Supportive Care in Cancer

, Volume 25, Issue 10, pp 3059–3066 | Cite as

Reliability and validity of the Pittsburgh Sleep Quality Index in breast cancer patients

  • Filipa Fontes
  • Marta Gonçalves
  • Susana Maia
  • Susana Pereira
  • Milton Severo
  • Nuno Lunet
Original Article



We aimed to assess the factor structure, internal consistency, test-retest reliability, and construct validity of the European Portuguese version of the Pittsburgh Sleep Quality Index (PSQI) in breast cancer patients.


This study was based on a cohort of breast cancer patients, among whom the PSQI was used to measure sleep quality three years after cancer diagnosis (N = 474). A sample of 62 participants underwent additional PSQI testing, wore a wrist actigraph for five consecutive days, and was reevaluated with the PSQI after one month. A confirmatory factor analysis, considering the components suggested by the principal component analysis (PCA), was performed to determine model fit. To evaluate internal consistency and test-retest reliability, Cronbach’s alpha and intraclass correlation coefficient (ICC) were calculated, respectively. To assess construct validity, Spearman’s correlation coefficients were computed between PSQI scores and actigraphy measures and other theoretical related constructs.


PCA suggested one or two components. The latter showed better fit to the data, though the two factors were strongly correlated (r = 0.76) and internal consistency was not satisfactory for one of the factors. Regarding the one-factor model, internal consistency (Cronbach’s alpha = 0.70) and test-retest reliability (ICC = 0.76) were adequate. Sleep duration, habitual sleep efficiency, and sleep disturbance dimensions were significantly correlated with the corresponding actigraphy measures; the PSQI global score derived from the one-factor model was more strongly correlated with subjective sleep complaints (r ≥ 0.60).


The unidimensional construct of the European Portuguese version of the PSQI showed adequate reliability and validity among breast cancer patients.


Actigraphy Breast neoplasms Principal component analysis Psychometrics Sleep 


Compliance with ethical standards


This study was funded by FEDER through the Operational Programme Competitiveness and Internationalization (POCI-01-0145-FEDER-016867) and national funding from the Foundation for Science and Technology (FCT) (Portuguese Ministry of Science, Technology and Higher Education) (PTDC/DTP-EPI/7283/2014) under the Unidade de Investigação em Epidemiologia - Instituto de Saúde Pública da Universidade do Porto (EPIUnit) (POCI-01-0145-FEDER-006862; Ref.UID/DTP/04750/2013); the PhD Grant SFRH/BD/92630/2013 (Filipa Fontes) co-funded by the FCT and the POPH/FSE Program.

Conflict of interest

The authors declare that they have no conflicts of interest.

Ethical approval

The study was approved by the Ethics Committee of the Portuguese Institute of Oncology of Porto (Ref. CES 99/2014 and CES 201/2015) and by the Portuguese Data Protection Authority (Ref. 8601/2014). All participants provided written informed consent.


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Copyright information

© Springer-Verlag Berlin Heidelberg 2017

Authors and Affiliations

  • Filipa Fontes
    • 1
  • Marta Gonçalves
    • 1
    • 2
  • Susana Maia
    • 2
  • Susana Pereira
    • 1
    • 3
  • Milton Severo
    • 1
    • 4
  • Nuno Lunet
    • 1
    • 4
  1. 1.ISPUP – EPIUnitUniversidade do PortoPortoPortugal
  2. 2.Centro de Medicina do Sono – Hospital CUF PortoPortoPortugal
  3. 3.Instituto Português de Oncologia do PortoPortoPortugal
  4. 4.Departamento de Ciências da Saúde Pública e Forenses e Educação Médica, Faculdade de MedicinaUniversidade do PortoPortoPortugal

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