Sleep Disorders Center, University of California, San Francisco, California, USA.
Department of Neurology, Memory and Aging Center, Global Brain Health Institute, University of California, San Francisco, San Francisco, California, USA.
J Womens Health (Larchmt). 2022 Jul;31(7):965-973. doi: 10.1089/jwh.2021.0328. Epub 2022 Feb 28.
Validity of the Pittsburgh Sleep Quality Index (PSQI) has not been established for midlife women before menopause, and evidence suggests that two-factor or three-factor models may be more informative than the PSQI global score derived from its seven components. We hypothesized that the PSQI and its factor structure would be valid in premenopausal women. We performed a validation study of the PSQI against wrist actigraphy in a community-based convenience sample of 71 healthy premenopausal women (aged 40-50 years). For convergent validity, PSQI and its component scores were compared with homologous actigraphy measures. For discriminant validity, characteristics known to affect sleep quality were compared, including body mass index, exercise, menopausal status, menopausal symptoms, and depressive symptoms measured with the Center for Epidemiological Studies-Depression (CES-D) Scale. The PSQI global score and Components 1 (quality) and 5 (disturbance) were correlated ( < 0.05) with actigraphy-measured wake after sleep onset. The PSQI global score and Components 1 (quality) and 7 (daytime dysfunction) were correlated with CES-D scores. PSQI Components 2 (onset latency) and 4 (efficiency) were not congruent with homologous actigraphy measures, while component 3 (duration) was congruent with actigraphy duration. The single-factor PSQI global score had a higher McDonald's omega (0.705) and Cronbach's alpha (0.702) than the two-factor or three-factor models. The PSQI global score is a valid measure of sleep quality in healthy midlife women, performing better than two-factor or three-factor models. However, overlapping CES-D and PSQI scores warrant further clinical assessment and research to better differentiate poor sleep quality from depression.
匹兹堡睡眠质量指数 (PSQI) 在绝经前的中年女性中尚未得到验证，并且有证据表明，双因素或三因素模型可能比 PSQI 全球评分更具信息量，因为它是由其七个组成部分得出的。我们假设 PSQI 及其因子结构在绝经前女性中是有效的。我们在一个基于社区的便利样本中对 71 名健康的绝经前女性（年龄在 40-50 岁之间）进行了 PSQI 与腕动图的验证研究。为了验证 PSQI 的聚合效度，我们将 PSQI 及其分量评分与同源动图测量进行了比较。为了验证 PSQI 的区分效度，我们比较了已知会影响睡眠质量的特征，包括体重指数、运动、绝经状态、绝经症状和使用流行病学研究中心抑郁量表 (CES-D) 测量的抑郁症状。PSQI 全球评分以及成分 1（质量）和 5（紊乱）与睡眠后觉醒的动图测量值呈相关性（ < 0.05）。PSQI 全球评分以及成分 1（质量）和 7（日间功能障碍）与 CES-D 评分呈相关性。PSQI 成分 2（潜伏期）和 4（效率）与同源动图测量值不一致，而成分 3（持续时间）与动图持续时间一致。单因素 PSQI 全球评分的 McDonald's omega（0.705）和 Cronbach's alpha（0.702）均高于双因素或三因素模型。PSQI 全球评分是健康中年女性睡眠质量的有效衡量标准，其表现优于双因素或三因素模型。然而，CES-D 和 PSQI 评分重叠，需要进一步的临床评估和研究，以更好地区分睡眠质量差和抑郁。
