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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 Tan
  • Hung Yong Tay
  • Cindy Khim Siang Lim
  • Biing-Jiun ShenEmail author
Article
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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 
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Notes

Acknowledgements

This work was supported by the Singapore Ministry of Education Academic Research Fund Tier 1 Grant [RG60/14] and a SUG award from Nanyang Technological University.

Compliance with Ethical Standards

Conflict of interest

Jonathan Jun Liang Tan, Hung Yong Tay, Cindy Khim Siang Lim, and Biing-Jiun Shen declare that they have no conflict of interest.

Ethical Approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

Informed Consent

Informed consent was obtained from all individual participants included in the study.

References

  1. Baldwin, C. M., Ervin, A. M., Mays, M. Z., Robbins, J., Shafazand, S., Walsleben, J., & Weaver, T. (2010). Sleep disturbances, quality of life, and ethnicity: The Sleep Heart Health Study. Journal of Clinical Sleep Medicine, 6, 176–183.PubMedPubMedCentralGoogle Scholar
  2. Blumenthal, J. A., Feger, B. J., Smith, P. J., Watkins, L. L., Jiang, W., Davidson, J., … Sherwood, A. (2016). Treatment of anxiety in patients with coronary heart disease: Rationale and design of the UNderstanding the benefits of exercise and escitalopram in anxious patients WIth coroNary heart Disease (UNWIND) randomized clinical trial. American Heart Journal, 176, 53–62.  https://doi.org/10.1016/j.ahj.2016.03.003.
  3. Browne, M. W., & Cudeck, R. (1992). Alternative ways of assessing model fit. Sociological Methods & Research, 21, 230–258.  https://doi.org/10.1177/0049124192021002005.CrossRefGoogle Scholar
  4. Buysse, D. J., Reynolds, C. F., Monk, T. H., Berman, S. R., & Kupfer, D. J. (1989). The Pittsburgh Sleep Quality Index: a new instrument for psychiatric practice and research. Psychiatry Research, 28, 193–213.  https://doi.org/10.1016/0165-1781(89)90047-4.CrossRefGoogle Scholar
  5. Carney, R. M., Freedland, K. E., Steinmeyer, B. C., Rubin, E. H., Stein, P. K., & Rich, M. W. (2016). Nighttime heart rate predicts response to depression treatment in patients with coronary heart disease. Journal of Affective Disorders, 200, 165–171.  https://doi.org/10.1016/j.jad.2016.04.051.CrossRefPubMedPubMedCentralGoogle Scholar
  6. Casement, M. D., Harrington, K. M., Miller, M. W., & Resick, P. A. (2012). Associations between Pittsburgh Sleep Quality Index factors and health outcomes in women with posttraumatic stress disorder. Sleep Medicine, 13, 752–758.  https://doi.org/10.1016/j.sleep.2012.02.014.CrossRefPubMedPubMedCentralGoogle Scholar
  7. Chasens, E. R., Korytkowski, M., Sereika, S. M., & Burke, L. E. (2013). Effect of poor sleep quality and excessive daytime sleepiness on factors associated with diabetes self-management. The Diabetes Educator, 39, 74–82.  https://doi.org/10.1177/0145721712467683.CrossRefPubMedGoogle Scholar
  8. Cole, J. C., Motivala, S. J., Buysse, D. J., Oxman, M. N., Levin, M. J., & Irwin, M. R. (2006). Validation of a 3-factor scoring model for the Pittsburgh Sleep Quality Index in older adults. Sleep, 29, 112–116.  https://doi.org/10.1093/sleep/29.1.112.CrossRefPubMedGoogle Scholar
  9. Cricco, M., Simonsick, E. M., & Foley, D. J. (2001). The impact of insomnia on cognitive functioning in older adults. Journal of the American Geriatrics Society, 49, 1185–1189.  https://doi.org/10.1046/j.1532-5415.2001.49235.x.CrossRefPubMedGoogle Scholar
  10. Duarte Freitas, P., Haida, A., Bousquet, M., Richard, L., Mauriege, P., & Guiraud, T. (2011). Short-term impact of a 4-week intensive cardiac rehabilitation program on quality of life and anxiety-depression. Annals of Physical and Rehabilitation Medicine, 54, 132–143.  https://doi.org/10.1016/j.rehab.2011.02.001.CrossRefPubMedGoogle Scholar
  11. Faubel, R., Lopez-Garcia, E., Guallar-Castillon, P., Balboa-Castillo, T., Gutierrez-Fisac, J. L., Banegas, J. R., & Rodriguez-Artalejo, F. (2009). Sleep duration and health-related quality of life among older adults: A population-based cohort in Spain. Sleep, 32, 1059–1068.  https://doi.org/10.1093/sleep/32.8.1059.CrossRefPubMedPubMedCentralGoogle Scholar
  12. Höfer, S., Lim, L., Guyatt, G., & Oldridge, N. (2004). The MacNew Heart Disease health-related quality of life instrument: A summary. Health and Quality of Life Outcomes, 2, 1–8.  https://doi.org/10.1186/1477-7525-2-3.CrossRefGoogle Scholar
  13. Hu, L. T., & Bentler, P. M. (1999). Cutoff criteria for fit indexes in covariance structure analysis: Conventional criteria versus new alternatives. Structural Equation Modeling: A Multidisciplinary Journal, 6, 1–55.  https://doi.org/10.1080/10705519909540118.CrossRefGoogle Scholar
  14. Johansson, A., Windahl, M., Svanborg, E., Fredrichsen, M., Swahn, E., Uhlin, P. Y., & Edell-Gustafsson, U. (2007). Perceptions of how sleep is influenced by rest, activity and health in patients with coronary heart disease: A phenomenographical study. Scandinavian Journal of Caring Sciences, 21, 467–475.  https://doi.org/10.1111/j.1471-6712.2007.00496.x.CrossRefPubMedGoogle Scholar
  15. Jomeen, J., & Martin, C. R. (2007). Assessment and relationship of sleep quality to depression in early pregnancy. Journal of Reproductive and Infant Psychology, 25, 87–99.  https://doi.org/10.1080/02646830601117308.CrossRefGoogle Scholar
  16. Lai, H. L., & Good, M. (2005). Music improves sleep quality in older adults. Journal of Advanced Nursing, 49, 234–244.  https://doi.org/10.1111/j.1365-2648.2004.03281.x.CrossRefPubMedGoogle Scholar
  17. Leineweber, C., Kecklund, G., Janszky, I., Åkerstedt, T., & Orth-Gomér, K. (2003). Poor sleep increases the prospective risk for recurrent events in middle-aged women with coronary disease: The Stockholm Female Coronary Risk Study. Journal of Psychosomatic Research, 54, 121–127.  https://doi.org/10.1016/S0022-3999(02)00475-0.CrossRefPubMedGoogle Scholar
  18. Lima, M. G., Barros, M. B., & Alves, M. C. (2012). Sleep duration and health status self-assessment (SF-36) in the elderly: A population-based study (ISA-Camp 2008). Cadernos de Saúde Pública, 28, 1674–1684.  https://doi.org/10.1590/S0102-311X2012000900007.CrossRefPubMedGoogle Scholar
  19. Lima, B. B., Hammadah, M., Wilmot, K., Pearce, B. D., Shah, A., Levantsevych, O., … Vaccarino, V. (2019). Posttraumatic stress disorder is associated with enhanced interleukin-6 response to mental stress in subjects with a recent myocardial infarction. Brain, Behavior, and Immunity, 75, 26–33.  https://doi.org/10.1016/j.bbi.2018.08.015.
  20. Magee, C. A., Caputi, P., Iverson, D. C., & Huang, X.-F. (2008). An investigation of the dimensionality of the Pittsburgh Sleep Quality Index in Australian adults. Sleep and Biological Rhythms, 6, 222–227.  https://doi.org/10.1111/j.1479-8425.2008.00371.x.CrossRefGoogle Scholar
  21. Manocchia, M., Keller, S., & Ware, J. E. (2001). Sleep problems, health-related quality of life, work functioning and health care utilization among the chronically ill. Quality of Life Research, 10, 331–345.  https://doi.org/10.1023/A:1012299519637.CrossRefPubMedGoogle Scholar
  22. Mauss, I. B., Troy, A. S., & LeBourgeois, M. K. (2013). Poorer sleep quality is associated with lower emotion-regulation ability in a laboratory paradigm. Cognition and Emotion, 27, 567–576.  https://doi.org/10.1080/02699931.2012.727783.CrossRefPubMedGoogle Scholar
  23. Morphy, H., Dunn, K. M., Lewis, M., Boardman, H. F., & Croft, P. R. (2007). Epidemiology of insomnia: A longitudinal study in a UK population. Sleep, 30, 274–280.  https://doi.org/10.1093/sleep/30.3.274.CrossRefPubMedGoogle Scholar
  24. Muthén, L. K., & Muthén, B. O. (1998–2010). Mplus user’s guide (6th ed.). Los Angeles: Muthén & Muthén.Google Scholar
  25. Nicassio, P. M., Ormseth, S. R., Custodio, M. K., Olmstead, R., Weisman, M. H., & Irwin, M. R. (2014). Confirmatory factor analysis of the Pittsburgh Sleep Quality Index in rheumatoid arthritis patients. Behavioral Sleep Medicine, 12, 1–12.  https://doi.org/10.1080/15402002.2012.720315.CrossRefPubMedGoogle Scholar
  26. Norra, C., Kummer, J., Boecker, M., Skobel, E., Schauerte, P., Wirtz, M., … Forkmann, T. (2012). Poor sleep quality is associated with depressive symptoms in patients with heart disease. International Journal of Behavioral Medicine, 19(4), 526–534.  https://doi.org/10.1007/s12529-011-9205-2.
  27. Nunes, D. M., Mota, R. M., de Pontes Neto, O. L., Pereira, E. D., de Bruin, V. M., & de Bruin, P. F. (2009). Impaired sleep reduces quality of life in chronic obstructive pulmonary disease. Lung, 187, 159–163.  https://doi.org/10.1007/s00408-009-9147-5.CrossRefPubMedGoogle Scholar
  28. Otte, J. L., Rand, K. L., Carpenter, J. S., Russell, K. M., & Champion, V. L. (2013). Factor analysis of the Pittsburgh Sleep Quality Index in breast cancer survivors. Journal of Pain and Symptom Management, 45, 620–627.  https://doi.org/10.1016/j.jpainsymman.2012.03.008.CrossRefPubMedGoogle Scholar
  29. Sevinc, S., & Akyol, A. D. (2010). Cardiac risk factors and quality of life in patients with coronary artery disease. Journal of Clinical Nursing, 19, 1315–1325.  https://doi.org/10.1111/j.1365-2702.2010.03220.x.CrossRefPubMedGoogle Scholar
  30. Soffer-Dudek, N., Sadeh, A., Dahl, R. E., & Rosenblat-Stein, S. (2011). Poor sleep quality predicts deficient emotion information processing over time in early adolescence. Sleep, 34, 1499–1508.  https://doi.org/10.5665/sleep.1386.CrossRefPubMedPubMedCentralGoogle Scholar
  31. Sonnentag, S., Binnewies, C., & Mojza, E. J. (2008). “Did you have a nice evening?” A day-level study on recovery experiences, sleep, and affect. Journal of Applied Psychology, 93, 674–684.  https://doi.org/10.1037/0021-9010.93.3.674.CrossRefPubMedGoogle Scholar
  32. Spiegel, K., Leproult, R., & Van Cauter, E. (1999). Impact of sleep debt on metabolic and endocrine function. The Lancet, 354, 1435–1439.  https://doi.org/10.1016/S0140-6736(99)01376-8.CrossRefGoogle Scholar
  33. Stafford, L., Berk, M., Reddy, P., & Jackson, H. J. (2007). Comorbid depression and health-related quality of life in patients with coronary artery disease. Journal of Psychosomatic Research, 62, 401–410.  https://doi.org/10.1016/j.jpsychores.2006.12.009.CrossRefPubMedGoogle Scholar
  34. Tang, M. F., Liou, T. H., & Lin, C. C. (2010). Improving sleep quality for cancer patients: Benefits of a home-based exercise intervention. Supportive Care in Cancer, 18, 1329–1339.  https://doi.org/10.1007/s00520-009-0757-5.CrossRefPubMedGoogle Scholar
  35. Valenti, L., Lim, L., Heller, R. F., & Knapp, J. (1996). An improved questionnaire for assessing quality of life after acute myocardial infarction. Quality of Life Research, 5, 151–161.  https://doi.org/10.1007/BF00435980.CrossRefPubMedGoogle Scholar

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© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Psychology Program, School of Social SciencesNanyang Technological UniversitySingaporeSingapore
  2. 2.Heart Wellness CentreSingapore Heart FoundationSingaporeSingapore

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