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.
Similar content being viewed by others
References
Lee KA (1998) Alterations in sleep during pregnancy and postpartum: a review of 30 years of research. Sleep Med Rev 2(4):231–242
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
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
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
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)
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)
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
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
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
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
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
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
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
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
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
Carpenter JS, Andrykowski MA (1998) Psychometric evaluation of the Pittsburgh Sleep Quality Index. J Psychosom Res 45(1):5–13
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
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
Jomeen J, Martin CR (2007) Assessment and relationship of sleep quality to depression in early pregnancy. J Reprod Infant Psychol 25(1):87–99
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
Kroenke K, Spitzer RL, Williams JB (2001) The PHQ-9. J Gen Intern Med 16(9):606–613
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
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
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
Lovibond PF (1998) Long-term stability of depression, anxiety, and stress syndromes. J Abnorm Psychol 107(3):520–526
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
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
Kaiser HF (1960) The application of electronic computers to factor analysis. Educ Psychol Meas 20:141–151
Brown TA (2012) Confirmatory factor analysis for applied research. Guilford Press, New York
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
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
Corresponding author
Ethics declarations
Conflict of interest
The authors declare that they have no competing interests.
Rights and permissions
About this article
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
Received:
Revised:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s11325-016-1313-4