Skip to main content
SpringerLink
Log in

Insomnia severity index: a psychometric investigation among Saudi nurses

  • Epidemiology • Original Article
  • Published:
Sleep and Breathing Aims and scope Submit manuscript

Abstract

Background

Insomnia is the most prevalent sleep disorder, but it is widely untreated and under-diagnosed in Saudi Arabia. Moreover, no tool to screen insomnia has been validated in the Saudi population in general or nurses in particular. This study, therefore, assessed the psychometric validity of the Insomnia Severity Index (ISI) in Saudi nurses.

Methods

A cross-sectional study with purposive sampling was performed with nurses (n = 134, age = 21–48 years) from Al Majmaah, Saudi Arabia. Both conventional and online survey methods using the ISI, a brief measure of metacognition, and a socio-demographics questionnaire were employed.

Results

No ceiling or floor effects were found in the ISI total score (8.84 ± 5.07) or the factor scores, but the floor effect was found in the item scores. A two-factor model showed the best fit (Pclose .97, comparative fit index [CFI] 1.00, root mean square error of approximation [RMSEA] 0.00, non-significant χ2test, χ2/df 0.904). This model showed favorable configural, metric, scalar, and partial strict invariance across gender groups (CFI > .95, RMSEA < .05, χ2/df < 3, non-significant Δχ2, ΔCFI ≤ .01). The internal consistency was adequate (Cronbach’s alpha = 0.75, 0.78 for the two factors of the ISI). The lack of correlations between the ISI scores and the scores of the brief measure of the metacognition favored its divergent validity.

Conclusion

The ISI showed adequate psychometric validity for screening insomnia among Saudi nurses.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

Availability of data, material, and methods

All the data files analyzed in this study are available from the corresponding author on reasonable request.

Abbreviations

ISI:

insomnia severity index

CFA:

confirmatory factor analysis

KMO:

Kaiser-Meyer-Olkin test of sampling adequacy

CFI:

comparative fit index

GFI:

goodness of fit index

RMR:

root mean square residual

RMSEA:

root mean square error of approximation

References

  1. Wickwire EM, Shaya FT, Scharf SM (2015) University of Maryland School of Pharmacy University of Maryland School of Medicine. Sleep Med Rev 30:72–82. https://doi.org/10.1016/j.smrv.2015.11.004

    Article  PubMed  Google Scholar 

  2. Pallesen S, Sivertsen B, Hilde I, Bjorvatn B (2014) A 10-year trend of insomnia prevalence in the adult Norwegian population. 15:173–179. https://doi.org/10.1016/j.sleep.2013.10.009

  3. Kronholm E, Partonen T, Härmä M, Hublin C, Lallukka T, Peltonen M, Laatikainen T (2016) Prevalence of insomnia-related symptoms continues to increase in the Finnish working-age population. J Sleep Res 25:454–457. https://doi.org/10.1111/jsr.12398

    Article  PubMed  Google Scholar 

  4. Ford ES, Cunningham TJ, Giles WH, Croft JB (2015) Trends in insomnia and excessive daytime sleepiness among US adults from 2002 to 2012. Sleep Med 16:372–378. https://doi.org/10.1016/j.sleep.2014.12.008

    Article  PubMed  PubMed Central  Google Scholar 

  5. Schmidt RE, Cullati S, Mostofsky E, Haller G (2015) Healthcare-related regret among nurses and physicians is associated with self-rated insomnia severity : a cross-sectional study. PLoS One 10(10):e0139770. 1–12. https://doi.org/10.1371/journal.pone.0139770

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  6. Thomas F, Hopkins RO, Handrahan DL, Walker J, Carpenter J (2006) Sleep and cognitive performance of flight nurses after 12-hour evening versus 18-hour shifts. Air Med J 25:216–225. https://doi.org/10.1016/j.amj.2006.06.005

    Article  PubMed  Google Scholar 

  7. Johnson AL, Brown K, Weaver MT (2010) Sleep deprivation and psychomotor performance among night-shift nurses. AAOHN J 58:147–154. https://doi.org/10.3928/08910162-20100316-02

    Article  PubMed  Google Scholar 

  8. Arimura M, Imai M, Okawa M et al (2010) Sleep, mental health status, and medical errors among hospital nurses in Japan. Ind Health 48:811–817. https://doi.org/10.2486/indhealth.MS1093

    Article  PubMed  Google Scholar 

  9. Almeneessier AS, Alamri BN, Alzahrani FR et al (2018) Insomnia in primary care settings : still overlooked and undertreated ? J Clin Sleep Med 13(8):937–939. https://doi.org/10.4103/JNSM.JNSM

    Article  Google Scholar 

  10. Morin CM, Jarrin DC (2013) Epidemiology of insomnia: prevalence, course, risk factors, and public health burden. Sleep Med Clin 8:281–297. https://doi.org/10.1016/j.jsmc.2013.05.002

    Article  Google Scholar 

  11. Manzar MD, Ejaz Hussain M (2012) Sleep-immune system interaction: advantages and challenges of human sleep loss model. Front Neurol 3:16–18. https://doi.org/10.3389/fneur.2012.00002

    Article  Google Scholar 

  12. Manzar MD, Zannat W, Hussain ME (2015) Sleep and physiological systems: a functional perspective. Biol Rhythm Res 46:195–206. https://doi.org/10.1080/09291016.2014.966504

    Article  Google Scholar 

  13. Manzar MD, Salahuddin M, Khan TA, Shah SA, Alamri M, Pandi-Perumal SR, Bahammam AS (2018) Psychometric properties of the Insomnia Severity Index in Ethiopian adults with substance use problems. J Ethn Subst Abus 0:1–15. https://doi.org/10.1080/15332640.2018.1494658

    Article  Google Scholar 

  14. Bastien CH, Vallières A, Morin CM (2001) Validation of the insomnia severity index as an outcome measure for insomnia research. Sleep Med 2:297–307. https://doi.org/10.1016/S1389-9457(00)00065-4

    Article  PubMed  Google Scholar 

  15. Morin CM, Belleville G, Bélanger L, Ivers H (2001) The insomnia severity index : psychometric indicators to detect insomnia cases and evaluate treatment response. Sleep 18–20 34:601–608. https://doi.org/10.1093/sleep/34.5.601

    Article  Google Scholar 

  16. Seng L, Seow E, Abdin E et al (2018) Identifying the best sleep measure to screen clinical insomnia in a psychiatric population. Sleep Med 41:86–93. https://doi.org/10.1016/j.sleep.2017.09.015

    Article  Google Scholar 

  17. Castronovo V, Galbiati A, Marelli S, et al (2016) Validation study of the Italian version of the Insomnia Severity Index ( ISI ). https://doi.org/10.1007/s10072-016-2620-z

  18. Chahoud M, Chahine R, Salameh P, Sauleau EA (2017) Reliability, factor analysis and internal consistency calculation of the Insomnia Severity Index (ISI) in French and in English among Lebanese adolescents. eNeurologicalSci 7:9–14. https://doi.org/10.1016/j.ensci.2017.03.003

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  19. Gerber M, Lang C, Lemola S, Colledge F, Kalak N, Holsboer-Trachsler E, Pühse U, Brand S (2016) Validation of the German version of the insomnia severity index in adolescents, young adults and adult workers: results from three cross-sectional studies. BMC Psychiatry 16:1–14. https://doi.org/10.1186/s12888-016-0876-8

    Article  Google Scholar 

  20. Klusmann V, Eversa A, Schwarzer R, Heuser I (2011) A brief questionnaire on metacognition: psychometric properties. Aging Ment Health 15:1052–1062. https://doi.org/10.1080/13607863.2011.583624

    Article  PubMed  Google Scholar 

  21. Chung K, Kan KK, Yeung W (2011) Assessing insomnia in adolescents : comparison of Insomnia Severity Index , Athens Insomnia Scale and Sleep Quality Index. Sleep Med 12:463–470. https://doi.org/10.1016/j.sleep.2010.09.019

    Article  PubMed  Google Scholar 

  22. Moscou- Jackson G, Allen J, Smith MT, HaywoodCarlton J (2016) Psychometric validation of the insomnia severity index in adults with sickle cell disease. J Heal Care Poor Underserved 27:209–218. https://doi.org/10.1353/hpu.2016.0010.Psychometric

    Article  Google Scholar 

  23. Savard M-H, Savard J, Sébastien Simardand HI (2005) Empirical validation of the insomnia. Psychooncology 14:429–441. https://doi.org/10.1002/pon.860

    Article  PubMed  Google Scholar 

  24. Chen PY, Yang CM, Morin CM (2015) Validating the cross-cultural factor structure and invariance property of the Insomnia Severity Index: evidence based on ordinal EFA and CFA. Sleep Med 16:598–603. https://doi.org/10.1016/j.sleep.2014.11.016

    Article  PubMed  Google Scholar 

  25. Fernandez-Mendoza J, Rodriguez-Muñoz A, Vela-Bueno A, Olavarrieta-Bernardino S, Calhoun SL, Bixler EO, Vgontzas AN (2012) The Spanish version of the Insomnia Severity Index: a confirmatory factor analysis. Sleep Med 13:207–210. https://doi.org/10.1016/j.sleep.2011.06.019

    Article  PubMed  Google Scholar 

  26. Jaccard J, Wan CK (1996) LISREL approaches to interaction effects in multiple regression. SAGE Publications, Thousand Oaks, California

    Book  Google Scholar 

  27. Tabachnick BG, Fidell LS (2013) Using multivariate statistics. Pearson Education, MA:Allyn & Bacon, Boston

  28. Yu DSF (2010) Insomnia Severity Index: psychometric properties with Chinese community-dwelling older people. J Adv Nurs 66:2350–2359. https://doi.org/10.1111/j.1365-2648.2010.05394.x

    Article  PubMed  Google Scholar 

  29. Manzar MD, Zannat W, Moiz JA, Spence DW, Pandi-Perumal SR, Bahammam AS, Hussain ME (2016) Factor scoring models of the Pittsburgh Sleep Quality Index: a comparative confirmatory factor analysis. Biol Rhythm Res 47:851–864. https://doi.org/10.1080/09291016.2016.1202375

    Article  Google Scholar 

  30. Manzar MD, Zannat W, Hussain ME, Pandi-Perumal SR, Bahammam AS, Barakat D, Ojike NI, Olaish A, Spence DW (2016) Dimensionality of the Pittsburgh Sleep Quality Index in the young collegiate adults. Springerplus 0–5 5:1550. https://doi.org/10.1186/s40064-016-3234-x

    Article  PubMed  PubMed Central  Google Scholar 

  31. Manzar MD, Bahammam AS, Hameed UA et al (2018) Dimensionality of the Pittsburgh Sleep Quality Index: a systematic review. Health Qual Life Outcomes 16:89 9–11. https://doi.org/10.1186/s12955-018-0915-x

    Article  PubMed  PubMed Central  Google Scholar 

  32. Gold MS, Bentler PM (2009) Structural equation modeling : a treatments of missing data : a Monte Carlo comparison of RBHDI , iterative stochastic regression imputation, and expectation-maximization. Struct Equ Model 7:319–355. https://doi.org/10.1207/S15328007SEM0703_1

    Article  Google Scholar 

  33. Lim CR, Harris K, Dawson J, Beard DJ, Fitzpatrick R, Price AJ (2015) Floor and ceiling effects in the OHS: an analysis of the NHS PROMs data set. BMJ Open 5:e007765. https://doi.org/10.1136/bmjopen-2015-007765

    Article  PubMed  PubMed Central  Google Scholar 

  34. Salahuddin M, Maru TT, Kumalo A, Pandi-Perumal SR, Bahammam AS, Manzar MD (2017) Validation of the Pittsburgh sleep quality index in community dwelling Ethiopian adults. Health Qual Life Outcomes 15:58. https://doi.org/10.1186/s12955-017-0637-5

    Article  PubMed  PubMed Central  Google Scholar 

  35. Field A (2013) Discovering statistics using IBM SPSS statistics, 4th edn. SAGE Publications Ltd, London

    Google Scholar 

  36. Costello AB, Osborne JW (2005) Best practices in exploratory factor analysis. Four Recommendations for Getting the Most From Your Analysis 10:1–9 https://pareonline.net/getvn.asp?v=10&n=7

    Google Scholar 

  37. Cheung GW, Rensvold RB (2002) Evaluating goodness-of- fit indexes for testing measurement invariance. Struct Equ Model A Multidiscip J 9:233–255. https://doi.org/10.1207/S15328007SEM0902

    Article  Google Scholar 

  38. Stockdale M, Royal K (2016) Missing data as a validity threat for medical and healthcare education research: problems and solutions. Int J Health 2:67–72. https://doi.org/10.5430/ijh.v2n2p67

    Article  Google Scholar 

  39. Manzar MD, Salahuddin M, Maru TT, Alghadir A, Anwer S, Bahammam AS, Pandi-Perumal SR (2018) Validation of the adapted Leeds sleep evaluation questionnaire in Ethiopian university students. Health Qual Life Outcomes 16:1–8. https://doi.org/10.1186/s12955-018-0876-0

    Article  Google Scholar 

  40. George D, Mallery P (2003) SPSS for Windows step by step: answers to selected exercises. A Simple Guid Ref 63

  41. Palagini L, Piarulli A, Lai E, Cheli E, Espie C, Gemignani A (2013) Metacognition selectively defines primary insomnia. Sleep Med 14:e228. https://doi.org/10.1016/j.sleep.2013.11.549

    Article  Google Scholar 

  42. Palagini L, Piarulli A, Menicucci D, Cheli E, Lai E, Bergamasco M, Mauri M, Kyle SD, Espie CA, Gemignani A (2014) Metacognitive beliefs relate specifically to sleep quality in primary insomnia: a pilot study. Sleep Med 15:918–922. https://doi.org/10.1016/j.sleep.2014.03.017

    Article  PubMed  Google Scholar 

  43. Palagini L, Cellini N, Mauri M, Mazzei I, Simpraga S, dell'Osso L, Linkenkaer-Hansen K, Riemann D (2016) Multiple phenotypes of resting-state cognition are altered in insomnia disorder. SLEH. 2:239–245. https://doi.org/10.1016/j.sleh.2016.05.003

    Article  Google Scholar 

  44. Palagini L, Ong JC, Riemann D (2017) The mediating role of sleep-related metacognitive processes in trait and pre-sleep state hyperarousal in insomnia disorder. J Psychosom Res 99:59–65. https://doi.org/10.1016/j.jpsychores.2017.03.001

    Article  PubMed  Google Scholar 

Download references

Acknowledgements

We are grateful to the participants in the study. The authors would like to thank Deanship of Scientific Research at Majmaah University for supporting this work under project number no. 1440-17.

Author information

Authors and Affiliations

  1. Department of Nursing, College of Applied Medical Sciences, Majmaah University, Al Majmaah, 11952, Saudi Arabia

    Abdulrhman Albougami & Md. Dilshad Manzar

Authors
  1. Abdulrhman Albougami
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Md. Dilshad Manzar
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

MDM and AA: concept development and study design, data acquisition, and critical revision of the manuscript

MDM: data analysis and interpretation and manuscript preparation.

All the authors read and approved the final version of the manuscript.

Corresponding author

Correspondence to Md. Dilshad Manzar.

Ethics declarations

Ethical approval and consent to participate

The study was approved by the Institutional Review Board (IRB log number: 18-257E) of the Saudi Ministry of Health, and all the participants provided written informed consent. All the authors approved the final draft.

Consent to publish

The participants provided written informed consent for publication, although no personal or identifiable information has been published.

Competing interests

The authors declare that they have no competing interests.

Additional information

Publisher’s note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Albougami, A., Manzar, M.D. Insomnia severity index: a psychometric investigation among Saudi nurses. Sleep Breath 23, 987–996 (2019). https://doi.org/10.1007/s11325-019-01812-8

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11325-019-01812-8

Keywords

Search

Navigation