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Psychometric evaluation and feasibility of the Greek Pittsburgh Sleep Quality Index (GR-PSQI) in patients with cancer receiving chemotherapy

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Abstract

Purpose

Quality of sleep in patients with cancer is regarded as of utmost importance. The aim of the present study was to assess psychometric properties and feasibility of the Greek version of the Pittsburgh Sleep Quality Index (GR-PSQI).

Methods

Following a “forward–backward” procedure, the scale was translated into Greek. The GR-PSQI was administered as a self-report instrument to 209 consecutive patients with cancer during active-phase chemotherapy treatment. For stability analysis purposes, a subgroup of 60 patients completed the GR-PSQI on two occasions, 14–21 days apart. All participants also completed the Insomnia Severity Index, the Epworth Sleepiness Scale–Greek version, a Sleep Quality–Visual Analogue Scale and the Hospital Anxiety and Depression Scale–Greek version. Validity and reliability analyses were performed for GR-PSQI data.

Results

The Chronbach’s alpha for the global GR-PSQI score was 0.76. Test–retest reliability analysis for the global GR-PSQI score yielded a high intra-class correlation coefficient of 0.82 (p < 0.001). Exploratory factor analysis generated a two-factor structure for the GR-PSQI, [quality of nocturnal sleep] and [daily disturbances and management of sleep problems]. This construct was further supported by its high correlations with similar content instruments, as well as by the instrument’s ability to discriminate well between contrasting groups of patients with different levels of anxiety, depression and performance status.

Conclusions

The present findings support the GR-PSQI as a reliable, stable over time and valid sleep quality instrument when administered to patients with cancer during chemotherapy treatment; however, it is suggested that the use of a two-factor scoring method (instead of the traditional unidimensional) could improve its sensitivity in this patient group.

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References

  1. Aloba OO, Adewuya AO, Ola BA, Mapayi BM (2007) Validity of the Pittsburgh Sleep Quality Index (PSQI) among Nigerian university students. Sleep Med 8:266–270

    Article  PubMed  Google Scholar 

  2. Ancoli-Israel S, Moore PJ, Jones V (2001) The relationship between fatigue and sleep in cancer patients: a review. Eur J Cancer Care Engl 10:245–255

    Article  PubMed  CAS  Google Scholar 

  3. 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 53:737–740

    Article  PubMed  Google Scholar 

  4. Bastien CH, Vallieres A, Morin CM (2001) Validation of the insomnia severity index as an outcome measure for insomnia research. Sleep Med 2:297–307

    Article  PubMed  Google Scholar 

  5. Beck SL, Dudley WN, Barsevick A (2005) Pain, sleep disturbance, and fatigue in patients with cancer: using a mediation model to test a symptom cluster. Oncol Nurs Forum 32:542

    Article  PubMed  Google Scholar 

  6. 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 Manage 27:140–148

    Article  PubMed  Google Scholar 

  7. Berger AM (2009) Update on the state of the science: sleep–wake disturbances in adult patients with cancer. Oncol Nurs Forum 36:E165–E177

    Article  PubMed  Google Scholar 

  8. Berger AM, Parker KP, Young-McCaughan S, Mallory GA, Barsevick AM, Beck SL, Carpenter JS, Carter PA, Farr LA, Hinds PS, Lee KA, Miaskowski C, Mock V, Payne JK, Hall M (2005) Sleep wake disturbances in people with cancer and their caregivers: state of the science. Oncol Nurs Forum 32:E98–E126

    Article  PubMed  Google Scholar 

  9. Berger AM, VonEssen S, Kuhn BR, Piper BF, Agrawal S, Lynch JC, Higginbotham P (2003) Adherence, sleep, and fatigue outcomes after adjuvant breast cancer chemotherapy: results of a feasibility intervention study. Oncol Nurs Forum 30:513–522

    Article  PubMed  Google Scholar 

  10. Buccheri G, Ferrigno D, Tamburini M (1996) Karnofsky and ECOG performance status scoring in lung cancer: a prospective, longitudinal study of 536 patients from a single institution. Eur J Cancer 32A:1135–1141

    Article  PubMed  CAS  Google Scholar 

  11. Buysse DJ, Hall ML, Strollo PJ, Kamarck TW, Owens J, Lee L, Reis SE, Matthews KA (2008) Relationships between the Pittsburgh Sleep Quality Index (PSQI), Epworth Sleepiness Scale (ESS), and clinical/polysomnographic measures in a community sample. J Clin Sleep Med 4:563–571

    PubMed  Google Scholar 

  12. Buysse DJ, Reynolds CF 3rd, Monk TH, Berman SR, Kupfer DJ (1989) The Pittsburgh Sleep Quality Index: a new instrument for psychiatric practice and research. Psychiatry Res 28:193–213

    Article  PubMed  CAS  Google Scholar 

  13. Carpenter JS, Andrykowski MA (1998) Psychometric evaluation of the Pittsburgh Sleep Quality Index. J Psychosom Res 45:5–13

    Article  PubMed  CAS  Google Scholar 

  14. Clark J, Cunningham M, McMillan S, Vena C, Parker K (2004) Sleep–wake disturbances in people with cancer part II: evaluating the evidence for clinical decision making. Oncol Nurs Forum 31:747–771

    Article  PubMed  Google Scholar 

  15. 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

    PubMed  Google Scholar 

  16. Davidson JR, MacLean AW, Brundage MD, Schulze K (2002) Sleep disturbance in cancer patients. Soc Sci Med 54:1309–1321

    Article  PubMed  Google Scholar 

  17. Doi Y, Minowa M, Uchiyama M, Okawa M, Kim K, Shibui K, Kamei Y (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 97:165–172

    Article  PubMed  CAS  Google Scholar 

  18. Fortner BV, Stepanski EJ, Wang SC, Kasprowicz S, Durrence HH (2002) Sleep and quality of life in breast cancer patients. J Pain Symptom Manage 24:471–480

    Article  PubMed  Google Scholar 

  19. Jimenez-Genchi A, Monteverde-Maldonado E, Nenclares-Portocarrero A, Esquivel-Adame G, de la Vega-Pacheco A (2008) Reliability and factorial analysis of the Spanish version of the Pittsburg Sleep Quality Index among psychiatric patients. Gac Méd Méx 144:491–496

    PubMed  Google Scholar 

  20. Johns MW (1991) A new method for measuring daytime sleepiness: the Epworth Sleepiness Scale. Sleep 14:540–545

    PubMed  CAS  Google Scholar 

  21. Kuo HH, Chiu MJ, Liao WC, Hwang SL (2006) Quality of sleep and related factors during chemotherapy in patients with stage I/II breast cancer. J Formos Med Assoc 105:64–69

    Article  PubMed  Google Scholar 

  22. Lee K, Cho M, Miaskowski C, Dodd M (2004) Impaired sleep and rhythms in persons with cancer. Sleep Med Rev 8:199–212

    Article  PubMed  Google Scholar 

  23. Magee CA, Caputi P, Iverson DC, Huang X-F (2008) An investigation of the dimensionality of the Pittsburgh Sleep Quality Index in Australian adults. Sleep Biol Rhythms 6:222–227

    Article  Google Scholar 

  24. Mystakidou K, Parpa E, Tsilika E, Pathiaki M, Galanos A, Vlahos L (2007) Depression, hopelessness, and sleep in cancer patients’ desire for death. Int J Psychiatry Med 37:201–211

    Article  PubMed  Google Scholar 

  25. Mystakidou K, Parpa E, Tsilika E, Pathiaki M, Gennatas K, Smyrniotis V, Vassiliou I (2007) The relationship of subjective sleep quality, pain, and quality of life in advanced cancer patients. Sleep 30:737–742

    PubMed  Google Scholar 

  26. Mystakidou K, Parpa E, Tsilika E, Pathiaki M, Patiraki E, Galanos A, Vlahos L (2007) Sleep quality in advanced cancer patients. J Psychosom Res 62:527–533

    Article  PubMed  Google Scholar 

  27. Mystakidou K, Tsilika E, Parpa E, Katsouda E, Galanos A, Vlahos L (2004) The hospital anxiety and depression scale in Greek cancer patients: psychometric analyses and applicability. Support Care Cancer 12:821–825

    Article  PubMed  Google Scholar 

  28. Nunally JC, Bernstein IH (1994) Psychometric theory. McGraw-Hill, New York

    Google Scholar 

  29. Oken MM, Creech RH, Tormey DC, Horton J, Davis TE, McFadden ET, Carbone PP (1982) Toxicity and response criteria of the Eastern Cooperative Oncology Group. Am J Clin Oncol 5:649–655

    Article  PubMed  CAS  Google Scholar 

  30. Page MS, Berger AM, Johnson LB (2006) Putting evidence into practice: evidence-based interventions for sleep–wake disturbances. Clin J Oncol Nurs 10:753–767

    Article  PubMed  Google Scholar 

  31. Savard J, Laroche L, Simard S, Ivers H, Morin CM (2003) Chronic insomnia and immune functioning. Psychosom Med 65:211–221

    Article  PubMed  Google Scholar 

  32. Savard J, Morin CM (2001) Insomnia in the context of cancer: a review of a neglected problem. J Clin Oncol 19:895–908

    PubMed  CAS  Google Scholar 

  33. Savard MH, Savard J, Simard S, Ivers H (2005) Empirical validation of the insomnia severity index in cancer patients. Psychooncology 14:429–441

    Article  PubMed  Google Scholar 

  34. Shochat T, Tzischinsky O, Oksenberg A, Peled R (2007) Validation of the Pittsburgh Sleep Quality Index Hebrew translation (PSQI-H) in a sleep clinic sample. Isr Med Assoc J 9:853–856

    PubMed  Google Scholar 

  35. Suleiman KH, Yates BC, Berger AM, Pozehl B, Meza J (2010) Translating the Pittsburgh Sleep Quality Index into Arabic. West J Nurs Res 32:250–68

    Article  PubMed  Google Scholar 

  36. Swore Fletcher BA, Dodd MJ, Schumacher KL, Miaskowski C (2008) Symptom experience of family caregivers of patients with cancer. Oncol Nurs Forum 35:E23–E44

    Article  PubMed  Google Scholar 

  37. Tsai PS, Wang SY, Wang MY, Su CT, Yang TT, Huang CJ, Fang SC (2005) Psychometric evaluation of the Chinese version of the Pittsburgh Sleep Quality Index (CPSQI) in primary insomnia and control subjects. Qual Life Res 14:1943–1952

    Article  PubMed  CAS  Google Scholar 

  38. Tsara V, Serasli E, Amfilochiou A, Constantinidis T, Christaki P (2004) Greek version of the Epworth Sleepiness Scale. Sleep Breath 8:91–95

    Article  PubMed  Google Scholar 

  39. Van Onselen C, Dunn LB, Lee K, Dodd M, Koetters T, West C, Paul SM, Aouizerat BE, Wara W, Swift P, Miaskowski C (2010) Relationship between mood disturbance and sleep quality in oncology outpatients at the initiation of radiation therapy. Eur J Oncol Nurs (in press)

  40. Vena C, Parker K, Allen R, Bliwise D, Jain S, Kimble L (2006) Sleep–wake disturbances and quality of life in patients with advanced lung cancer. Oncol Nurs Forum 33:761–769

    Article  PubMed  Google Scholar 

  41. Vena C, Parker K, Cunningham M, Clark J, McMillan S (2004) Sleep–wake disturbances in people with cancer part I: an overview of sleep, sleep regulation, and effects of disease and treatment. Oncol Nurs Forum 31:735–746

    Article  PubMed  Google Scholar 

  42. Wang RC, Wang SJ, Chang YC, Lin CC (2007) Mood state and quality of sleep in cancer pain patients: a comparison to chronic daily headache. J Pain Symptom Manage 33:32–39

    Article  PubMed  Google Scholar 

  43. Wewers ME, Lowe NK (1990) A critical review of visual analogue scales in the measurement of clinical phenomena. Res Nurs Health 13:227–236

    Article  PubMed  CAS  Google Scholar 

  44. Zigmond AS, Snaith RP (1983) The hospital anxiety and depression scale. Acta Psychiatr Scand 67:361–370

    Article  PubMed  CAS  Google Scholar 

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Conflict of interest

The authors declare that there are no conflicts of interest.

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Authors and Affiliations

  1. School of Nursing and Midwifery, University of Dundee, 11 Airlie Place, Dundee, DD1 4HJ, UK

    Grigorios C. Kotronoulas & Constantina N. Papadopoulou

  2. Faculty of Nursing, University of Athens, Athens, 115 27, Greece

    Anastasia Papapetrou & Elisabeth Patiraki

Authors
  1. Grigorios C. Kotronoulas
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  2. Constantina N. Papadopoulou
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  3. Anastasia Papapetrou
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  4. Elisabeth Patiraki
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Correspondence to Grigorios C. Kotronoulas.

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Kotronoulas, G.C., Papadopoulou, C.N., Papapetrou, A. et al. Psychometric evaluation and feasibility of the Greek Pittsburgh Sleep Quality Index (GR-PSQI) in patients with cancer receiving chemotherapy. Support Care Cancer 19, 1831–1840 (2011). https://doi.org/10.1007/s00520-010-1025-4

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