people performing shift work, impairs glucose regulation and metabolism. Healthy adults spent >5 weeks under controlled laboratory conditions in which they experienced an initial baseline segment of optimal sleep, 3 weeks of sleep restriction (5.6 hours of sleep per 24 hours) combined with circadian disruption (recurring 28-hour "days"), followed by 9 days of recovery sleep with circadian re-entrainment. Exposure to prolonged sleep restriction with concurrent circadian disruption, with measurements taken at the same circadian phase, decreased the participants' resting metabolic rate and increased plasma glucose concentrations after a meal, an effect resulting from inadequate pancreatic insulin secretion. These parameters normalized during the 9 days of recovery sleep and stable circadian re-entrainment. Thus, in humans, prolonged sleep restriction with concurrent circadian disruption alters metabolism and could increase the risk of obesity and diabetes.
- Rotating night shift work disrupts circadian rhythms and has been associated with obesity, metabolic syndrome, and glucose dysregulation. However, its association with type 2 diabetes remains unclear. Therefore, we aimed to evaluate this association in two cohorts of US women. We followed 69,269 women aged 42-67 in Nurses' Health Study I (NHS I, 1988-2008), and 107,915 women aged 25-42 in NHS II (1989-2007) without diabetes, cardiovascular disease, and cancer at baseline. Participants were asked how long they had worked rotating night shifts (defined as at least three nights/month in addition to days and evenings in that month) at baseline. This information was updated every 2-4 years in NHS II. Self-reported type 2 diabetes was confirmed by a validated supplementary questionnaire. We documented 6,165 (NHS I) and 3,961 (NHS II) incident type 2 diabetes cases during the 18-20 years of follow-up. In the Cox proportional models adjusted for diabetes risk factors, duration of shift work was monotonically associated with an increased risk of type 2 diabetes in both cohorts. Compared with women who reported no shift work, the pooled hazard ratios (95% confidence intervals) for participants with 1-2, 3-9, 10-19, and ≥20 years of shift work were 1.05 (1.00-1.11), 1.20 (1.14-1.26), 1.40 (1.30-1.51), and 1.58 (1.43-1.74, p-value for trend <0.001), respectively. Further adjustment for updated body mass index attenuated the association, and the pooled hazard ratios were 1.03 (0.98-1.08), 1.06 (1.01-1.11), 1.10 (1.02-1.18), and 1.24 (1.13-1.37, p-value for trend <0.001). Our results suggest that an extended period of rotating night shift work is associated with a modestly increased risk of type 2 diabetes in women, which appears to be partly mediated through body weight. Proper screening and intervention strategies in rotating night shift workers are needed for prevention of diabetes.
- Despite routine use with older adults, the Pittsburgh Sleep Quality Index (PSQI) and Epworth Sleepiness Scale (ESS) have not been adequately validated in older samples, particularly those from diverse racial backgrounds. The objective of this study was to determine the reliability and validity of and to provide normative data for these questionnaires in community-dwelling older women. Participants were 306 black and 2662 white women aged ≥70 from the Study of Osteoporotic Fractures. Participants completed the PSQI and ESS; provided self-reported assessments of mood, cognition and functioning; and underwent wrist actigraphy for sleep-wake estimation. Good internal consistency in both black and white women was demonstrated for the PSQI and ESS. Two PSQI subscales, however, were found to have inadequate reliability (Medications and Daytime Dysfunction). Both the PSQI and ESS were associated with theoretically similar measures in the expected directions. The PSQI also differentiated participants with no reported sleep disorder from those reporting at least one sleep disturbance, such as insomnia, sleep apnea and restless legs. The ESS only differentiated women reporting no sleep disorder from those reporting insomnia. In general, findings suggest that the PSQI and ESS are internally consistent, valid measures of self-reported sleep problems in older women. Additional research is required to evaluate the impact of removing the Medications and Daytime Dysfunction PSQI subscales on this measure's internal consistency in older women.
- Fibromyalgia (FM) is a chronic pain syndrome associated with adverse symptoms of cognitive, behavioural, and emotional dysfunction. Accumulating evidence supports the notion that sleep dysfunction, which affects almost all FM patients, has a reciprocal influence on pain. Yet, little is known about the relationship between sleep and other FM symptoms. The present study analysed the role of sleep dysfunction as a mediator of the impact of pain intensity on anxiety, depression, and daily functioning, comparing them with the mediating role of self-efficacy. A cross-sectional design was used. A sample of 104 women with FM and 86 healthy control women completed a semi-structured interview and self-reported measures of pain, sleep quality, anxiety, depression, and daily functioning. Multiple mediation models were proposed and a bootstrapping approach was used to test these models. Women diagnosed with FM had more dysfunctional scores on the variables examined than control participants, and there were significant relationships between all the variables examined in the mediation models for the FM group. The mediation analyses suggested that sleep quality and self-efficacy significantly mediated the relationship between pain and emotional distress. Additionally, self-efficacy was a significant mediator and sleep quality a likely mediator that was marginally significant in the relationship between pain and functioning. Sleep dysfunction is importantly related to FM symptoms and deserves more attention in both research and clinical practice. Our results suggest that, in addition to the usual treatment of FM, improving sleep could optimize the current management of the syndrome.
- The Pittsburgh Sleep Quality Index (PSQI) and the Epworth Sleepiness Scale (ESS) are commonly used to quantify sleep and excessive daytime sleepiness in older adults. These measures, however, have not been comprehensively evaluated for their psychometrics in older men. We determined the internal consistency reliability and construct validity of the PSQI and ESS in a sample of older men. Participants were 3,059 men (mean age = 76.4 years) in the Osteoporotic Fractures in Men Study (MrOS) who completed the two questionnaires, wrist actigraphy, and a range of additional psychosocial and health measures. Internal consistency was adequate for the PSQI (Cronbach's α =.69) and the ESS (α = .70) total scores. PSQI daytime dysfunction and sleep medications components were weakly associated with the total score, but their removal did not notably improve internal consistency. PSQI and ESS totals were associated with each other and with theoretically related variables (ie, actigraphic variables, depressive symptoms, mobility/instrumental activities of daily living, health-related quality of life) in expected directions. The PSQI differentiated participants reporting no sleep disorder from those reporting particular disorders more reliably than the ESS. In general, we found evidence of the internal consistency reliability and construct validity of the PSQI and ESS in older men. Despite low correlation with the PSQI global score, the PSQI daytime dysfunction and sleep medications components do not appreciably reduce the PSQI total score's reliability or validity in older men.
- Mounting evidence suggests that many cancer patients suffer from sleep difficulty, but there is conflicting evidence regarding the prevalence and predictors of this adverse symptom. The present study investigated the prevalence and predictors of clinically significant sleep difficulty in women with primary breast cancer. Danish women (n=3343) with primary breast cancer completed the Pittsburgh Sleep Quality Index (PSQI) along with measures of depression, anxiety, physical activity/functioning, and health behaviors three to four months postsurgery. Data on disease status, treatment, and comorbidity were obtained from the Danish Cancer Cooperative Group and surgical departments, and information on sociodemographic factors and psychiatric history was obtained from Danish national longitudinal registries. More than half (57.9%) of the women reported clinically significant sleep difficulty (PSQI >5). Multiple logistic regression identified seven significant predictors of sleep difficulty in the full sample. In order of strength, these were the following: more depressive symptoms, poorer physical functioning, older age, higher levels of trait anxiety, consuming more cigarettes, having undergone lumpectomy, and lower levels of physical activity. Subgroup analysis found that more depressive symptoms and poorer physical functioning were the only two predictors that were significant in both pre- and postmenopausal women. These findings indicate that a high proportion of women with breast cancer experience sleep difficulty. Depression and poorer physical functioning appear to be robust predictors of sleep difficulty, whereas other predictors may depend on sample characteristics, including menopausal status.
- The Pittsburgh Sleep Quality Index (PSQI) is a questionnaire that assesses sleep quality and disturbances over a 1-month period. It is a valuable tool for research purposes. The aim of this study was to validate a Brazilian Portuguese version of the PSQI. The Brazilian Portuguese version (PSQI-BR) was developed according to the following steps: (a) translation, (b) back-translation, (c) comparison between translation and back-translation performed by a group of experts, and (d) pretest in bilingual individuals. Between January 2006 and September 2007, the PSQI-BR was applied to a group of consecutive patients who were submitted to overnight polysomnography with clinical suspicion of obstructive sleep apnea syndrome (OSAS) or insomnia. As in the original article, a group of patients with depression and a control group were included. The depression group was composed of patients from the Mood Disorders Unit of the Psychiatry Department of Hospital de Clínicas de Porto Alegre (HCPA), Brazil. The control group was composed of subjects with a history of normal sleep habits, without noticed snoring. A total of 83 patients and 21 controls completed the questionnaire and were submitted to overnight polysomnography. The seven-component scores of the PSQI-BR had an overall reliability coefficient (Cronbach's α) of 0.82, indicating a high degree of internal consistency. The groups included 43 patients with OSAS, 21 with insomnia, 19 with depression and 21 controls. The mean (±SD) PSQI-BR score was 8.1±4.0 for patients with OSAS, 12.8±3.7 for insomnia patients, 14.5±3.7 for those with depression and 2.5±2.0 for control subjects. The one-way ANOVA demonstrated significant differences in PSQI-BR scores across the four diagnostic groups (p<0.001). Post hoc tests between paired groups showed that scores for OSAS, depression and insomnia were significantly higher than for controls (p<0.05). PSQI-BR scores for insomnia did not differ from those obtained for depression (p>0.05), but both were higher than for OSAS (p<0.05). The results of the present study demonstrate that the PSQI-BR is a valid and reliable instrument for the assessment of sleep quality and equivalent to its original version when applied to individuals who speak the Brazilian Portuguese language. Despite relevant influences of language and cultural background, no major cultural adaptations were necessary during the validation process. The PSQI-BR can be a tool either for clinical management or research.
- Sleep quality seems to be an antecedent to depressive symptoms during pregnancy. We sought to 1) examine the psychometrics of the Pittsburgh Sleep Quality Index (PSQI) in pregnancy; 2) examine whether sleep quality predicted increases in depressive symptoms; and 3) compare PSQI scores across 3 or 2 levels of depressive symptoms. Each of the 252 participants completed the Beck Depression Inventory (short form) and a sleep quality measure at mid and late pregnancy. PSQI total scores showed good internal consistency and construct validity. An improved model of the internal structure of the PSQI in pregnancy was found with 1 factor labeled Sleep Efficiency, a second labeled Night and Daytime Disturbances, and an Overall Sleep Quality component associated with, but separate from, both of these 2 factors. Although PSQI scores showed moderate stability over time, sleep disturbance scores increased in late pregnancy. Importantly, PSQI prospectively predicted increases in depressive symptoms. Findings suggest that the PSQI is useful in pregnancy research. Findings also support the idea that sleep problems are prospective risk factors for increases in depressive symptoms during pregnancy. Practitioners are advised to screen for sleep quality during early pregnancy.
- 1) To characterize PSQI and ESS scores, and their relationship to each other, in an adult community sample; 2) To determine whether PSQI and ESS scores, in combination with each other, were associated with distinct demographic, clinical, and sleep characteristics. The PSQI, ESS, clinical rating scales, sleep diaries, actigraphy, and home polysomnography were collected from 187 community-dwelling adults (mean age 59.5 years, 47.1% women, 41.2% African Americans) as part of a study investigating novel cardiovascular risk factors. Correlations, cluster analysis, principal components analysis, MANOVA, ANOVA, and regressions were used to characterize the relationships between the PSQI, ESS, and other study variables Mean PSQI score was 6.3 (3.4), and mean ESS score was 8.2 (3.9). PSQI and ESS correlated weakly with each other (r = 0.16, p = 0.03), but segregated from each other on principal components analysis. Groups of participants categorized by either cluster analysis of PSQI and ESS scores, or by scores above or below traditional cut-off values, differed from each other on psychological/stress symptoms and quantitative and qualitative sleep diary measures, but not on actigraphic or polysomnographic measures. Specifically, higher PSQI scores were associated with female sex, greater psychological distress, and greater sleep disturbance on sleep diaries. The PSQI and ESS measure orthogonal dimensions of sleep-wake symptoms, but neither is related to objective sleep measures. The PSQI is more closely related to psychological symptom ratings and sleep diary measures than the ESS. These instruments are not likely to be useful as screening measures for polysomnographic sleep abnormalities.
- Despite the prevalence of sleep complaints among psychiatric patients, few questionnaires have been specifically designed to measure sleep quality in clinical populations. The Pittsburgh Sleep Quality Index (PSQI) is a self-rated questionnaire which assesses sleep quality and disturbances over a 1-month time interval. Nineteen individual items generate seven "component" scores: subjective sleep quality, sleep latency, sleep duration, habitual sleep efficiency, sleep disturbances, use of sleeping medication, and daytime dysfunction. The sum of scores for these seven components yields one global score. Clinical and clinimetric properties of the PSQI were assessed over an 18-month period with "good" sleepers (healthy subjects, n = 52) and "poor" sleepers (depressed patients, n = 54; sleep-disorder patients, n = 62). Acceptable measures of internal homogeneity, consistency (test-retest reliability), and validity were obtained. A global PSQI score greater than 5 yielded a diagnostic sensitivity of 89.6% and specificity of 86.5% (kappa = 0.75, p less than 0.001) in distinguishing good and poor sleepers. The clinimetric and clinical properties of the PSQI suggest its utility both in psychiatric clinical practice and research activities.
- As part of the National Institute of Mental Health Epidemiologic Catchment Area study, 7954 respondents were questioned at baseline and 1 year later about sleep complaints and psychiatric symptoms using the Diagnostic Interview Schedule. Of this community sample, 10.2% and 3.2% noted insomnia and hypersomnia, respectively, at the first interview. Forty percent of those with insomnia and 46.5% of those with hypersomnia had a psychiatric disorder compared with 16.4% of those with no sleep complaints. The risk of developing new major depression was much higher in those who had insomnia at both interviews compared with those without insomnia (odds ratio, 39.8; 95% confidence interval, 19.8 to 80.0). The risk of developing new major depression was much less for those who had insomnia that had resolved by the second visit (odds ratio, 1.6; 95% confidence interval, 0.5 to 5.3). Further research is needed to determine if early recognition and treatment of sleep disturbances can prevent future psychiatric disorders.
- Data for this report come from a nationally representative probability sample survey of noninstitutionalized adults, aged 18 to 79 years. The survey, conducted in 1979, found that insomnia afflicts 35% of all adults during the course of a year; about half of these persons experience the problem as serious. Those with serious insomnia tend to be women and older, and they are more likely than others to display high levels of psychic distress and somatic anxiety, symptoms resembling major depression, and multiple health problems. During the year prior to the survey, 2.6% of adults had used a medically prescribed hypnotic. Typically, use occurred on brief occasions, one or two days at a time, or for short durations of regular use lasting less than two weeks. The survey also found a small group of hypnotic users (11% of all users; 0.3% of all adults) who reported using the medication regularly for a year or longer. If we include anxiolytics and antidepressants, 4.3% of adults had used a medically prescribed psychotherapeutic drug that was prescribed for sleep; 3.1% had used an over-the-counter sleeping pill. The majority of serious insomniacs (85%) were untreated by either prescribed or over-the-counter medications.
- The complex nature of insomnia and its relationship with organic and mental disorders render diagnosis problematic for epidemiologists and physicians. A representative UK sample (non-institutionalised, > 14 years old) was interviewed by telephone (n = 4972; 79.6% participation rate) with the Sleep-EVAL system. Subjects fell into three groups according to presence of insomnia symptom(s) and/or sleep dissatisfaction. Insomnia symptoms occurred in 36.2% of subjects. Most of these (75.9%), however, reported no sleep dissatisfaction. In comparison, those also with sleep dissatisfaction had higher prevalence of sleep and mental disorders and longer duration of insomnia symptoms, and were more likely to take sleep-promoting medication, dread bedtime, and complain of light sleep, poor night-time sleep and daytime sleepiness. Insomnia sufferers differ as to whether they are satisfied or dissatisfied with sleep. Although insomnia symptoms are common in the general population, sleep disturbances among sleep-dissatisfied individuals are more severe. Sleep dissatisfaction seems a better indicator of sleep pathology than insomnia symptoms.
- Insomnia is an extremely common symptom both de novo and in the context of other medical and psychiatric disorders. The impact of insomnia is often ignored both by the individual and by society in terms of its clinical and socioeconomic ramifications. Insomnia is therefore under-appreciated and almost certainly under-treated, thus making it a serious health concern. It is estimated that more than 60 million Americans suffer from insomnia annually, and this figure is expected to grow to 100 million by the middle of the 21st century. Whether it be difficulty initiating or maintaining sleep, the disruption of nocturnal sleep will invariably impact on daytime activities and often results in daytime fatigue, performance deficits (including memory and other cognitive deficits), an increase in the number of sick days taken by an individual and accidents (some catastrophic). This review examines the costs directly related to insomnia in various sectors of healthcare, the indirect costs associated with accidents, sick days and decreased work productivity, and related costs resulting from insomnia but which meet neither the criteria of direct nor indirect cost categories. The total direct, indirect and related costs of insomnia are conservatively estimated at $US30 to 35 billion annually in the US (1994 dollars). Economic gains can be made by treating patients on an outpatient basis in sleep centres.
- With the increase in the number of multinational and multicultural research projects, the need to adapt health status measures for use in other than the source language has also grown rapidly. 1,4,27 Most questionnaires were developed in English-speaking countries, 11 but even within these countries, researchers must consider immigrant populations in studies of health, especially when their exclusion could lead to a systematic bias in studies of health care utilization or quality of life. 9,11 The cross-cultural adaptation of a health status selfadministered questionnaire for use in a new country, culture, and/or language necessitates use of a unique method, to reach equivalence between the original source and target versions of the questionnaire. It is now recognized that if measures are to be used across cultures, the items must not only be translated well linguistically, but also must be adapted culturally to maintain the content validity of the instrument at a conceptual level across different cultures. 6,11‐13,15,24 Attention to this level of detail allows increased confidence that the impact of a disease or its treatment is described in a similar manner in multinational trials or outcome evaluations. The term “cross-cultural adaptation” is used to encompass a process that looks at both language (translation) and cultural adaptation issues in the process of preparing a questionnaire for use in another setting. Cross-cultural adaptations should be considered for several different scenarios. In some cases, this is more obvious than in others. Guillemin et al 11 suggest five different examples of when attention should be paid to this adaptation by comparing the target (where it is going to be used) and source (where it was developed) language and culture. The first scenario is that it is to be used in the same language and culture in which it was developed. No adaptation is necessary. The last scenario is the opposite extreme, the application of a questionnaire in a different culture, language and country—moving the Short Form 36-item questionnaire from the United States (source) to Japan (target) 7 which would necessitate translation and cultural adaptation. The other scenarios are summarized in Table 1 and reflect situations when some translation and/or adaptation is needed. The guidelines described in this document are based on a review of cross-cultural adaptation in the medical, sociological, and psychological literature. This review led to the description of a thorough adaptation process designed to maximize the attainment of semantic, idiomatic, experiential, and conceptual equivalence between the source and target questionnaires. 13 . Further experience in cross-cultural adaptation of generic and diseasespecific instruments and alternative strategies driven by different research groups 18 have led to some refinements
- This article reviews the evidence on the diagnosis, epidemiology, etiology, and treatment of insomnia in the context of cancer and proposes several areas for future research. Clinical and diagnostic features of insomnia are described and prevalence estimates of insomnia complaints in cancer patients are summarized. Then, potential etiologic factors (ie, predisposing, precipitating, and perpetuating factors) and consequences of insomnia (ie, psychologic, behavioral, and health impact) in the context of cancer are discussed. Finally, pharmacologic and psychologic treatments previously shown effective to treat insomnia in healthy individuals are discussed as valuable treatment options for cancer patients as well. Because long-term use of hypnotic medications is associated with some risks (eg, dependence), it is argued that psychologic interventions (eg, stimulus control, sleep restriction, cognitive therapy) are the treatment of choice for sleep disturbances in the context of cancer, especially when it has reached a chronic course. However, the efficacy of these treatments has yet to be verified specifically in cancer patients.
- Statistical procedures for missing data have vastly improved, yet misconception and unsound practice still abound. The authors frame the missing-data problem, review methods, offer advice, and raise issues that remain unresolved. They clear up common misunderstandings regarding the missing at random (MAR) concept. They summarize the evidence against older procedures and, with few exceptions, discourage their use. They present, in both technical and practical language, 2 general approaches that come highly recommended: maximum likelihood (ML) and Bayesian multiple imputation (MI). Newer developments are discussed, including some for dealing with missing data that are not MAR. Although not yet in the mainstream, these procedures may eventually extend the ML and MI methods that currently represent the state of the art.
- In summary, the treatment of patients with FM requires a proper assessment of the reason for the unrefreshing sleep, which is an important component of the FM syndrome. Sleep laboratory investigations provides a suitable rationale for management where a specific primary sleep disorder is determined. Nonspecific treatments include various behavioral approaches to improve sleep hygiene, fitness, and regular proper nutrition that serve to regularize disturbances in circadian sleep-wake rhythms. As yet, no medication is known to improve the EEG sleep arousal disorders that include phasic (alpha-delta), tonic alpha non-REM sleep disorders, or the periodic K alpha cycling alternating pattern disorder. Traditional hypnotic agents, while helpful in initiating and maintaining sleep and reducing daytime tiredness, do not provide restorative sleep or reduce pain. Tricyclic drugs, such as amitriptyline and cyclobenzaprine, may provide long term benefit for improving sleep but may not have a continuing benefit beyond one month for reducing pain. The use of a biologic agent that facilitates sleep-related neuroendocrine functions, for example growth hormone, is reported to improve symptoms but the need for injection and high cost restrict its use. No systematic studies have been reported on the use of remedial measures for the management of PLMS/restless legs syndrome and sleep apnea that occur in some patients with FM.
- Insomnia, a highly prevalent disorder with direct and indirect economic and professional consequences, affects daytime functioning, behavior, and quality of life. Several studies have shown that insomnia affects the workforce and is associated with an increased risk of accidents. Insomnia may also play a role in other disorders. Our study attempted to evaluate the socio-professional correlates of insomnia by comparing a group of insomniacs to a group of good sleepers. With a questionnaire focused on the socio-professional and medical consequences of insomnia, we surveyed a group of severe insomniacs and a group of good sleepers. Persons with psychiatric disorders according to the DSM-IV minimum criteria for anxiety and depression were eliminated from each group. After screening, 240 insomniacs and 391 good sleepers remained and were then compared. Compared to good sleepers, severe insomniacs reported more medical problems, had more physician-office visits, were hospitalized twice as often, and used more medication. Severe insomniacs had a higher rate of absenteeism, missing work twice as often as did good sleepers. They also had more problems at work (including decreased concentration, difficulty performing duties, and more work-related accidents). Our study showed that insomnia has socio-professional consequences and is correlated with lower medical status.
- To assess primary care physician (PCP) sleep knowledge and attitudes. A sample of 580 PCPs practicing adult medicine in Northeast Ohio was selected, using a systematic random method (every 10th name on the American Medical Association mailing list). A three-part structured survey consisted of 30 attitude items and 33 multiple-choice test questions assessing knowledge, with some demographic questions. Repeat mailings were sent to nonrespondents 4 to 6 weeks apart from October 1999 through April 2000. 46 surveys were undeliverable and 105 (20%) useable questionnaires were returned. Of respondents, 94% were board certified with 76% certified in more than one area. When asked to rate their knowledge of sleep disorders, none rated themselves as excellent, 10% rated themselves as good, 60% as fair, and 30% as poor. The factors rated highest in influencing current practices regarding sleep and sleep disorders were articles in journals, continuing medical education courses, and discussions with specialists. Knowledge average was 34% (3 to 94%). Though virtually all agreed that prevention counseling should be a part of patient care, fewer agreed that they spend more time counseling patients on the benefits of sleep than of diet or exercise. The majority of PCPs rated their own knowledge of sleep disorders as fair or poor. Knowledge testing and attitude assessment lend credence to these perceptions.
- This study described sleep in a heterogeneous sample of breast cancer patients using the Pittsburgh Sleep Quality Index (PSQI) and examined the relation between sleep disturbance and health-related quality of life as measured by the Rand 36-Item Health Survey. Chemotherapy and radiation therapy were explored as predictors of sleep disturbance in breast cancer patients, and the sleep characteristics of breast cancer patients were compared to the sleep characteristics of a sample of medical patients with general medical conditions. Results showed that 61% of breast cancer patients had significant sleep problems. Sleep was characterized by reduced total sleep time with sleep frequently being disturbed by pain, nocturia, feeling too hot, and coughing or snoring loudly. Despite the frequency of significant sleep disturbance, pharmacological and cognitive-behavioral treatments of sleep problems were observed to be inadequate. Limited evidence was found for the role of chemotherapy and radiation therapy in the sleep disturbance of breast cancer patients, and the general pattern of sleep disturbance in breast cancer patients was not significantly different than that observed in medical patients with general medical conditions. Breast cancer patients having significant sleep problems had greater deficits in many areas of health-related quality of life. The implications of the findings and study limitations are discussed.
- Åkerstedt T, Nilsson PM (Karolinska Institutet, Stockholm, University Hospital, Malmö, Sweden). Sleep as restitution: an introduction (Minisymposium). J Intern Med 2003; 254: 6–12. This paper summarizes a symposium that has shown that sleep is a state of altered metabolism, and that disturbances and curtailments of sleep have far-reaching effects on endocrinology, immunology and metabolism, changes that may be linked to disease. As yet, the entire causal chain is weak but there are indications that, in particular, the risk of type 2 diabetes and cardiovascular disease may result from disturbed sleep. It is hypothesized that both insulin resistance and chronic low-grade inflammation may be involved.
- To assess the prevalence of insomnia disorders using DSM-IV classification, and the consequences of insomnia in the Italian general population. A representative sample of the Italian general population composed of 3970 individuals aged 15 years or older were interviewed by telephone using the Sleep-EVAL system (participation rate: 89.4%). Participants were interviewed about their sleep habits and sleep disorders. DSM-IV classification was used by Sleep-EVAL to determine the sleep disorder diagnosis. Insomnia symptoms were reported by 27.6% of the sample. Sleep dissatisfaction was found in 10.1% and insomnia disorder diagnoses in 7% of the sample. The use of sleep-enhancing medication was reported by 5.7% of the sample. Most of these subjects were using anxiolytics. Dissatisfaction with sleep was associated with daytime sleepiness. Middle-aged drivers dissatisfied with their sleep were three times more likely to have had a road accident in the previous year compared to other drivers. However, fewer than 30% of subjects dissatisfied with their sleep or with an insomnia disorder diagnosis had consulted a physician about their sleep problem. As in other European and non-European countries, insomnia is widespread in Italy. The consequences are important. Appropriate recognition and treatment of insomnia should be part of an educational program for general practitioners everywhere.
- To assess the association between sleep problems and chronic disease in older adults. Self-reported standardized questionnaire data from 1506 community-dwelling men and women aged 55-84 years in the continental United States who completed a 20-min telephone interview when contacted from lists of randomly selected telephone numbers. A majority of the participants (83%) reported one or more of 11 medical conditions and nearly one in four elderly respondents (age 65-84 years) had major comorbidity (i.e. four or more conditions). Depression, heart disease, bodily pain and memory problems were associated with more prevalent symptoms of insomnia. Other conditions such as obesity, arthritis, diabetes, lung diseases, stroke and osteoporosis were associated with other sleep-related problems such as breathing pauses, snoring, daytime sleepiness, restless legs or insufficient sleep (<6 h nightly). Poll findings are consistent with epidemiological studies of sleep, aging and chronic disease. These results suggest that the sleep complaints common in older adults are often secondary to their comorbidities and not to aging per se. These types of studies may be useful in promoting sleep awareness among health professionals and among older adults, especially those with heart disease, depression, chronic bodily pain or major comorbidity.
- This study examines the prevalence and associated factors of insomnia symptoms and sleep dissatisfaction in the general population of Portugal. We interviewed by telephone 1858 participants aged 18 years or older and representative of the general population of Portugal using the Sleep-EVAL system. Participation rate was 83%. The questionnaire included the assessment of sleep habits, insomnia symptomatology according to DSM-IV and ICSD classifications, associated and sleep/mental disorders and daytime consequences. Insomnia symptoms occurring at least 3 nights per week were reported by 28.1% of the sample and global sleep dissatisfaction (GSD) by 10.1%. Difficulty maintaining sleep was the most frequent symptom (21.0%); 29.4% of subjects with insomnia symptoms reported GSD. Daytime consequences, medical consultations for sleep and use of sleep medication were at least 2 times more frequent among subjects with insomnia symptoms and GSD compared to subjects with insomnia symptoms without GSD; insomnia diagnoses were also more frequent in the GSD group. The results show a severity gradation among subjects with only 1 insomnia symptom, those with 2 or 3 insomnia symptoms but without GSD and those with at least 1 insomnia symptom and GSD. Specific sleep or psychiatric disorders were identified for the majority of GSD subjects (86%); this rate dropped to 50.6% when only 1 insomnia symptom without GSD was reported. GSD appeared to be a good indicator of the presence of a sleep or psychiatric disorder and a good discriminator of the severity of sleep disturbances among subjects with insomnia symptoms.
- 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.
