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Adaptation and validation of the Chinese version of the Sleep Quality Questionnaire

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Abstract

Study objectives

Sleep quality is essential to health. The current study aimed to adapt and validate the Sleep Quality Questionnaire (SQQ) into Chinese language.

Methods

The Chinese version of the SQQ (SQQ-C) was created following the guidelines for cross-cultural adaptation. Compliant with the COSMIN methodology, baseline data (N = 13,325) examined three validity domains and internal consistency, including content validity using the content validity index (CVI) and the cognitive debriefing and focus group (relevance, comprehensiveness and comprehensibility), construct validity using structural validity and cross‑sectional measurement invariance, and criterion validity using concurrent/convergent validity. Follow-up data (N = 3410) gathered within a mean of 168 (167–207) h interval were used to additionally assess longitudinal measurement invariance and test–retest reliability using intraclass correlation coefficient (ICC).

Results

Scale-level CVI/Average was equal to 0.922; Item-level CVIs ranged from 0.889 to 1.000 (excellent), except for item 2 (0.556-fair). A panel of local experts and local participants during cognitive debriefing and focus group stated that it had sufficient relevance and comprehensibility but a slight deficiency in comprehensiveness. Confirmatory factor analysis indicated a stable two-factor structure encompassing Daytime Sleepiness Subscale and Sleep Difficulty Subscale from baseline to follow-up data. The SQQ-C-9 (without item 2) outperformed the SQQ-C-10 (full form). The SQQ-C-9 provided evidence of measurement invariance (strict) across subgroups (cohorts, gender, and age) and across time. The SQQ-C was negatively correlated with the Chinese Nonrestorative Sleep Scale and the Chinese Sleep Condition Indicator. Cronbach's alpha (α), McDonald's Omega (ω), and ICC, respectively, ranged from 0.712 to 0.838, 0.723 to 0.840, and 0.738 to 0.764 for total scale and each subscale.

Conclusion

The SQQ-C exhibits adequate psychometric properties and a stable two-factor structure, and should enable valuable assessments of sleep quality in clinical and research settings.

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Data availability

Not available.

Code availability

Not available.

Material availability

Anyone interested in using the formatted SQQ-C and its scoring rubric should contact the corresponding author when ready to initiate research collaboration.

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Acknowledgements

The authors wish to thank group of consultant experts on the CVI, including Lu Dong (Ph.D., Behavioral Scientist, RAND Corporation, USA), Daniel Yee Tak Fong (Ph.D., Associate Professor, Li Ka Shing Faculty of Medicine, The University of Hong Kong, China), Yuantao Hao (Ph.D., Professor, School of Public Health, Sun Yat-Sen University, China), Esther Yuet Ying Lau (Ph.D., Associate Professor, Department of Psychology, The Education University of Hong Kong, China), Jian Li (M.D., Ph.D., Senior Researcher, Faculty of Medicine, University of Düsseldorf, Germany), Jingjing Li (M.D., Ph.D., PostDoc, Rollins School of Public Health, Emory University, USA), Zhen Wang (M.D., Ph.D., Chief Psychiatrist, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, China), Qiong Wu (Ph.D., Associate Research Fellow, Institute of Social Science Survey, Peking University, China) and Yu-Tao Xiang (M.D., Ph.D., Professor, Faculty of Health Sciences, University of Macau, China). The authors appreciate comments and edits on earlier drafts from Assoc. Prof. Dr. Esther Yuet Ying Lau. The authors are grateful to Lidwine B. Mokkink (Ph.D., Senior Researcher, Department of Epidemiology and Data Science, Amsterdam Public Health Research Institute, Amsterdam UMC, Vrije Universiteit Amsterdam, the Netherlands) for discussion on content validity and Chen Jiang (M.B.B.S., Master Candidate, School of Public Health, Hangzhou Normal University, China) for assistance in data visualization during the revision process. The authors are indebted to four anonymous reviewers and two editors who provided insightful comments and constructive suggestions to facilitate this manuscript. Lastly, Dr. Runtang Meng thanks a panel of independent experts, the partners, the participants and the research assistants who made this study possible.

Funding

This study was supported by the Research Initiation Fund of Hangzhou Normal University (Grant No. RWSK20201003). This study was supported by a grant from an independent self-funded project to Runtang Meng during the doctorate at Wuhan University.

Author information

Authors and Affiliations

  1. School of Public Health, Hangzhou Normal University, No. 2318, Yuhangtang Rd, Yuhang District, Hangzhou, 311121, Zhejiang, China

    Runtang Meng

  2. School of Public Health, Wuhan University, Wuhan, Hubei, China

    Runtang Meng, Jinhong Cao & Chuanhua Yu

  3. Department of Social Psychology, Toyo University, Tokyo, Japan

    Tsukasa Kato

  4. Department of Psychology, University of Crete, Rethymno, Crete, Greece

    Stefanos Mastrotheodoros

  5. Department of Youth and Family, Utrecht University, Utrecht, the Netherlands

    Stefanos Mastrotheodoros

  6. Department of Behavioral & Policy Sciences, RAND Corporation, Santa Monica, CA, USA

    Lu Dong

  7. School of Nursing, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China

    Daniel Yee Tak Fong

  8. School of Public Health, Xuzhou Medical University, Xuzhou, Jiangsu, China

    Fang Wang

  9. Faculty of Psychology, Southwest University, Chongqing, China

    Menglu Cao

  10. School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK

    Xinliang Liu

  11. The State Key Laboratory Breeding Base of Basic Science of Stomatology (Hubei-MOST) & Key Laboratory of Oral Biomedicine Ministry of Education (KLOBM), School & Hospital of Stomatology, Wuhan University, Wuhan, Hubei, China

    Chenmin Yao

  12. School of Public Health, Hubei University of Medicine, Shiyan, Hubei, China

    Yong Yu

  13. School of Nursing, Ningbo College of Health Sciences, Ningbo, Zhejiang, China

    Yi Luo

  14. Global Health Institute, Wuhan University, Wuhan, Hubei, China

    Chuanhua Yu

  15. Department of Child Health, University of Missouri School of Medicine, Columbia, MO, USA

    David Gozal

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  1. Runtang Meng
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  2. Tsukasa Kato
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  3. Stefanos Mastrotheodoros
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  4. Lu Dong
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  5. Daniel Yee Tak Fong
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  6. Fang Wang
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  7. Menglu Cao
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  8. Xinliang Liu
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  9. Chenmin Yao
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  10. Jinhong Cao
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  11. Yong Yu
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  13. Chuanhua Yu
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  14. David Gozal
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Corresponding author

Correspondence to Runtang Meng.

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Conflict of interest

All authors declare that they have no conflict of interest to disclose.

Ethical approval

The study protocol was approved by the Ethics Committee of Wuhan University School of Medicine (WUSM) (Reference No. 2019YF2034) and the Ethics Committee of Shiyan Taihe Hospital (Reference No. 201917). This study followed the ethical standards of the institutional and/or national research committee and the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Routinely collected data were anonymized and informed consent was obtained from all participants enrolled in the study.

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Meng, R., Kato, T., Mastrotheodoros, S. et al. Adaptation and validation of the Chinese version of the Sleep Quality Questionnaire. Qual Life Res 32, 569–582 (2023). https://doi.org/10.1007/s11136-022-03241-9

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