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Rehabilitation Measures

Pittsburgh Sleep Quality Index

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Purpose

The Pittsburgh Sleep Quality Index assesses sleep quality to identify “good” or “poor” sleepers, detects the presence of significant sleep disturbances of various types, and provides an index that can be interpreted by patients, clinicians, and researchers.

Link to Instrument

Instrument Details

Acronym PSQI

Area of Assessment

Sleep

Assessment Type

Patient Reported Outcomes

Administration Mode

Paper & Pencil

Cost

Free

Actual Cost

$0.00

Cost Description

The PSQI instrument, the scoring algorithm, the original article, and the scoring database available from University of Pittsburgh.

The PSQI has been translated into 56 additional languages. For more information on these languages, or to request the PSQI in a different language, visit the MAPI website. You will have to create a profile (free) and then click on PSQI Request for Translations.

Please complete a request form with the University of Pittsburgh (Center for Sleep and Circadian Science) or contact Daniel J Buysse, MD (buyssedj@upmc.edu) for permission to use this instrument. The copyright is owned by the University of Pittsburgh and may be reprinted without charge only for non-commercial research and educational purposes. No changes or modifications of this form can be made without prior written permission from the University of Pittsburgh. If you would like to use this instrument for commercial purposes or for commercially sponsored research, please contact the Office of Technology Management at the University of Pittsburgh at 412-648-2206 for licensing information.
https://www.sleep.pitt.edu/instruments/sleep-measures-request-form/

Key Descriptions

  • 19 self-reported items
  • Minimum score: 0; Maximum score: 21
  • 0-3 scoring for each of the 7 components
  • Higher scores indicate worse sleep quality
  • 7 components/sub-scales: subjective sleep quality, sleep latency, sleep duration, habitual sleep efficiency, sleep disturbances, use of sleeping medications and daytime dysfunction
  • 5 optional bedpartner/roommate-reported items

Number of Items

19

Equipment Required

  • None

Time to Administer

5-10 minutes

5-10 minutes to administer, 5 minutes to score

Required Training

No Training

Age Ranges

Adolescent

13 - 17

years

Adult

18 - 64

years

Elderly Adult

65 +

years

Instrument Reviewers


Gabrielle Khalifa, BA, OTS, Jefferson University; Eron Bozec, OTD, OTR/L, Northwestern Medicine Marianjoy Rehabilitation Hospital; Namrata Grampurohit, PhD, OTR/L, Jefferson University, Dec 2020

ICF Domain

Body Function

Measurement Domain

General Health

Professional Association Recommendation

American Academy Sleep Medicine (AASM): PSQI is recommended as a screening tool for insomnia in college students (https://aasm.org/psqi-may-be-a-good-screening-tool-for-insomnia-in-college-students/)

Considerations

  • Available in 56 languages
  • Certain items have been modified for use in adolescents, e.g., modification of the item on sleep disturbances affecting driving.
  • 5 bedpartner/roommate-reported items are available and do not contribute to the global score (Buysse et al., 1989)     

Cancer

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Cut-Off Scores

General Cancer Diagnosis

  • Taiwanese version (Tzeng, Fu and Lin, 2012; n = 205; mean age = 58.39 (14.87) years; inpatient and outpatient; 43% metastatic)
    • PSQI global sleep score of 8 was found to generate the best sensitivity (0.90) and specificity (0.83) for measuring sleep disturbance in patients with cancer.
    • Excellent validity with ROC curve analysis area 0.94 (SE 0.015, asymptotic significance < 0.001)
  • Greek version (Kotronoulas, Papadopoulou, Papapetrou and Patiraki, 2011; n = 209; mean age = 54.85 (12.91) years; mean global sleep score= 8.88 (4.51); undergoing active phase chemotherapy treatment; 37.3% on sleep medications)
    • Global sleep scores higher than 8 indicated poor sleepers among patients with cancer.

Multiple cancer diagnoses: (Carpenter and Andrykowksi, 1998; Breast Cancer: n =102, mean age = 56.5 (10.8) years; Bone Marrow Transplant: n = 155, mean age 38.7 (10.0); Renal Transplant: n = 56, mean age 39.8 (10.3); Benign Breast Problems: n = 159, mean age 48.3 (11.1))

  • Mean global PSQI score was higher than 8 for all populations with known poor sleep quality, and mean global PSQI score was lower 5 in all groups with known good sleep quality.

Normative Data

Adolescents with Osteosarcoma: (Chinese version: Ju et al. 2019; n = 31; mean age = 15.2 (1.7) years)

  • Mean global PSQI score = 8.3 ± 3.9 among participants who reported sleep disturbance

General Cancer Diagnosis: (Taiwanese version: Tzeng, Fu and Lin, 2012; n = 16; inpatient; test-retest 20 to 28 days apart)

  • Mean global PSQI score = 8.75 ± 4.65

General Cancer Diagnosis: (Beck, Shwartz, Towsley, Dudley and Barsevick, 2004; Study 1 cross-sectional: n = 214, mean age = 53 years, 49% female; Study 2 longitudinal: n = 259, mean age = 56.6 years, 89.2% female)

  • Study 1 mean global PSQI = 8.15 ± 4.7
  • Study 2 mean global PSQI = 7.31 ± 4.03

Test/Retest Reliability

General Cancer Diagnosis: (Taiwanese version: Tzeng, Fu and Lin, 2012; n = 16; inpatient; test-retest 20 to 28 days apart)

  • Excellent test-retest reliability (ICC= 0.91) for PSQI global sleep score
  • Excellent test-retest reliability for four sub-scales sleep latency (ICC = 0.84), sleep duration (ICC=0.81), sleep efficiency (ICC = 0.89), and use of sleeping medication (ICC = 0.75)
  • Adequate test-retest reliability for three sub-scales sleep disturbances (ICC = 0.68), sleep quality (ICC = 0.59), and daytime dysfunction (ICC = 0.69)
  • No significant difference on t-test between the measurements at the two time-points (p > 0.05)

General Cancer Diagnosis: (Greek version: Kotronoulas, Papadopoulou, Papapetrou and Patiraki, 2011; n = 60; mean age = 54.85 (12.91) years; mean global sleep score = 8.88 (4.51); undergoing active chemotherapy; test-retest 14 to 21 days apart)

  • Excellent test-retest reliability (ICC = 0.82) for PSQI global sleep score
  • Excellent test-retest reliability for Factor 1 (quality of nocturnal sleep: subscales of sleep quality, latency, duration, efficiency, and disturbances)

Internal Consistency

Adolescents with Osteosarcoma (Chinese version: Ju et al. 2019; n = 54; mean age = 15.2 (1.7) years; mean PSQI score = 8.3 (3.9))

  • Excellent internal consistency (Cronbach’s alpha = 0.87)

General Cancer Diagnosis: (Taiwanese version: Tzeng, Fu and Lin, 2012; n = 205; mean age = 58 (14.87) years; inpatient and outpatient; 43% metastatic)

  • Adequate internal consistency for global PSQI score (Cronbach’s alpha = 0.79)

General Cancer Diagnosis: (Greek version: Kotronoulas, Papadopoulou, Papapetrou and Patiraki, 2011; n = 60; mean age = 54.85 (12.91) years; mean global sleep score = 8.88 (4.51); undergoing active chemotherapy)

  • Adequate internal consistency for global PSQI score: Cronbach’s alpha = 0.76
  • Adequate internal consistency Cronbach’s alpha = 0.78 After omitting sleep medication subscale:
  • Adequate internal consistency Cronbach’s alpha for Factor 1 (quality of nocturnal sleep: subscales of sleep quality, latency, duration, efficiency, and disturbances) = 0.80
  • Poor internal consistency Cronbach’s alpha for Factor 2 (daily disturbances and management of sleep problems: subscales of sleep medication and daytime dysfunction) = 0.40 

General Cancer Diagnosis: (Beck, Shwartz, Towsley, Dudley and Barsevick, 2004; Study 1 cross-sectional: n = 214, mean age = 53 years, 49% female, mean global PSQI score = 8.15 (4.70); Study 2 longitudinal: n = 259, mean age = 56.6 years, 89.2% female, mean global PSQI score = 7.31 (4.03))

  • Excellent internal consistency (Cronbach’s alpha = 0.80 in Study 1 and 0.77 in Study 2)

Mixed Cancer Diagnoses: (Carpenter and Andrykowksi, 1998; Breast Cancer: n =102, mean age = 56.5 (10.8) years; Bone Marrow Transplant: n = 155, mean age 38.7 (10.3); Renal Transplant: n = 56, mean age 39.8 (10.3); Benign Breast Problems: n = 159, mean age 48.3 (11.1))

  • Excellent internal consistency global sleep score (Cronbach’s alpha = 0.80) and sleep disturbance subscale (ranged from 0.70 to 0.78 for the different cancer populations). Mean global sleep score was higher than 5 for all populations indicating poor sleep quality on average.

Construct Validity

Adolescents with Osteosarcoma (Chinese version: Ju et al. 2019; n = 54; mean age = 15.2 (1.7) years; mean PSQI global score = 8.3 (3.9))

  • Excellent correlation between Multidimensional Assessment of Fatigue scale and PSQI sleep quality factor (r = 0.71), subject sleep quality (r = 0.61), daytime dysfunction (r = 0.72)
  • Adequate correlation between Multidimensional Assessment of Fatigue scale and PSQI sleep efficiency factor (r = 0.57), sleep duration (r = 0.34), habitual sleep efficiency (r = 0.45), and sleep disturbances (r = 0.51)
  • Poor correlation between Multidimensional Assessment of Fatigue scale and PSQI sleep latency (r = 0.26), use of sleep medications (r = 0.15).
  • PSQI can discriminate between subgroups. Significantly high sleep global score (poor sleep quality) in those with metastasis compared to those without metastasis (p = 0.02) and in those receiving more than 2 cycles of chemotherapy compared to those receiving less than 2 (p = 0.04). No difference based on gender, tumor size, or tumor location.

General Cancer Diagnosis

  • Taiwanese version (Tzeng, Fu and Lin, 2012; n = 205; mean age = 59 (14.87) years; inpatient and outpatient; 43% metastatic) 
    • Adequate correlation with symptom distress items of the M.D. Anderson Symptom Inventory (r = 0.54)
    • Adequate correlation with fatigue severity items of the Brief Fatigue Inventory (r = 0.55)
    • Excellent correlation between PSQI global sleep score and sleep disturbance item of the M. D. Anderson Symptom Inventory (r = 0.72)
    • Excellent correlation between Sleep Log and PSQI subscale scores of sleep latency (r = 0.57), sleep duration (r = 0.82), sleep efficiency (r = - 0.63), sleep quality (r = - 0.68)
    • Significant difference between known groups: Patients with low fatigue severity (Brief Fatigue Inventory Score < 4) reported significantly better (p < 0.001) sleep quality than patients with high fatigue severity (Brief Fatigue Inventory Score > 7) 
  • Greek version (Kotronoulas, Papadopoulou, Papapetrou and Patiraki, 2011; n = 209; mean age = 54.85 (12.91) years; mean global sleep score = 8.88 (4.51);undergoing active chemotherapy)
    • Excellent correlation between PSQI global sleep score and  Sleep Quality-Visual Analogue Scale (r = - 0.75)
    • Excellent correlation between  PSQI global sleep score and Insomnia Severity Index (r = 0.81)
    • No correlation with Epworth Sleepiness Scale Greek version (no values provided)
    • Excellent correlation of Factor 1 (quality of nocturnal sleep: subscales of sleep quality, latency, duration, efficiency, and disturbances) with Sleep Quality-Visual Analogue Scale (r = - 0.73) and Insomnia Severity Index (r = 0.80)
    • Poor correlation of Factor 2 (daily disturbances and management of sleep problems: subscales of sleep medication and daytime dysfunction) with Epworth Sleepiness Scale Greek version (r = 0.30) and daytime functioning item of Insomnia Severity Index (r = 0.31)
    • Significant difference between known groups: Patients with high anxiety or depression and poor performance status had significantly (p < 0.05)  high global PSQI scores (indicating poorer sleep quality).

 

Different cancer populations: (Carpenter and Andrykowksi, 1998)

  • Known Groups Validity
    • Significant difference (p < 0.05) between known groups for the scores in all populations for the following groups:
      • With and without sleep problems based on Symptom Experience Report
      • Good and poor sleep quality based on Sleep, Energy, Appetite Scale
      • With and without sleep restlessness based on subscale of Center for Epidemiological Studies Depression Scale 
  • Breast Cancer (women n=102; mean age= 56.5 (10.8) years; mean global PSQI score = 7 (4.4)):
    • Convergent Validity
      • Excellent correlation between PSQI global PSQI score and sleep problems (r = 0.65) measured by Symptom Experience Report and sleep restlessness (r = 0.69) measured by Centers for Epidemiological Studies Depression Scale
      • Adequate correlation between PSQI global score and feeling tired (r = 0.44), weakness (r = 0.43) measured by Symptom Experience Report, and all subscales of the Profile of Mood states (r = 0.45 to 0.53)
      • Adequate negative correlation between PSQI global score and vigor/activity (r = - 0.39) subscale of Profile of Mood states where higher scores indicate better activity, and Medical Outcomes Survey SF-36 (r = - 0.53) where higher scores indicate better quality of life
    • Divergent Validity
      • Adequate correlation between PSQI global score and nausea (r = 0.36) measured by Symptom Experience Report
      • Poor correlation between global PSQI score and vomiting (r = 0.26) measured by Symptom Experience Report
  • Bone Marrow Transplant (n = 155, mean age 38.7 (10.3); mean global PSQI score = women 6.0(4.3), men 5.4 (3.6);
    • Convergent Validity
      • Excellent correlation between PSQI global score and sleep problems (r = 0.72) measured by Symptom Experience Report
      • Excellent negative correlation between PSQI global score and Functional Living Index for Cancer Patients (r = - 0.63) where higher scores indicate better quality of life, and sleep quality (r = - 0.75) measured by Sleep, Energy and Appetite Scale where higher scores indicate better sleep quality
      • Adequate correlation between PSQI global score and feeling tired (r = 0.54), weakness (r = 0.52) measured by Symptom Experience Report, all subscales of Profile of Mood states (r = - 0.36 to 0.60)
      • Adequate negative correlation between PSQI global score and energy (r = - 0.54) and appetite (r = - 0.37) measured by Sleep, Energy and Appetite Scale where higher scores indicate better sleep quality
    • Divergent Validity
      • Poor correlation between global PSQI score and nausea (r= 0.17), vomiting (r = 0.12), and taste (r= 0.13) measured by Symptom Experience Report
  • Renal Transplant (n = 56, mean age 39.8 (10.3), mean global PSQI score = women 7.9 (4.5), men 7.3 (4.3))
    • Convergent Validity
      • Excellent correlation between PSQI global score and sleep problems (r = 0.74), feeling tired (r = 0.67) measured by Symptom Experience Report
      • Excellent negative correlation between PSQI global score and sleep quality (r = - 0.76) measured by Sleep, Energy and Appetite Scale where higher scores indicate better sleep quality.
      • Adequate negative correlation between PSQI global score and Functional Living Index for Cancer Patients (r = - 0.57) where higher scores indicate better quality of life, and energy (r = - 0.52) measured by Sleep, Energy and Appetite Scale where higher scores indicate better sleep quality and vigor/activity (r = - 0.56) subscale of Profile of Mood states where higher score indicates better activity.
      • Adequate correlation between PSQI global score and weakness (r = 0.43) measured by Symptom Experience Report, and between the total score (r = 0.47), tension/anxiety (r = 0.36), fatigue/inertia (r = 0.54), depression/dejection (r = 0.42), confusion bewilderment (r = 0.32) subscales of Profile of Mood states
      • Poor negative correlation between PSQI global score and appetite (r = - 0.27) subscale of Sleep, Energy, and Appetite Scale where higher score indicates better appetite.
      • Poor correlation between PSQI global score and anger/hostility (r = 0.22) subscale of Profile of Mood states
    • Divergent Validity
      • Adequate correlation between PSQI global score and nausea (r = 0.37) measured by Symptom Experience Report
      • Poor correlation between PSQI global score and vomiting (r = 0.08), change in taste (r = 0.03) measured by Symptom Experience Report
  • Benign Breast Problems (women n = 159, mean age 48.3 (11.1), mean global PSQI score = 6.4 (4.2))
    • Convergent Validity
      • Excellent correlation between PSQI global score and sleep problems (r = 0.77) measured by Symptom Experience Report, total score (r = 0.62) and tension/anxiety (r = 0.62) subscale of Profile of Mood states, sleep restlessness (r = 0.75), and total score (r = 0.65) measured by Centers for Epidemiological Studies Depression Scale
      • Adequate correlation between PSQI global score and feeling tired (r = 0.49), weakness (r = 0.52) measured by Symptom Experience Report, fatigue/inertia (r = 0.53), depression/dejection (r = 0.58), confusion/bewilderment (0.46), anger/hostility (r = 0.45) subscale of Profile of Mood states
      • Adequate negative correlation between PSQI global score and vigor/activity (r = - 0.45) subscale of Profile of Mood states where higher score indicates better activity.
    • Divergent Validity
      • Poor correlation between PSQI global score and nausea (r = 0.27), vomiting (r = 0.04), change in taste (r = 0.28) measured by Symptom Experience Report

 

General Cancer Diagnosis (Beck, Shwartz, Towsley, Dudley and Barsevick, 2004; Study 1 cross-sectional: n = 214, mean age = 53 years, 49% female, mean global PSQI score = 8.15 (4.70); Study 2 longitudinal: n = 259, mean age = 56.6 years, 89.2% female, mean global PSQI score = 7.31 (4.03))

  • Known Groups Validity
    • Significant difference in global PSQI scores when the study sample was split into two groups of low and high fatigue, defined using the Schwartz Cancer Fatigue Scale. These significant differences were seen in both, Study 1 and Study 2 samples.

Content Validity

General Cancer Diagnosis: (Greek version: Kotronoulas, Papadopoulou, Papapetrou and Patiraki, 2011; n = 209; mean age = 54.85 (12.91) years; mean global PSQI score = 8.88 (4.51); undergoing active phase chemotherapy treatment)

  • Two-factor structure identified using exploratory factor analysis: quality of nocturnal sleep, and daily disturbances and management of sleep problems

Adolescents with Osteosarcoma: (Chinese version: Ju et al. 2019; n = 54; mean age = 15.2 (1.7) years; mean PSQI score = 8.3 (3.9))

  • Excellent with a fit index of 0.97 for the two-factor structure: perceived sleep quality and sleep efficiency

General Cancer Diagnosis (Beck, Shwartz, Towsley, Dudley and Barsevick, 2004; Study 1 cross-sectional: n = 214, mean age = 53 years, 49% female, mean global PSQI score = 8.15 (4.70); Study 2 longitudinal: n = 259, mean age = 56.6 years, 89.2% female, mean global PSQI score = 7.31 (4.03))

  • No redundancy in the 7 subscales: Item to total correlations less than 0.70 in Study 1 and Study 2
  • Distinct factors are likely within the subscales: Sleep medications and Daytime dysfunction with low item to total correlations less than 0.3 in Study 1 and 2, additionally Sleep disturbances with less than 0.3 in Study 2

Older Adults and Geriatric Care

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Cut-Off Scores

Older Women: (Beaudreau et al. 2012; n = 2968; mean age = 83.4 (3.7) years; mean global sleep score = 6.3 (3.6); 10.3% black women participants, 89.7% white women participants)

  • Standard cut-point for clinical significance was >5 for PSQI global score

 

Older Men: (Spira et al., 2012; n = 3059; mean age= 76.4 (5.5) years; mean global sleep score = 5.6 (3.2))

  • Standard cut-point for clinical significance was >5 for PSQI global score

Normative Data

Older Women: (Beaudreau et al. 2012; n = 2968; mean age = 83.4 (3.7) years; 10.3% black women participants, 89.7% white women participants)

  • Mean global PSQI score = 6.3 ± 3.6

Older Men: (Spira et al., 2012; n = 3059; mean age= 76.4 (5.5) years)

  • Mean global PSQI score = 5.6 ± 3.2

General Anxiety disorder: (Bush et al. 2012; n = 134; mean age= 66.9 (5.8) years)

  • Mean global PSQI score = 8.74 ± 4.05

Internal Consistency

Older Men: (Spira et al., 2012; n = 3059; mean age= 76.4 (5.5) years; mean global sleep score = 5.6 (3.2))

  • Adequate internal consistency (Cronbach’s alpha= 0.69)
  • Adequate internal consistency after omitting daytime dysfunction and sleep medications (Cronbach’s Alpha = 0.72)

General Anxiety disorder: (Bush et al. 2012; n = 134; mean age= 66.9 (5.8) years; mean global sleep score = 8.74 (4.05))

  • Excellent internal consistency (Cronbach’s alpha = 0.80)

Older Women: (Beaudreau et al. 2012; n = 2968; mean age = 83.4 (3.7) years; mean global sleep score = 6.3 (3.6))

  • Adequate internal consistency for total sample(Cronbach’s alpha = 0.72)
    • Adequate internal consistency for 17 items of PSQI: Cronbach’s Alpha = 0.78
  • Adequate internal consistency for older white women (Cronbach’s alpha = 0.72)
    • Adequate internal consistency for 17 items of PSQI: Cronbach’s Alpha = 0.78
  • Adequate internal consistency for older black women(Cronbach’s alpha = 0.74)
    • Adequate internal consistency for 17 items of PSQI: Cronbach’s Alpha = 0.80

Construct Validity

Older Men: (Spira et al., 2012; n = 3059; mean age = 76.4 (5.5) years; mean global sleep score = 5.6 (3.2))

  • Poor correlation between PSQI global score and sleepiness items of the Epworth Sleepiness Scale (r = 0.13)
  • Poor  correlation between PSQI global score and wake after sleep onset measured by actigraphy (r = 0.18)
  • Poor correlation between greater disturbance on PSQI and greater depressive symptoms on Geriatric Depression Scale (r = 0.34)
  • Poor correlation between greater disturbance on PSQI and lower mental health-related quality of life on SF-12 mental component (r = - 0.30)
  • Poor correlation between PSQI score and lower SF-12 physical component summaries (r = -0.31)
  • Known groups validity. Men reporting insomnia or periodic leg movements had significantly (p <0.001) worse scores than those reporting no sleep disorder history.  

General Anxiety disorder: (Bush et al. 2012; n = 134; mean age = 66.9 (5.8) years; mean global sleep score = 8.74 (4.05))

  • Convergent validity 
    • Adequate correlation between PSQI global sleep score and the Beck Depression Inventory-II (r = 0.50)
        • Adequate correlation between component scores of PSQI to the Beck Depression Inventory-II for subjective sleep quality (r = 0.44), sleep duration (r = 0.38), and daytime dysfunction (r = 0.53)
        • Poor correlation between component scores of PSQI to the Beck Depression Inventory-II for sleep latency (r = 0.17), sleep efficiency (r = 0.28), and sleep disturbances (r = 0.28), sleep medications (r =0.22).  
    • Poor correlation between PSQI global sleep score and the Pennsylvania State Worry Questionnaire (r = 0.25). All component scores were poorly correlated as well (r = 0.02 to 0.28)
    • Poor correlation between PSQI global sleep score and anti-anxiety medication use (r = 0.20), anti-depressant use (r = -0.08), and sedative medication use (r = 0.22)
  • Discriminant validity 
    • Poor correlation between PSQI global sleep score and Multidimensional Scale of Perceived Support (r = -0.24) and Life Orientation Test (r = -0.26)
  • Known groups validity
    • Mean global PSQI scores were significantly different between those with Generalized anxiety disorder and other diagnosis or no anxiety.

Older Women: (Beaudreau et al. 2012; n = 2968; mean age = 83.4 (3.7) years; mean global sleep score = 6.3 (3.6))

  • Poor correlation between PSQI global score and daytime sleepiness measured by Epworth Sleepiness Scale (r = 0.11)
  • Poor correlation between PSQI global score and actigraphic wake after sleep onset (r = 0.14)
  • Poor correlation between PSQI global score and actigraphic daytime inactivity (r = 0.05)
  • Poor correlation between PSQI global score and depressive symptoms measured by Geriatric Depression Scale (r = 0.31)

Content Validity

Older adults: (Cole et al., 2006; n = 417; mean global score 4.98 (3.63); mean age = 68.9 (6.34) years; 207 healthy, 143 with depressive disorder in full remission, 67 with current depressive disorder; 55.2% women, 97.1% Caucasian)

  • 3-factor model: Sleep efficiency, perceived sleep quality, and daily disturbances
  • Confirmatory factor analysis showed 3-factor model was a better fit than 2-factor that was obtained through exploratory factor analysis or 1-factor model reported in original literature

Non-Specific Patient Population

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Standard Error of Measurement (SEM)

Adolescents (Brazilian version): (Passos et al., 2016; n = 209; mean age = 14.38 (1.94) years)

  • SEM for entire group (n = 209): 1.12 points

Minimal Detectable Change (MDC)

Adolescents (Brazilian version): (Passos et al., 2016; n = 209; mean age = 14.38 (1.94) years)

  • MDC for entire group (n = 209): 3.10 points

Cut-Off Scores

Adolescents (Indonesian version): (Setyowati & Chung, 2020; n= 528; age range 13 to 16 years; PSQI global score = 7.25 (2.50))

  • PSQI global score of 6.5 was found to represent the best relationship of sensitivity and specificity (1.41) for measuring sleep disturbances in adolescents
  • Adequate area below the ROC curve, 0.74 (SE 0.03)

Normative Data

Adolescents (Indonesian version): (Setyowati & Chung, 2020; n= 528; age range 13 to 16 years)

  • Mean global PSQI score = 7.25 ± 2.50

Adolescents with Osteosarcoma (Chinese version): (Ju et al. 2019; n = 54; mean age = 15.2 (1.7))

  • Mean global PSQI score = 8.3 ± 3.9

Adolescents: (Raniti et al., 2018; n = 889; mean age = 15.71 (1.57) years)

  • Mean global PSQI score = 6.36 ± 3.22

Test/Retest Reliability

Adolescents (Brazilian version): (Passos et al., 2016; n = 209; mean age = 14.38 (1.94) years)

  • Adequate test-retest reliability (ICC = 0.65; 95% CI: 0.21---0.85) for PSQI global sleep score
  • Adequate  test-rest reliability for factor 1 (ICC = 0.59; 95% CI: 0.09-0.82)
  • Adequate  test-rest reliability for factor 2 (ICC = 0.71; 95% CI: 0.35-0.87)
  • Excellent test-rest reliability for factor 3 (ICC = 0.81; 95% CI: 0.56-0.91)

Adolescents and Young Adults (Spanish Version): (De La Vega et al., 2015; n = 216; mean age = 17.12 (3.05) years; test-retest 6 weeks apart)

  • Excellent test-retest reliability (r = 0.81, p < .001)

Internal Consistency

Adolescents with Osteosarcoma (Chinese version): (Ju et al. 2019; n = 54; mean age = 15.2 (1.7); mean PSQI score = 8.3 (3.9))

  • Excellent internal consistency (Cronbach’s alpha = 0.87)

Adolescents (Brazilian version): (Passos et al., 2016; n = 209; mean age = 14.38 (1.94) years)

  • Adequate internal consistency (Cronbach’s alpha = 0.71)
  • Adequate internal consistency omitting sleep medication use: Cronbach’s Alpha =  0.73

Adolescents: (Raniti, et al.,, 2018; n = 889; mean age = 15.71 (1.57) years; mean global sleep score = 6.36 (3.22))

  • Adequate internal consistency (Cronbach’s alpha = 0.73)

Adolescents and Young Adults (Spanish Version): (De La Vega et al., 2015; n = 216; mean age = 17.12 (3.05) years)

  • Adequate internal consistency (Cronbach’s alpha = 0.72)

Adolescents (Indonesian version): (Setyowati & Chung, 2020; n= 528; age range 13 to 16 years; PSQI global score = 7.25 (2.50))

  • Adequate internal consistency (Cronbach’s alpha = 0.72)

Construct Validity

Adolescents: (Raniti et al., 2018; n = 889; mean age = 15.71 (1.57) years; mean global sleep score = 6.36 (3.22))

  • Adequate correlation between PSQI global sleep score and the Center for Epidemiological Studies-Depression scale (r = 0.58)
  • Adequate correlation between PSQI global sleep score and the Spence Children’s Anxiety Scale (r = 0.45)

Adolescents with Osteosarcoma (Chinese version): (Ju et al. 2019; n = 54; mean age = 15.2 (1.7) years; mean PSQI global score = 8.3 (3.9))

  • Excellent correlation between Multidimensional Assessment of Fatigue scale and PSQI sleep quality factor (r = 0.71), subject sleep quality (r = 0.61), daytime dysfunction (r = 0.72)
  • Adequate correlation between Multidimensional Assessment of Fatigue scale and PSQI sleep efficiency factor (r = 0.57), sleep duration (r = 0.34), habitual sleep efficiency (r = 0.45), and sleep disturbances (r = 0.51)
  • Poor correlation between Multidimensional Assessment of Fatigue scale and PSQI sleep latency (r = 0.26), use of sleep medications (r = 0.15).
  • PSQI can discriminate between subgroups. Significantly high sleep global score (poor sleep quality) in those with metastasis compared to those without metastasis (p = 0.02) and in those receiving more than 2 cycles of chemotherapy compared to those receiving less than 2 (p = 0.04). No difference based on gender, tumor size, or tumor location.

Adolescents (Indonesian version): (Setyowati & Chung, 2020; n= 528; age range 13 to 16 years; PSQI global score = 7.25 (2.50))

  • Poor correlation with Indonesian Beck Depression Inventory (r = 0.22)

Adolescents and Young Adults (Spanish Version): (De La Vega et al., 2015; n = 216; mean age = 17.12 (3.05) years)

  • Adequate correlation of global PSQI score with mood (r = -0.35) as measured by numerical rating scales (0 to 10) of mood (best imaginable mood to worst imaginable mood)
  • Adequate correlation of global PSQI score with fatigue (r = 0.42) as measured by numerical rating scales (0 to 10) of fatigue (no fatigue to worst imaginable fatigue)

Content Validity

Adolescents with Osteosarcoma (Chinese version): Ju et al. 2019; n = 54; mean age = 15.2 (1.7) years; mean PSQI score = 8.3 (3.9))

  • Excellent with a fit index of 0.97 for the two-factor structure: perceived sleep quality and sleep efficiency

Adolescents (Brazilian version): (Passos et al., 2016; n = 100; mean age = 13.66 (2.35) years)

  • Two factors identified using factor analysis explained 60.41% of the total variance: Daytime dysfunction and sleep disorders

Adolescents and Young Adults (Spanish Version): (De La Vega et al., 2015; n = 216; mean age = 17.12 (3.05) years)

  • Excellent with a comparative fit index of 0.91 for a one factor model without the sleep medication component/subscale.

Adolescents: (Raniti, et al., 2018; n = 889; mean age = 15.71 (1.57) years; mean global sleep score = 6.36 (3.22))

  • Excellent with a comparative fit index of 0.96 for a single factor model  

Adolescents (Indonesian version): (Setyowati & Chung, 2020; n= 528; age range 13 to 16 years; PSQI global score = 7.25 (2.50))

  • Significant differences in mean score of PSQI between adolescents with and without depression on global score, and subscale scores of sleep quality, sleep disturbances, and daytime dysfunction.

Mixed Populations

back to Populations

Cut-Off Scores

Mixed Population: (Buysse et al., 1989; n = 91; test-retest average: 28.2 days apart)

  • PSQI global sleep score of 5 was found to identify 88.5 % of all patients and controls, and generate the sensitivity (89.6%) and specificity (86.5%)
    • PSQI global score of 5 was found to identify 84.4% of patients with disorders of initiating and maintain sleep
    • PSQI global score of 5 was found to identify 88% of patients with disorders of excessive somnolence
    • PSQI global score of 5 was found to identify 97% of patients with depression

Primary insomnia: (Backhaus et al., 2002; n = 80; mean age = 46.3 (15) years)

  • PSQI mean global sleep score >5 indicates relevant sleep disturbances with a higher sensitivity (sensitivity 98.7%; specificity 84.4%)
  • PSQI mean global sleep score >6 indicates relevant sleep disturbances with a lower sensitivity (sensitivity 93.4%; specificity 100%)

Chinese version (Primary insomnia and healthy controls): (Tsai et al., 2005; Primary insomnia n = 87: PSQI and sleep scales data for n = 51, mean age = 41 (10) years; mean global sleep score = 10.2 (3.2); Controls n = 157: mean age (37 (14) years)

  • PSQI global scores >5 discriminated poor from good sleepers (sensitivity 98%; specificity 55%)
  • PSQI global sleep score >6 discriminated poor from good sleepers (sensitivity 90%; specificity 67%)

Psychiatric disorders (Japanese Version):  (Doi et al., 2000; n = 92)

  • Primary insomnia (n= 14; mean age = 50.4 (14.6) years; mean global sleep score = 8.93 (4.1))
    • Estimations were based on a 5.5 cut-off points (sensitivity 85.7%; specificity 86.6%)
  • Major depression (n = 30; mean age = 47 (16.3) years; mean global sleep score = 9.33 (4.58))
    • Estimations were based on a 5.5 cut-off points (sensitivity 80%; specificity 86.6%)
  • Generalized anxiety disorder (n = 24; mean age = 40.9 (15.8) years; mean global sleep score = 9.63 (3.42))
    • Estimations were based on a 5.5 cut-off points (sensitivity 83.3%; specificity 86.6%)
  • Schizophrenia (n = 24; mean age = 29.3 (9.4) years; mean global sleep score = 9.13 (4.2))
    • Estimations were based on a 5.5 cut-off points (sensitivity 83.3%; specificity 86.6%)

Normative Data

Primary Insomnia (Chinese version): (Tsai et al., 2005; Primary insomnia n = 87: PSQI and sleep scales data for n = 51, mean age = 41 (10) years)

  • Mean global PSQI score = 10.2 ± 3.2

Primary insomnia: (Backhaus et al., 2002; n = 76; mean age = 46.3 (15) years)

  • Mean global PSQI score = 12.5 ± 3.8

Mixed Population: (Buysse et al., 1989)

  • Mean global PSQI score = 7.4 ± 5.1

Test/Retest Reliability

Mixed Population: (Buysse et al., 1989; n = 91; test-retest average: 28.2 days apart)

  • Excellent test-retest reliability for global PSQI score (r = 0.85)
    • Excellent test-retest reliability for component PSQI scores for all components (r = 0.65 to 0.84)

Primary insomnia: (Backhaus et al., 2002; n = 76; mean age = 46.3 (15) years; mean global sleep score = 12.5 (3.8); test-retest 2 days apart)

  • Excellent test-retest reliability (r = 0.87) for PSQI global score
    • Adequate test-retest reliability for sleep quality subscale mean score (r = 0.53)
    • Excellent test-retest reliability for the components:
      • Sleep latency subscale mean score (r = 0.79)
      • Sleep duration subscale mean score (r = 0.80)
      • Sleep efficiency subscale mean score (r = 0.81)
      • Sleep disturbances subscale mean score (r = 0.69)
      • Sleep medication subscale mean score (r = 0.88)
      • Daytime dysfunction subscale mean score (r = 0.81)
    • When administered 2 days apart (n = 45): Excellent test-retest reliability for global and all subscale mean scores (r = 0.90 to 0.76)
    • When administered 47 days apart (n = 31): Excellent test-retest reliability for global and subscales of latency, duration, efficiency and duration mean scores (r = 0.86 to 0.71). Adequate test-retest reliability for daytime dysfunction subscale mean score (r = 0.59). Poor test-retest reliability for sleep quality (r = 0.23) and disturbances  (r = 0.27) subscale mean scores.

Chinese version: (Tsai et al., 2005; Primary insomnia n = 87: PSQI and sleep scales data for n = 51, mean age = 41 (10) years; mean global sleep score = 10.2 (3.2); Controls n = 157: mean age (37 (14) years)

  • Excellent test-retest reliability (r = 0.77) for PSQI global sleep score for individuals with primary insomnia
    • Excellent test-retest reliability for PSQI subscale scores for sleep quality (r = 0.77), sleep latency (r = 0.74), daytime dysfunction (r = 0.74), sleep medications (r = 0.91)  
    • Adequate test-retest reliability for PSQI subscale scores for sleep duration (r = 0.56), sleep disturbance (r = 0.56)
    • Poor test-retest reliability for PSQI subscale scores for sleep efficiency (r = 0.23)
  • Excellent test-retest reliability (r = 0.85) for PSQI global sleep score for all participants including those with insomnia and controls
    • Excellent test-retest reliability for PSQI subscale scores for sleep quality (r = 0.75), sleep latency (r = 0.74), daytime dysfunction (r = 0.69), sleep medications (r = 0.94), sleep duration (r = 0.68), sleep disturbance (r = 0.63), and sleep efficiency (r = 0.60)

Internal Consistency

Mixed Population: (Buysse et al., 1989; n = 91; test-retest average: 28.2 days apart)

  • Excellent test-retest reliability for global PSQI score (r = 0.85)
    • Excellent test-retest reliability for component PSQI scores for all components (r = 0.65 to 0.84)

Primary insomnia: (Backhaus et al., 2002; n = 76; mean age = 46.3 (15) years; mean global sleep score = 12.5 (3.8); test-retest 2 days apart)

  • Excellent test-retest reliability (r = 0.87) for PSQI global score
    • Adequate test-retest reliability for sleep quality subscale mean score (r = 0.53)
    • Excellent test-retest reliability for the components:
      • sleep latency subscale mean score (r = 0.79)
      • sleep duration subscale mean score (r = 0.80)
      • sleep efficiency subscale mean score (r = 0.81)
      • sleep disturbances subscale mean score (r = 0.69)
      • sleep medication subscale mean score (r = 0.88)
      • daytime dysfunction subscale mean score (r = 0.81)
    • When administered 2 days apart (n = 45): Excellent test-retest reliability for global and all subscale mean scores (r = 0.90 to 0.76)
    • When administered 47 days apart (n = 31): Excellent test-retest reliability for global and subscales of latency, duration, efficiency and duration mean scores (r = 0.86 to 0.71). Adequate test-retest reliability for daytime dysfunction subscale mean score (r = 0.59). Poor test-retest reliability for sleep quality (r = 0.23) and disturbances  (r = 0.27) subscale mean scores.

Chinese version: (Tsai et al., 2005; Primary insomnia n = 87: PSQI and sleep scales data for n = 51, mean age = 41 (10) years; mean global sleep score = 10.2 (3.2); Controls n = 157: mean age (37 (14) years)

  • Excellent test-retest reliability (r = 0.77) for PSQI global sleep score for individuals with primary insomnia
    • Excellent test-retest reliability for PSQI subscale scores for sleep quality (r = 0.77), sleep latency (r = 0.74), daytime dysfunction (r = 0.74), sleep medications (r = 0.91)  
    • Adequate test-retest reliability for PSQI subscale scores for sleep duration (r = 0.56), sleep disturbance (r = 0.56)
    • Poor test-retest reliability for PSQI subscale scores for sleep efficiency (r = 0.23)
  • Excellent test-retest reliability (r = 0.85) for PSQI global sleep score for all participants including those with insomnia and controls
    • Excellent test-retest reliability for PSQI subscale scores for sleep quality (r = 0.75), sleep latency (r = 0.74), daytime dysfunction (r = 0.69), sleep medications (r = 0.94), sleep duration (r = 0.68), sleep disturbance (r = 0.63), and sleep efficiency (r = 0.60)

Construct Validity

Mixed Population: (Buysse et al., 1989)

  • No significant positive correlations between PSQI and polysomnographic results except sleep latency for all participants (r = 0.33) and participants with depression (r = 0.37)
  • Poor correlation between global PSQI score for all participants and objective sleep latency (r = 0.20)
  • Poor correlation between global PSQI score for control group and Rapid Eye Movement, REM% (r = 0.34)
  • Poor correlation between global PSQI score for participants with depression and number of arousals (r = 0.47)
  • Poor negative correlation between age and component scores of PSQI for subjective sleep quality (r = -0.22) daytime dysfunction (r = -0.29)
  • Known groups validity. Global PSQI differed significantly between those with and without sleep disorders when adjusted for age and sex. Component PSQI scores for sleep latency, sleep efficiency, and sleep duration also differed significantly between those with and without polysomnography findings of sleep disorder.   

Chinese version: (Tsai et al., 2005; Primary insomnia n = 87: PSQI and sleep scales data available for n = 51, mean age = 41 (10) years; mean global sleep score = 10.2 (3.2); Controls n = 157: mean age (37 (14) years)

  • Poor negative correlation between PSQI mean global score and sleep quality visual analogue scale score (r = -0.30) and sleep efficiency from sleep diary (r = -0.37) in primary insomnia
  • Poor correlation between PSQI and sleep onset latency from sleep diary (r = 0.30) in primary insomnia
  • Adequate negative correlation between PSQI sleep quality subscale score with sleep quality visual analog scale (r = -0.54)
  • Excellent correlation between PSQI sleep latency subscale score with sleep onset latency with sleep log (r = 0.60).
  • Excellent negative correlation between PSQI sleep duration subscale score with total sleep time (r = -0.64)
  • Adequate negative correlation between PSQI sleep efficiency subscale score with sleep efficiency through sleep log (r = -0.36)

Primary insomnia: (Backhaus et al., 2002; n = 80; mean age = 46.3 (15) years)

  • Significant difference (p = 0.000) between mean global sleep score for those with insomnia (12.5 (3.8)) and healthy controls (3.3 (1.8))
  • Significantly higher (p = 0.000) mean subscale scores in those with insomnia than healthy controls.
  • Excellent correlation between PSQI and sleep log data (r =  0.81)
  • Excellent correlation between PSQI and sleep latency using sleep diary (r = 0.71)
  • Poor correlation between PSQI global score and polysomnography total sleep time (r = - 0.27), sleep onset latency (r = 0.28), number of nightly awakenings (r = 0.12), percentage of stage 1 sleep (r = 0.24), percentage of stage 3 and 4 (r = - 0.20) and percentage of rapid eye movement sleep (r = - 0.13).
  • Adequate correlation between PSQI global score and polysomnography total sleep time without stage 1 sleep (r = -0.32), sleep efficiency (r = - 0.32), percentage of stage 2 sleep (r = - 0.33)

Content Validity

Chinese version: (Tsai et al., 2005; Primary insomnia n = 87: PSQI and sleep scales data available for n = 51, mean age = 41 (10) years; mean global sleep score = 10.2 (3.2); Controls n = 157: mean age (37 (14) years)

  • Significant difference (p < 0.01) between mean scores (global and subscale) in primary insomnia group and control group at both initial test and retest.

Psychiatric disorders (Japanese version):  (Doi et al., 2000; n = 92)

  • Significant difference (p < 0.05) between the mean scores (global and subscale) in the control group and each of the diagnostic categories (primary insomnia, major depression, generalized anxiety disorder, schizophrenia)

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