Measurement Structure of the Pittsburgh Sleep Quality Index and Its Association with Health Functioning in Patients with
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Measurement Structure of the Pittsburgh Sleep Quality Index and Its Association with Health Functioning in Patients with Coronary Heart Disease Jonathan Jun Liang Tan1 · Hung Yong Tay2 · Cindy Khim Siang Lim2 · Biing‑Jiun Shen1
© Springer Science+Business Media, LLC, part of Springer Nature 2019
Abstract Research on the underlying structure of sleep measures in patients with coronary heart disease (CHD) is lacking. Existing research on sleep and health outcomes primarily focused on only one dimension of sleep (e.g., sleep duration), leaving other aspects unexamined. To address this gap, this study examined the measurement structure of Pittsburgh Sleep Quality Index (PSQI) and its associations with health-related quality of life among CHD patients. Participants were 167 CHD patients from a cardiac wellness program. Confirmatory factor analysis revealed that the two-factor structure with sleep efficiency and perceived sleep quality best fitted the data. Concurrent validity analyses with structural equation modeling showed that, when considered simultaneously, perceived sleep quality, but not sleep efficiency, was significantly associated with emotional, physical, and social quality of life. Findings demonstrated that the PSQI consists of two moderately correlated factors that are differentially associated with separate health domains in cardiac patients. Keywords Factor structure · Heart disease · Pittsburgh Sleep Quality Index · Quality of life · Sleep quality
Introduction Poor sleep has been associated with reduced health functioning among individuals with chronic illness (Manocchia, Keller, & Ware, 2001), including patients with coronary heart disease (CHD) (Leineweber, Kecklund, Janszky, Åkerstedt, & Orth-Gomér, 2003). Research has observed that poor sleep may increase physical and mental fatigue and hinder CHD patients’ ability to perform daily activities (Johansson et al., 2007). Patients with heart disease experiencing poor sleep quality and daytime dysfunctions were found more likely to exhibit depressive symptoms (Norra et al., 2012). Even after controlling for depression, poor sleep quality in CHD patients was linked to higher risk of myocardial
* Biing‑Jiun Shen [email protected] 1
Psychology Program, School of Social Sciences, Nanyang Technological University, HSS‑04‑02, 48 Nanyang Avenue, Singapore 639818, Singapore
Heart Wellness Centre, Singapore Heart Foundation, 9 Bishan Place, #07‑01 Junction 8, Office Tower, Singapore 579837, Singapore
2
infarction, cardiac-related surgeries, and deaths (Leineweber et al., 2003). To evaluate sleep problems in clinical settings where there are often time and resource constraints, the Pittsburgh Sleep Quality Index (PSQI) (Buysse, Reynolds, Monk, Berman, & Kupfer, 1989) is a widely used instrument to assess sleep in patients. Although the PSQI has been utilized as a unidimensional measure with a sum score as the global index of sleep quality, several studies have shown that the instrument is, in fact, multidimensional. For example, Cole et al.
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