Abstract
Fibromyalgia (FM) is recognized as a common condition, characterized by widespread pain and associated with sleep disturbances and poor-quality sleep. The Pittsburgh Sleep Questionnaire Index (PSQI) is one of the most recommended instruments to measure sleep quality and sleep disorders. The purpose of our study was to translate the questionnaire into Spanish and to assess the psychometric properties of the Spanish version of the PSQI. A total of 138 women with FM belonging to a FM association (AFIXA, Andalusia, Spain) completed the study. Internal consistency and test–retest reliability were analyzed. Factorial analysis was performed for the PSQI components. Convergent validity of the PSQI was evaluated using Spearman’s rank correlation coefficient with the Spanish versions of the Fibromyalgia Impact Questionnaire (FIQ) and the health survey short form-36 (SF-36). In our analysis, the Spanish version of the PSQI has shown a good internal consistency of the total score, with a Cronbach’s alpha of 0.805, and an acceptable test–retest reliability, with a Spearman’s correlation coefficient of 0.773 (p < 0.001), for the total score. A two-factor structure was generated by exploratory factor analysis, with a Cronbach’s alpha of 0.866 for factor 1 and of 0.712 for factor 2. In convergent validity analysis, the PSQI total score showed a significant correlation (p < 0.01) with the FIQ total score and with the mental and physical health summaries scores of the SF-36. Our results show that the Spanish version of the PSQI provides a reliable instrument, with a good convergent validity for measuring sleep quality among Spanish FM patients.
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References
Branco JC, Bannwarth B, Failde I, Abello Carbonell J, Blotman J (2010) Prevalence of fibromyalgia: a survey in five European countries. Semin Arthritis Rheum 39(6):448–453
McNally JD, Matheson DA, Bakowsky VS (2006) The epidemiology of self-reported fibromyalgia in Canada. Chronic Dis Can 27:9–16
Hauser W, Zimer C, Felde E, y Kollner V (2008) What are they symptoms of fibromyalgia? Results of a survey of the German Fibromyalgia Association. Schmerz 22(2):176–183
Wilson HD, Robinson JP, Turk DC (2009) Toward the identification of symptom patterns in people with fibromyalgia. Arthritis Rheum 61:527–534
Martinez-Lavín M, Hermosillo AG, Rosas M, Soto ME (1998) Circadian studies of autonomic nervous balance in patients with fibromyalgia: a heart rate variability analysis. Arthritis Rheum 41(11):1966–1971
Roizenblatt S, Moldofsky H, Benedito-Silva AA, Tufik S (2001) Alpha sleep characteristics in fibromyalgia. Arthritis Rheum 44(1):222–230
Spaeth M, Rizzi M, Sarzi-Puttini P (2011) Fibromyalgia and sleep. Best Pract Res Clin Rheumatol 25(2):227–239
Yunus MB, Masi AT, Aldaq JC (1989) A controlled study of primary fibromyalgia syndrome: clinical features and association with other functional syndromes. J Rheumatol 16:62–71
Drewes AM (1999) Pain and sleep disturbances with special reference to fibromyalgia and rheumatoid arthritis. Rheumatology (Oxford) 38:1035–1038
Ağargün MY, Tekeoğlu I, Güneş A, Adak B, Kara H, Ercan M (1999) Sleep quality and pain threshold in patients with fibromyalgia. Compr Psychiatry 40(3):226–228
Tzeng JI, Fu YW, Lin CC (2012) Validity and reliability of the Taiwanese version of the Pittsburgh Sleep Quality Index in cancer patients. Int J Nurs Stud 49(1):102–108
Krystal AD, Edinger JD (2008) Measuring sleep quality. Sleep Med 9(Suppl 1):S10–S17
Buysse DJ, Reynolds CF, Monk TH, Berman SR, Kupfer DJ (1989) The Pittsburgh Sleep Quality Index: a new instrument for psychiatric practice and research. Psychiatry Res 28(2):193–213
Mariman A, Vogelaers D, Hanoulle I, Delesie L, Tobback E, Pevernagie D (2012) Validation of the three-factor model of the PSQI in a large sample of chronic fatigue syndrome (CFS) patients. J Psychosom Res 72(2):111–113
Buysse DJ, Ancoli-Israel S, Edinger JD, Lichstein KL, Morin CM (2006) Recommendations for a standard research assessment of insomnia. Sleep 29:1155–1173
Pech M, O’Kearney R (2013) A randomized controlled trial of problem-solving therapy compared to cognitive therapy for the treatment of insomnia in adults. Sleep 36(5):739–749
Plante DT, Frankenburg FR, Fitzmaurice GM, Zanarini MC (2013) Relationship between sleep disturbance and recovery in patients with borderline personality disorder. J Psychosom Res 74(4):278–282
Futagami S, Yamawaki H, Izumi N, Shimpuku M, Kodaka Y, Wakabayashi T et al (2013) Impact of sleep disorders in Japanese patients with functional dyspepsia (FD): Nizatidine improves clinical symptoms, gastric emptying and sleep disorders in FD patients. J Gastroenterol Hepatol 28(8):1314–1320
Lee J, Nicholl DD, Ahmed SB, Loewen AH, Hemmelgarn BR, Beecroft JM et al (2013) The prevalence of restless legs syndrome across the full spectrum of kidney disease. J Clin Sleep Med 9(5):455–459
Soler X, Diaz-Piedra C, Ries AL (2013) Pulmonary rehabilitation improves sleep quality in chronic lung disease. COPD 10(2):156–163
Monas L, Csorba S, Kovalyo M, Zeligman R, Dror YF, Musgrave CF (2012) The relationship of sleep disturbance and symptom severity, symptom interference, and hospitalization among Israeli in patients with cancer. Oncol Nurs Forum 39(4):E361–E372
Sanford SD, Wagner LI, Beaumont JL, Butt Z, Sweet JJ, Cella D (2013) Longitudinal prospective assessment of sleep quality: before, during, and after adjuvant chemotherapy for breast cancer. Support Care Cancer 21(4):959–967
Omachi TA (2011) Measures of sleep in rheumatologic diseases: epworth sleepiness scale (ESS), Functional Outcome of Sleep Questionnaire (FOSQ), Insomnia Severity Index (ISI), and Pittsburgh Sleep Quality Index (PSQI). Arthritis Care Res (Hoboken) 63(Suppl 11):S287–S296
Costa DD, Bernatsky S, Dritsa M (2005) Determinants of sleep quality in women with systemic lúpus erythematosus. Arthritis Rheum 53(2):272–278
Osorio CD, Gallinaro AL, Lorenzi-Filho G, Lage LV (2006) Sleep quality in patients with fibromyalgia using the Pittsburgh Sleep Quality Index. J Rheumatol 33(9):1863–1865
Escobar-Córdoba F, Eslava-Schmalbach J (2005) Colombian validation of the Pittsburgh Sleep Quality Index. Rev Neurol 40(3):150–155
Aloba OO, Adewuya AO, Ola BA, Mapayi BM (2007) Validity of the Pittsburgh Sleep Quality Index (PSQI) among Nigerian university students. Sleep Med 8(3):266–270
Bertolazi AN, Fagondes SC, Hoff LS, Dartora EG, Miozzo IC, de Barba ME et al (2011) Validation of the Brazilian Portuguese version of the Pittsburgh Sleep Quality Index. Sleep Med 12(1):70–75
Sohn SI, Kim DH, Lee MY, Cho YW (2012) The reliability and validity of the Korean version of the Pittsburgh Sleep Quality Index. Sleep Breath 16(3):803–812
Curcio G, Tempesta D, Scarlata S, Marzano C, Moroni F, Rossini PM et al (2013) Validity of the Italian version of the Pittsburgh Sleep Quality Index (PSQI). Neurol Sci 34(4):511–519
Tsai PS, Wang SY, Wang MY, Su CT, Yang TT, Huang CJ et al (2005) Psychometric evaluation of the Chinese version of the Pittsburgh Sleep Quality Index (CPSQI) in primary insomnia and control subjects. Qual Life Res 14(8):1943–1952
Kotronoulas GC, Papadopoulou CN, Papapetrou A, Patiraki E (2011) Psychometric evaluation and feasibility of the Greek Pittsburgh Sleep Quality Index (GR-PSQI) in patients with cancer receiving chemotherapy. Support Care Cancer 19(11):1831–1840
Nicassio PM, Ormseth SR, Custodio MK, Olmstead R, Weisman MH, Irwin MR (2012) Confirmatory factor analysis of the Pittsburgh Sleep Quality Index in Rheumatoid Arthritis Patients. Behav Sleep Med. Aug 17. [Epub ahead of print]
Nunnally JC (1978) Psychometric theory. McGraw-Hill, New York
Backhaus J, Junghanns K, Broocks A, Riemann D, Hohagen F (2002) Test-retest reliability and validity of the Pittsburgh Sleep Quality Index in primary insomnia. J Psychosom Res 53(3):737–740
Wolfe F, Smythe HA, Yunus MB, Bennett RM, Bombardier C, Goldenberg DL et al (1990) The American College of Rheumatology 1990 criteria for the classification of Fibromyalgia. Report of the multicenter criteria committee. Arthritis Rheum 33:160–172
Burckhardt CS, Clark SR, Bennett RM (1991) The Fibromyalgia Impact Questionnaire: development and validation. J Rheumatol 18:728–733
Rivera J, Gonzalez T (2004) The Fibromyalgia Impact Questionnaire: a validated Spanish version to assess the health status in women with fibromyalgia. Clin Exp Rheumatol 22(5):554–560
Bennett R (2005) The Fibromyalgia Impact Questionnaire (FIQ): a review of its development, current version, operating characteristics and uses. Clin Exp Rheumatol 23(5 Suppl. 39):S154–S162
Ware JE Jr, Sherbourne CD (1992) The MOS 36-item short-form health survey (SF-36) (I). Conceptual framework and item selection. Med Care 30:473–483
Alonso J, Prieto L, Antó JM (1995) The Spanish version of the SF-36 health survey (the SF-36 health questionnaire): an instrument for measuring clinical results. Med Clín 104:771–776
Beck SL, Schwartz AL, Towsley G, Dudley W, Barsevick A (2004) Psychometric evaluation of the Pittsburgh Sleep Quality Index in cancer patients. J Pain Symptom Manag 27:140–148
Orlandi AC, Ventura C, Gallinaro AL, Costa RA, Lage LV (2012) Improvement in pain, fatigue, and subjective sleep quality through sleep hygiene tips in patients with fibromyalgia. Rev Bras Reumatol 52(5):666–678
Cole JC, Motivala SJ, Buysse DJ, Oxman MN, Levin MJ, Irwin MR (2006) Validation of a 3-factor scoring model for the Pittsburgh Sleep Quality Index in older adults. Sleep 29:112–116
Doi Y, Minowa M, Uchiyama M, Okawa M, Kim K, Shibui K et al (2000) 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 Res 27; 97(2–3):165–72
Carpenter JS, Andrykowski MA (1998) Psychometric evaluation of the Pittsburgh Sleep Quality Index. J Psychosom Res 45:5–13
Nunally JC, Bernstein IH (1994) Psychometric theory. McGraw-Hill, New York
Sariyildiz MA, Batmaz I, Budulgan M, Bozkurt M, Yazmalar L, Inanir A et al (2013) Sleep quality in patients with systemic sclerosis: relationship between the clinical variables, depressive symptoms, functional status, and the quality of life. Rheumatol Int 33(8):1973–1979
Zhou M, Chen M, Feng P, Liang H, Tong WJ, Zhang YH et al (2012) Partial canonical correlation analysis on the association between quality of sleep and quality of life among residents in Suzhou city. Zhonghua Liu Xing Bing Xue Za Zhi 33(10):1040–1043
Stein MB, Belik SL, Jacobi F, Sareen J (2008) Impairment associated with sleep problems in the community: relationship to physical and mental health comorbidity. Psychosom Med 70(8):913–919
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Hita-Contreras, F., Martínez-López, E., Latorre-Román, P.A. et al. Reliability and validity of the Spanish version of the Pittsburgh Sleep Quality Index (PSQI) in patients with fibromyalgia. Rheumatol Int 34, 929–936 (2014). https://doi.org/10.1007/s00296-014-2960-z
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DOI: https://doi.org/10.1007/s00296-014-2960-z