Measurement Structure of the Pittsburgh Sleep Quality Index and Its Association with Health Functioning in Patients with Coronary Heart Disease


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.

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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.

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Correspondence to Biing-Jiun Shen.

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

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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.

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Tan, J.J.L., Tay, H.Y., Lim, C.K.S. et al. Measurement Structure of the Pittsburgh Sleep Quality Index and Its Association with Health Functioning in Patients with Coronary Heart Disease. J Clin Psychol Med Settings 27, 677–685 (2020).

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  • Factor structure
  • Heart disease
  • Pittsburgh Sleep Quality Index
  • Quality of life
  • Sleep quality