OBJECTIVES: Psychometric properties of the Czech version of the Pittsburgh Sleep Quality Index (PSQI-CZ) have been evaluated only in patients with chronic insomnia, and thus, it is unclear whether PSQI-CZ is suitable for use in other clinical and nonclinical populations. This study was aimed at examining the validity and reliability of the PSQI-CZ and at assessing whether the unidimensional or multidimensional scoring of the instrument would be recommended. METHODS: A total of 524 adult subjects from the Czech population participated in the study. The internal consistency of PSQI was evaluated using Cronbach's alpha. The known-group validity was tested using the Kruskal-Wallis H test to verify the difference between patients with sleep disorders and healthy control sample. For testing the structural validity, a cross-validation approach was used with both exploratory factor analysis (EFA) and confirmatory factor analysis (CFA). For EFA, the maximum likelihood method with direct oblimin rotation and parallel analysis was used. RESULTS: The internal consistency of PSQI-CZ items was moderate (α = 0.75). Receiver operating characteristic (ROC) curve analysis showed high specificity (0.79) and moderate sensitivity (0.64) using an optimal cut-off score of 10. The EFA revealed a 3-factor structure with factors labelled as "sleep duration and efficiency," "sleep disturbances and quality," and "sleep latency." The CFA showed that the emerged 3-factor model had a partly acceptable fit, which was better than other previously supported models. CONCLUSIONS: A high cut-off score of 10 is recommended to define poor sleep quality. Given the inconsistency of structural analyses, alternative scoring was not recommended. However, the individual components in addition to a total score should be interpreted when assessing sleep quality. We recommend editing and verifying the PSQI-CZ translation.

3rd Faculty of Medicine Charles University Ruská 87 100 00 Prague Czech Republic

Department of Anthropology and Human Genetics Faculty of Science Charles University Viničná 7 128 00 Prague Czech Republic

Department of Neurology and Center of Clinical Neuroscience Charles University 1st Faculty of Medicine and General University Hospital Kateřinská 30 128 21 Prague Czech Republic

National Institute of Mental Health Topolová 25067 Klecany Czech Republic

Zobrazit více v PubMed

Mollayeva T., Thurairajah P., Burton K., Mollayeva S., Shapiro C. M., Colantinio A. The Pittsburgh sleep quality index as a screening tool for sleep dysfunction in clinical and non-clinical samples: a systematic review and meta-analysis. Sleep Medicine Reviews. 2016;25:52–73. PubMed

Krystal A. D., Edinger J. D. Measuring sleep quality. Sleep Medicine. 2008;9(Supplement 1):S10–S17. doi: 10.1016/S1389-9457(08)70011-X. PubMed DOI

Hinz A., Glaesmer H., Brähler E., et al. Sleep quality in the general population: psychometric properties of the Pittsburgh Sleep Quality Index, derived from a German community sample of 9284 people. Sleep Medicine. 2017;30:57–63. doi: 10.1016/j.sleep.2016.03.008. PubMed DOI

Buysse D. J., Germain A., Moul D., Nofzinger E. A. Insomnia. In: Buysse D. J., editor. Sleep Disorders and Psychiatry. Arlington: American Psychiatric Publishing Inc; 2005. pp. 29–75.

Passos M. H. P., Silva H. A., Pitangui A. C. R., Oliveira V. M. A., Lima A. S., Araújo R. C. Confiabilidade e validade da versao brasileira do Índice de Qualidade do Sono de Pittsburgh em adolescentes. Jornal de Pediatra. 2017;93(2):200–206. doi: 10.1016/j.jped.2016.06.006. PubMed DOI

Qui C., Gelaye B., Zhong Q.-Y., Enquobahrie D. A., Frederick I. O., Williams M. A. Construct validity and factor structure of the Pittsburgh Sleep Quality Index among pregnant women in a Pacific-Northwest cohort. Sleep & Breathing. 2016;20:293–301. PubMed PMC

Doi Y., Minowa M., Uchiyama M., et al. Psychometric assessment of subjective sleep quality using the Japanese version of the Pittsburgh Sleep Quality Index (PSQI-J) in psychiatric disordered and control subjects. Psychiatry Research. 2000;97(2-3):165–172. doi: 10.1016/S0165-1781(00)00232-8. PubMed DOI

Backhaus J., Junghanns K., Broocks A., Riemann D., Hohagen F. Test-retest reliability and validity of the Pittsburgh Sleep Quality Index in primary insomnia. Journal of Psychosomatic Research. 2002;53(3):737–740. doi: 10.1016/S0022-3999(02)00330-6. PubMed DOI

Tsai P.-S., Wang S.-Y., Wang M.-Y., et al. Psychometric evaluation of the Chinese version of the Pittsburgh Sleep Quality Index (CPSQI) in primary insomnia and control subjects. Quality of Life Research. 2005;14(8):1943–1952. doi: 10.1007/s11136-005-4346-x. PubMed DOI

Takács J., Bódizs R., Ujma P. P., Horváth K., Rajna P., Harmat L. Reliability and validity of the Hungarian version of the Pittsburgh Sleep Quality Index (PSQI-HUN): comparing psychiatric patients with control subjects. Sleep & Breathing. 2016;20(3):1045–1051. doi: 10.1007/s11325-016-1347-7. PubMed DOI

Buysse D. J., Reynolds C. F., III, Monk T. H., Berman S. R., Kupfer D. J. The Pittsburgh Sleep Quality Index: a new instrument for psychiatric practice and research. Psychiatry Research. 1989;28(2):193–213. doi: 10.1016/0165-1781(89)90047-4. PubMed DOI

Cole J. C., Motivala S. J., Buysse D. J., Oxman M. N., Levin M. J., Irwin M. R. Validation of a 3-factor scoring model for the Pittsburgh Sleep Quality Index in older adults. Sleep. 2006;29(1):112–116. doi: 10.1093/sleep/29.1.112. PubMed DOI

Sohn S. I., Kim D. H., Lee M. Y., Cho Y. W. The reliability and validity of the Korean version of the Pittsburgh Sleep Quality Index. Sleep and Breathing. 2012;16(3):803–812. doi: 10.1007/s11325-011-0579-9. PubMed DOI

Kotronoulas G., Papadopoulou C. N., Papapetrou A., Patiraki E. Psychometric evaluation and feasibility of the Greek Pittsburgh Sleep Quality Index (GR-PSQI) in patients with cancer receiving chemotherapy. Supportive Care in Cancer. 2011;19(11):1831–1840. doi: 10.1007/s00520-010-1025-4. PubMed DOI

Tzeng J. I., Fu Y.-W., Lin C.-C. Validity and reliability of the Taiwanese version of the Pittsburgh Sleep Quality Index in cancer patients. International Journal of Nursing Studies. 2012;49(1):102–108. doi: 10.1016/j.ijnurstu.2011.08.004. PubMed DOI

Manzar M. D., BaHammam A. S., Hameed U. A., et al. Dimensionality of the Pittsburgh Sleep Quality Index: a systematic review. Health and Quality of Life Outcomes. 2018;16(1):p. 89. doi: 10.1186/s12955-018-0915-x. PubMed DOI PMC

Ho R. T. H., Fong T. C. T. Factor structure of the Chinese version of the Pittsburgh Sleep Quality Index in breast cancer patients. Sleep Medicine. 2014;15(5):565–569. doi: 10.1016/j.sleep.2013.10.019. PubMed DOI

Gomes A. A., Marques D. R., Meiavia A. M., Cunha F., Clemente V. Psychometric properties and accuracy of the European Portuguese version of the Pittsburgh Sleep Quality Index in clinical and non-clinical samples. Sleep and Biological Rhythms. 2018;16(4):413–422. doi: 10.1007/s41105-018-0171-9. DOI

Magee C. A., Caputi P., Iverson D. C., Huang X.-F. An investigation of the dimensionality of the Pittsburgh Sleep Quality Index in Australian adults. Sleep and Biological Rhythms. 2008;6(4):222–227. doi: 10.1111/j.1479-8425.2008.00371.x. DOI

Nicassio P. M., Ormseth S. R., Custodio M. K., Olmstead R., Weisman M. H., Irwin M. R. Confirmatory factor analysis of the Pittsburgh Sleep Quality Index in rheumatoid arthritis patients. Behavioral Sleep Medicine. 2014;12(1):1–12. doi: 10.1080/15402002.2012.720315. PubMed DOI PMC

Babson K. A., Blonigen D. M., Boden M. T., Drescher K. D., Bonn-Miller M. O. Sleep quality among U.S. military veterans with PTSD: a factor analysis and structural model of symptoms. Journal of Traumatic Stress. 2012;25(6):665–674. doi: 10.1002/jts.21757. PubMed DOI

Gelaye B., Lohsoonthorn V., Lertmeharit S., et al. 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. 2014;9(12, article e116383) doi: 10.1371/journal.pone.0116383. PubMed DOI PMC

Burkhalter H., Sereika S. M., Engberg S., Wirz-Justice A., Steiger J., de Geest S. Structure validity of the Pittsburgh Sleep Quality Index in renal transplant recipients: a confirmatory factor analysis. Sleep and Biological Rhythms. 2010;8(4):274–281. doi: 10.1111/j.1479-8425.2010.00473.x. DOI

Jia Y., Chen S., Deutz N. E. P., Bukkapatnam S. T. S., Woltering S. Examining the structure validity of the Pittsburgh Sleep Quality Index. Sleep and Biological Rhythms. 2019;17(2):209–221. doi: 10.1007/s41105-018-00201-0. DOI

Dudysová D., Malá I., Mladá K., Saifutdinova E., Koprivova J., Sos P. Structural and construct validity of the Czech version of the Pittsburgh Sleep Quality Index in chronic insomnia. Neuroendocrinology Letters. 2017;38(1):67–73. PubMed

Portaluppi F., Smolensky M., Touitou Y. Ethics and methods for biological rhythm research on animals and human beings. Chronobiology International. 2010;27(9-10):1911–1929. doi: 10.3109/07420528.2010.516381. PubMed DOI

Zhang C., Zhang H., Zhao M., et al. Reliability, validity, and factor structure of Pittsburgh Sleep Quality Index in community-based centenarians. Frontiers in Psychiatry. 2020;11:p. 573530. doi: 10.3389/fpsyt.2020.573530. PubMed DOI PMC

Fawcett T. An introduction to ROC analysis. Pattern Recognition Letters. 2006;27(8):861–874. doi: 10.1016/j.patrec.2005.10.010. DOI

Youden W. J. Index for rating diagnostic tests. Cancer. 1950;3(1):32–35. doi: 10.1002/1097-0142(1950)3:1<32::AID-CNCR2820030106>3.0.CO;2-3. PubMed DOI

Cronbach L. J. Coefficient alpha and the internal structure of tests. Psychometrika. 1951;16(3):297–334. doi: 10.1007/BF02310555. DOI

George D. Pearson Education India; 2003. SPSS for Windows Step by Step: A Simple Study Guide and Reference, 17.0 Update, 10/e.

Field A. Sage; 2013. Discovering Statistics Using IBM SPSS Statistics.

Hair J. F., Tatham R. L., Anderson R. E., Black W. Multivariate Data Analysis. 5th. London: Prentice-Hall; 1998.

Revelle W. Northwestern University; 2021. How to: use the psych package for factor analysis and data reduction. http://personality-project.org/r/psych/HowTo/factor.pdf.

Hooper D., Coughlan J., Mullen M. R. Structural equation modelling: guidelines for determining model fit. The Electronic Journal of Business Research Methods. 2008;6:53–60.

R Development Core Team. R Foundation for Statistical Computing; 2018. R: a language and environment for statistical computing. http://www.R-project.org.

The jamovi project. 2019. https://www.jamovi.org.

Wickham H. tidyverse: easily install and load the "Tidyverse". 2017. https://CRAN.R-project.org/package=tidyverse.

Revelle W. R. Psych: procedures for personality and psychological research. 2017. https://www.scholars.northwestern.edu/en/publications/psych-procedures-for-personality-and-psychological-research.

Thiele C. An introduction to cutpointr. 2019. https://cran.r-project.org/web/packages/cutpointr/vignettes/cutpointr.html.

Robin X., Turck N., Hainard A., et al. pROC: an open-source package for R and S+ to analyze and compare ROC curves. BMC Bioinformatics. 2011;12(1) doi: 10.1186/1471-2105-12-77. PubMed DOI PMC

Cohen J. Statistical Power Analysis for the Behavioral Sciences. 2nd. Hillsdale. NJ: Lawrence Erlbam; 1988.

Farrahi Moghaddam J., Nakhaee N., Sheibani V., Garrusi B., Amirkafi A. Reliability and validity of the Persian version of the Pittsburgh Sleep Quality Index (PSQI-P) Sleep and Breathing. 2016;16(1):79–82. doi: 10.1007/s11325-010-0478-5. PubMed DOI

Raniti M. B., Waloszek J. M., Schwartz O., Allen N. B., Trinder J. Factor structure and psychometric properties of the Pittsburgh Sleep Quality Index in community-based adolescents. Sleep. 2018;41(6):p. zsy066. doi: 10.1093/sleep/zsy066. PubMed DOI

Skouteris H., Wertheim E. H., Germano C., Paxton S. J., Milgrom J. Assessing sleep during pregnancy: a study across two time points examining the Pittsburgh Sleep Quality Index and associations with depressive symptoms. Womens Health Issues. 2009;19(1):45–51. doi: 10.1016/j.whi.2008.10.004. PubMed DOI

Jomeen J., Martin C. R. Assessment and relationship of sleep quality to depression in early pregnancy. Journal of Reproductive and Infant Psychology. 2007;25(1):87–99. doi: 10.1080/02646830601117308. DOI

Tomfohr L. M., Schweizer C. A., Dimsdale J. E., Loredo J. S. Psychometric characteristics of the Pittsburgh Sleep Quality Index in English speaking non-Hispanic whites and English and Spanish speaking Hispanics of Mexican descent. Journal of Clinical Sleep Medicine. 2013;9(1):61–66. doi: 10.5664/jcsm.2342. PubMed DOI PMC

Li L., Sheehan C. M., Thompson M. S. Measurement invariance and sleep quality differences between men and women in the Pittsburgh Sleep Quality Index. Journal of Clinical Sleep Medicine. 2019;15(12):1769–1776. doi: 10.5664/jcsm.8082. PubMed DOI PMC

Buysse D. J., Hall M. L., Strollo P. J., et al. Relationships between the Pittsburgh Sleep Quality Index (PSQI), Epworth Sleepiness Scale (ESS), and clinical/polysomnographic measures in a community sample. Journal of Clinical Sleep Medicine. 2008;4(6):563–571. doi: 10.5664/jcsm.27351. PubMed DOI PMC

Dostálová S., Šusta M., Nepožitek J., et al. Polysomnographic findings in individuals over 50 years of age lacking subjective signs of sleep disturbance. Česká a Slovenská Neurologie a Neurochirurgie. 2020;83/116(1):57–63. doi: 10.14735/amcsnn202057. DOI

Janečková D. Cirkadiánní preference. Rozdílný život ranních ptáčat a nočních sov. Olomouc: Univerzita Palackého v Olomouci; 2014.

Matthews T., Danese A., Gregory A. M., Caspi A., Moffitt T. E., Arseneault L. Sleeping with one eye open: loneliness and sleep quality in young adults. Psychological Medicine. 2017;47(12):2177–2186. doi: 10.1017/S0033291717000629. PubMed DOI PMC

Franquelo-Morales P., Sánchez-López M., Notario-Pacheco B., et al. Association between health-related quality of life, obesity, fitness, and sleep quality in young adults: the Cuenca adult study. Behavioral Sleep Medicine. 2018;16(4):347–355. doi: 10.1080/15402002.2016.1228638. PubMed DOI

Šmotek M., Fárková E., Manková D., Kopřivová J. Evening and night exposure to screens of media devices and its association with subjectively perceived sleep: should "light hygiene" be given more attention? Sleep Health. 2020;6(4):498–505. doi: 10.1016/j.sleh.2019.11.007. PubMed DOI

Personality Traits, Burnout, Workplace Bullying and Sleep Quality Among Midwives: A Pilot Study

Sleep quality and duration: A key to life satisfaction among military students

Alarm fatigue and sleep quality in medical staff-a Polish-Czech-Slovak study on workplace ergonomics

Physiological evidence of stress reduction during a summer Antarctic expedition with a significant influence of previous experience and vigor