Skip to main content
Log in

Construct validity and factor structure of the Pittsburgh Sleep Quality Index among pregnant women in a Pacific-Northwest cohort

  • Psychiatrics • Original Article
  • Published:
Sleep and Breathing Aims and scope Submit manuscript

Abstract

Purpose

Poor sleep quality during pregnancy is associated with adverse obstetric and neuropsychiatric outcomes. Despite its routine use as a sleep quality assessment scale among men and non-pregnant women, the psychometric properties of the Pittsburgh Sleep Quality Index (PSQI) have not been assessed among US pregnant women. We sought to evaluate the construct validity and factor structure of the PSQI among 1488 pregnant women.

Methods

A structured interview was used to collect information about demographics and sleep characteristics in early pregnancy. The Patient Health Questionnaire-9 (PHQ-9) and the Depression, Anxiety, and Stress Scale-21 (DASS-21) were used to assess symptoms of depression, anxiety, and stress. Consistency indices, exploratory and confirmatory factor analyses (EFA and CFA), correlations, and logistic regression procedures were used.

Results

The reliability coefficient, Cronbach’s alpha for the PSQI items was 0.74. Results of the EFA showed that a rotated factor solution for the PSQI contained two factors with eigenvalues >1.0 accounting for 52.8 % of the variance. The PSQI was significantly positively correlated with the PHQ-9 (r s = 0.48) and DASS-21 (r s = 0.42) total scores. Poor sleepers (PSQI global score >5) had increased odds of experiencing depression (OR = 6.47; 95 % CI = 4.56–9.18), anxiety (OR = 3.59; 95 % CI = 2.45–5.26), and stress (OR = 4.37; 95 % CI = 2.88–6.65) demonstrating evidence of good construct validity. CFA results corroborated the two-factor structure finding from the EFA and yielded reassuring measures indicating goodness of fit (comparative fit index = 0.975) and accuracy (root mean square error of approximation = 0.035).

Conclusions

The PSQI has good construct validity and reliability for assessing sleep quality among pregnant women.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Lee KA (1998) Alterations in sleep during pregnancy and postpartum: a review of 30 years of research. Sleep Med Rev 2(4):231–242

    Article  CAS  PubMed  Google Scholar 

  2. Chen Y-H, Kang J-H, Lin C-C, Wang I-T, Keller JJ, Lin H-C (2012) Obstructive sleep apnea and the risk of adverse pregnancy outcomes. Am J Obstet Gynecol 206(2):136, e131-136. e135

    PubMed  Google Scholar 

  3. Micheli K, Komninos I, Bagkeris E, Roumeliotaki T, Koutis A, Kogevinas M, Chatzi L (2011) Sleep patterns in late pregnancy and risk of preterm birth and fetal growth restriction. Epidemiology 22(5):738–744

    Article  PubMed  Google Scholar 

  4. Qiu C, Enquobahrie D, Frederick IO, Abetew D, Williams MA (2010) Glucose intolerance and gestational diabetes risk in relation to sleep duration and snoring during pregnancy: a pilot study. BMC Women’s Health 10(1):17

    Article  PubMed  PubMed Central  Google Scholar 

  5. Zhong QY, Gelaye B, Sanchez SE, Williams MA (2015) Psychometric properties of the Pittsburgh Sleep Quality Index (PSQI) in a cohort of peruvian pregnant women. J Clin Sleep Med. Mar 9 (Epub ahead of print)

  6. Gelaye B, Barrios YV, Zhong QY, Rondon MB, Borba CP, Sanchez SE, Henderson DC, Williams MA (2015) Association of poor subjective sleep quality with suicidal ideation among pregnant Peruvian women. General Hospital Psychiatry. May 6 (Epub ahead of print)

  7. Skouteris H, Germano C, Wertheim EH, Paxton SJ, Milgrom J (2008) Sleep quality and depression during pregnancy: a prospective study. J Sleep Res 17(2):217–220

    Article  PubMed  Google Scholar 

  8. Kotronoulas GC, Papadopoulou CN, Papapetrou A, Patiraki E (2011) Psychometric evaluation and feasibility of the Greek Pittsburgh Sleep Quality Index (GR-PSQI) in patients with cancer receiving chemotherapy. Support Care Cancer 19(11):1831–1840

    Article  PubMed  Google Scholar 

  9. Curcio G, Tempesta D, Scarlata S, Marzano C, Moroni F, Rossini PM, Ferrara M, De Gennaro L (2013) Validity of the Italian version of the Pittsburgh Sleep Quality Index (PSQI). Neurol Sci 34(4):511–519

    Article  PubMed  Google Scholar 

  10. Doi Y, Minowa M, Uchiyama M, Okawa M, Kim K, Shibui K, Kamei Y (2000) Psychometric assessment of subjective sleep quality using the Japanese version of the Pittsburgh Sleep Quality Index (PSQI-J) in psychiatric disordered and control subjects. Psychiatr Res 97(2-3):165–172

    Article  CAS  Google Scholar 

  11. Hita-Contreras F, Martínez-López E, Latorre-Román PA, Garrido F, Santos MA, Martínez-Amat A (2014) Reliability and validity of the spanish version of the Pittsburgh Sleep Quality Index (PSQI) in patients with fibromyalgia. Rheumatol Int 34(7):929–936

    Article  PubMed  Google Scholar 

  12. Aloba OO, Adewuya AO, Ola BA, Mapayi BM (2007) Validity of the Pittsburgh Sleep Quality Index (PSQI) among Nigerian university students. Sleep Med 8(3):266–270

    Article  PubMed  Google Scholar 

  13. Beaudreau SA, Spira AP, Stewart A, Kezirian EJ, Lui L-Y, Ensrud K, Redline S, Ancoli-Israel S, Stone KL (2012) Validation of the Pittsburgh Sleep Quality Index and the Epworth Sleepiness Scale in older black and white women. Sleep Med 13(1):36–42

    Article  PubMed  PubMed Central  Google Scholar 

  14. Burkhalter H, Sereika SM, Engberg S, Wirz‐justice A, Steiger J, De Geest S (2010) Structure validity of the Pittsburgh Sleep Quality Index in renal transplant recipients: a confirmatory factor analysis. Sleep Biol Rhythms 8(4):274–281

    Article  Google Scholar 

  15. Beck SL, Schwartz AL, Towsley G, Dudley W, Barsevick A (2004) Psychometric evaluation of the Pittsburgh Sleep Quality Index in cancer patients. J Pain Sympt Manag 27(2):140–148

    Article  Google Scholar 

  16. Carpenter JS, Andrykowski MA (1998) Psychometric evaluation of the Pittsburgh Sleep Quality Index. J Psychosom Res 45(1):5–13

    Article  CAS  PubMed  Google Scholar 

  17. Buysse DJ, Reynolds CF III, Monk TH, Berman SR, Kupfer DJ (1989) The Pittsburgh Sleep Quality Index: a new instrument for psychiatric practice and research. Psychiatr Res 28(2):193–213

    Article  CAS  Google Scholar 

  18. Gelaye B, Lohsoonthorn V, Lertmeharit S, Pensuksan WC, Sanchez SE, Lemma S, Berhane Y, Zhu X, Vélez JC, Barbosa C et al (2014) Construct validity and factor structure of the Pittsburgh Sleep Quality Index and Epworth Sleepiness Scale in a multi-national study of African, South east Asian and South American college students. PLoS One 9(12), e116383

    Article  PubMed  PubMed Central  Google Scholar 

  19. Jomeen J, Martin CR (2007) Assessment and relationship of sleep quality to depression in early pregnancy. J Reprod Infant Psychol 25(1):87–99

    Article  Google Scholar 

  20. Kirchmann M, Seven E, Bjornsson A, Bjornssdottir G, Gulcher JR, Stefansson K, Olesen J (2006) Validation of the deCODE migraine questionnaire (DMQ3) for use in genetic studies. Eur J Neurol 13(11):1239–1244

    Article  CAS  PubMed  Google Scholar 

  21. Kroenke K, Spitzer RL, Williams JB (2001) The PHQ-9. J Gen Intern Med 16(9):606–613

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  22. Spitzer RL, Kroenke K, Williams JB, Group PHQPCS (1999) Validation and utility of a self-report version of PRIME-MD: the PHQ primary care study. JAMA 282(18):1737–1744

    Article  CAS  PubMed  Google Scholar 

  23. Zhong Q, Gelaye B, Fann JR, Sanchez SE, Williams MA (2014) Cross-cultural validity of the spanish version of PHQ-9 among pregnant Peruvian women: a Rasch item response theory analysis. J Affect Disord 158:148–153

    Article  PubMed  PubMed Central  Google Scholar 

  24. Zhong Q, Gelaye B, Rondon ME, Sánchez SJ, García P, Sánchez EV, Barrios YE, Simon GC, Henderson D, May Cripe S (2014) Comparative performance of Patient Health Questionnaire-9 and Edinburgh Postnatal Depression Scale for screening antepartum depression. J Affect Disord 162:1–7

    Article  PubMed  PubMed Central  Google Scholar 

  25. Lovibond PF (1998) Long-term stability of depression, anxiety, and stress syndromes. J Abnorm Psychol 107(3):520–526

    Article  CAS  PubMed  Google Scholar 

  26. Lovibond PF, Lovibond SH (1995) The structure of negative emotional states: comparison of the Depression Anxiety Stress Scales (DASS) with the beck depression and anxiety inventories. Behav Res Ther 33(3):335–343

    Article  CAS  PubMed  Google Scholar 

  27. World Health Organization: Global database on body mass index: available at [http://apps.who.int/bmi/index.jsp?introPage=intro_3.html] Accessed on 07/14/2015

  28. Kaiser HF (1960) The application of electronic computers to factor analysis. Educ Psychol Meas 20:141–151

    Article  Google Scholar 

  29. Brown TA (2012) Confirmatory factor analysis for applied research. Guilford Press, New York

    Google Scholar 

  30. Cole JC, Motivala SJ, Buysse DJ, Oxman MN, Levin MJ, Irwin MR (2006) Validation of a 3-factor scoring model for the Pittsburgh Sleep Quality Index in older adults. Sleep 29(1):112–116

    PubMed  Google Scholar 

Download references

Acknowledgments

Awards from the Eunice Kennedy Shriver Institute of Child Health and Human Development (R01-HD-055566 and R01-HD-059835) at the National Institutes of Health (NIH) supported this research. The NIH had no further role in the study design; in the collection, analysis, and interpretation of data; in the writing of the report; and in the decision to submit the paper for publication.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Chunfang Qiu.

Ethics declarations

Conflict of interest

The authors declare that they have no competing interests.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Qiu, C., Gelaye, B., Zhong, QY. et al. Construct validity and factor structure of the Pittsburgh Sleep Quality Index among pregnant women in a Pacific-Northwest cohort. Sleep Breath 20, 293–301 (2016). https://doi.org/10.1007/s11325-016-1313-4

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11325-016-1313-4

Keyword

Navigation