Dimensionality of the Pittsburgh Sleep Quality Index: a systematic review

Psychometric Validation of the Athens Insomnia Scale Among Nurses: A Robust Approach Using Both Classical Theory and Rating Scale Model Parameters

PURPOSE

Few studies have investigated the validity of the Athens insomnia scale (AIS) using a robust approach of both classical theory and the rating scale model. Therefore, in this study, we investigated psychometric validation of the AIS using both of these approaches in nurses.

METHODS

Nurses (n= 563, age= 33.2±7.1 years) working in health facilities in Saudi Arabia participated in a cross-sectional study. Participants completed the AIS, socio-demographics tool, and sleep health-related questions.

RESULTS

Confirmatory factor analysis (CFA) favored a 2-factor structure with both comparative fit index (CFI), and incremental fit index (IFI) having values above 0.95. The 2-factor model had the lowest values of Akaike information criterion (AIC), root mean square error of approximation (RMSEA), χ ², and χ ²/df. This 2-factor structure showed configural invariance (CFI more than 0.95, RMSEA less than 0.08, and Χ²/df less than 3), and metric, scalar, and strict invariance (based on Δ CFI ≤-0.01, and Δ RMSEA ≥ 0.015 criteria). No ceiling/floor effects were seen for the AIS total scores. Infit and outfit mean square values for all the items were within the acceptable range (<1.4, >0.6). The threshold estimates for each item were ordered as expected. Cronbach's α for the AIS tool, factor-1 score, factor-2 score was 0.86, 0.82, and 0.72, respectively. AIS factor scores-1/2 were significantly associated with a habitual feeling of tiredness after usual night sleep (p<0.001), Impairment of daytime socio-occupational functioning (p<0.05), and with a feeling of daytime fatigue, irritability, and restlessness (p<0.05).

CONCLUSION

The findings favor the validity of a 2-factor structure of the AIS with adequate item properties, convergent validity, and reliability in nurses.

Psychometric properties of the Generalized Anxiety Disorder-7 Scale in Ethiopian university students

The prevalence of anxiety and its associated factors in Ethiopians necessitates availability of a valid questionnaire tool to screen for this disorder. Therefore, this study aimed to assess the factor structure, its stability, and psychometric measures of the Generalized Anxiety Disorder-7 Scale GAD-7) in Ethiopian university students. A cross-sectional study with random sampling was carried out in students (n = 354, age = 21.79 ± 4.49) attending Mizan-Tepi University, Ethiopia. The GAD-7, the Perceived Stress Scale (PSS), and a sociodemographic questionnaire were completed by participants. The unidimensional model of the GAD-7 showed configural, metric, scalar, and strict invariance among gender groups. The Cronbach's alpha (0.77), item-total score correlations (r = .51-.72, p < .01), and inter-item correlations (all significant, p < .05) indicated adequate internal consistency. GAD-7 scale scores correlated significantly with the PSS, suggesting desired convergent validity. The GAD-7 has good psychometric validity with Ethiopian university students.

Independent and combined influences of physical activity, screen time, and sleep quality on adiposity indicators in Indian adolescents

BACKGROUND

Inadequate physical activity (PA), excess screen time (ST), and sub-optimal sleep quality tend to co-occur during adolescence. Yet, little is known about the associations of these behaviors as a cluster with adiposity indicators in Indian adolescents. This study aimed to evaluate the independent and combined influences of PA, ST, and sleep quality on body mass index (BMI) and waist to height ratio (WHtR) in 10-15 years old adolescents in Mumbai, India. A secondary aim was to explore if these influences vary between sexes.

METHODS

Cross-sectional study. Adolescents (n = 772, mean age 13.2 (1.4) years) reported frequency and duration of moderate to vigorous PA (MVPA) and time spent using screens on a previously validated instrument. Sleep quality was estimated using the Pittsburg Sleep Quality Index (PSQI). Weight, height, and waist circumference were measured. Mixed effect logistic regression analyses were performed to explore associations between adiposity indicators (BMI z scores > +1SD and WHtR > 0.5) and unhealthy behaviors (PA < 60 min/d, ST > 120 min/d and PSQI scores > 5), stratified by sex.

RESULTS

The combined prevalence of overweight and obesity was 38.3%. Overall, 62.0 and 85.0% reported MVPA< 60 min/d and ST > 120 min/d respectively. Girls reported higher ST (218.21 (69.01) min/d) as compared to boys (165.3 (101.22) min/d, p < 0.001). Clustering of low PA and excess ST was observed in 69.2% and of all three unhealthy behaviors in 18.8%. Among girls, MVPA < 60 min/d (OR = 1.78, 95% CI 1.54-1.92, p < 0.001) and PSQI scores > 5 (OR = 2.01, 95% CI 1.78-2.25, p < 0.001) predicted increased BMI. The odds of overweight/obesity were 2.10 times higher in boys reporting low PA and 4.13 times higher in those with low PA+ ST > 120 min/d. Clustering of all three unhealthy behaviors increased prevalence of obesity in both sexes.

CONCLUSIONS

The results indicated a co-existence of multiple unhealthy lifestyle factors of obesity and that clustering of these behaviors can further aggravate obesity risk as compared to their independent effects. Integrated interventions that leverage the cumulative benefits of being active, less sedentary and sufficient sleep are warranted to facilitate greater improvements in obesity risk behaviors.

Sleep Measurements in Women

Sleep in women and men have been studied in several studies with higher prevalence of sleep complaints in women compared with men. Several factors can affect sleep and could be argued to contribute to sex and gender differences in general sleep. There are no differences in guidelines when measuring sleep in women but several sleep assessment tools have been validated or compared between sexes. Because there is still a lack of knowledge on sleep measurements in women, the present review aimed to produce an overview of the current knowledge of objective and subjective sleep measurements in women.

Do self-ratings of the Pittsburgh Sleep Quality Index reflect actigraphy recordings of sleep quality or variability? An exploratory study of bipolar disorders versus healthy controls

Sleep disturbances are typical symptoms of acute episodes of bipolar disorder (BD) and differentiate euthymic BD cases from healthy controls (HC). Researchers often employ objective recordings to evaluate sleep patterns, such as actigraphy, whilst clinicians often use subjective ratings, such as the Pittsburgh Sleep Quality Index (PSQI). As evidence suggests the measures may disagree, we decided to compare subjective (PSQI) and objective (3 weeks of actigraphy) sleep profiles in BD cases and HC (n = 154). We examined whether a dimensional approach helps to illustrate different patterns of sleep disturbances and whether the concordance between subjective and objective recordings varies according to clinical status (BD versus HC). Principal component analysis (PCA) extracted two factors from the PSQI, and separate PCAs of actigraphy recordings extracted two factors for mean values of sleep parameters and one factor for intra-individual variability. Correlational and linear regression analyses of PCA-derived dimensions demonstrated that, in both BD and HC, a PSQI "Sleep duration-efficiency" factor was significantly correlated with an actigraphy "Sleep initiation-duration" factor. Furthermore, in BD cases only, the PSQI total score and a PSQI "Sleep Impairments" factor were each significantly correlated with an actigraphy "Sleep Variability" factor. Overall, we found that subjective experiences of sleep may be modulated by different components of objectively recorded sleep in BD compared with HC. Also, the use of PCA enabled us to consider the multi-dimensional nature of subjective sleep, whilst the inclusion of intra-individual sleep variability afforded a more subtle evaluation of objective sleep.

Short-term insomnia symptoms are associated with level and not type of physical activity in a sample of Indian college students

Objective

There is diverse results on the association between physical activity and sleep. So this study investigated association of level and type of physical activity with short term insomnia among college students.

Methods

A cross sectional study was conducted among college students in India. The sample was 662 students with 359 males and 303 females. The predictor variables were type and level of physical activity and predicted variables were sleep complaints.Physical activity components were aseesesed through international physical activity questionnaire and sleep complaints using Pitsburg sleep questionnaire. The binary logistic regression models were used for data analysis. Level of significance was set at p ≤ 0.05 for all the analysis.

Results

The age (mean + SD) of the participants were 23.2 ± 3.5 years. The self reported symptoms of short trem insomnia such as global sleep quality (adjusted odds ratio(AOR) = 15.58), subjective sleep quality (AOR = 6.01), sleep latency (AOR = 5.09), sleep duration (AOR = 0.13), sleep disturbances (AOR = 4.88), day time sleep dysfunction (AOR = 5.59) had shown association with level of physical activity. There was no association of type of physical activity with any other predicted variables.

Conclusions

The findings of the present study supports that level of physical activity is a key predictor of short term insomnia symptoms among college students. There should be Interventions to maintain and improve the level of physical activity among students.

Sleep Quality in Elite Athletes: Normative Values, Reliability and Understanding Contributors to Poor Sleep

BACKGROUND

The aims of this retrospective study were to (i) provide a description of sleep quality in elite athletes as measured by the Pittsburgh Sleep Quality Index (PSQI), (ii) provide normative PSQI data, (iii) identify differences across sex and sport, (iv) identify components that contribute to high PSQI scores and (v) assess PSQI test-retest reliability.

METHODS

The PSQI was completed by 479 athletes (371 female and 108 male) across 20 Olympic team and individual sports. For ordinal and categorical variables, the Wilcoxon rank sum test and Chi Squared tests were used, respectively. A random forest regression was built to determine the importance of each PSQI component. Test-retest reliability was assessed using two-way mixed effects intraclass correlation coefficients.

RESULTS

Fifty-two percent of athletes had a global PSQI score ≥ 5. Team sport athletes reported significantly longer sleep onset latency times but longer sleep durations compared with individual sport athletes. Sleep onset latency and sleep quality made the greatest contribution to the global PSQI scores. The PSQI demonstrated variability over periods of 2 months or more, with a minimal detectable change of 3 arbitrary units (AU).

CONCLUSION

Long sleep onset latency and poor perceived sleep quality made the greatest contribution to the high PSQI scores observed in approximately half of elite athletes investigated. The PSQI should be administered at regular intervals due to variability within individuals over periods of 2 months or more. Individual questionnaire items or component scores of the PSQI may be useful for practitioners in guiding decision-making regarding sleep interventions in athletes.

Components of Pittsburgh Sleep Quality Index in Iranian adult population: an item response theory model

Objective/background

There have been conducted few studies in Iran on the quality of sleep in the general population. This study aimed to use the item response theory (IRT) model to examine the accuracy of the seven components of the Pittsburgh Sleep Quality Index (PSQI) and to provide an appropriate cut-off point for population-based studies.

Methods

This study was performed using the data of the second phase of the Shahroud Eye Cohort Study (ShECS) in 2014. The sleep quality of 4710 participants was measured through PSQI. Using an IRT model, the seven components of the index are considered as indicators and sleep quality as the latent variable in the measurement model. This model supposed that there is only one hidden component to explain the respondent's behavior to a number of items.

Results

Results of analyzing different components of PSQI showed that component 6 (using sleep medication) and 7 (daytime dysfunction disorder) had the lowest values of discrimination parameter and component 4 (habitual sleep efficiency) and 1 (sleep quality) had the highest value of discrimination parameter. Persons with an expected sleep quality score of less than or equal to 6.5 will be defined as good sleep quality pattern.

Conclusions

Since discrimination values for components 6 and 7 are less than the values for other components, the use of the standardized latent scores is emphasized for assessing the quality of sleep in the population.

•

For seven components of PSQI, difficulty and discrimination parameters were estimated using IRT.

•

Using an IRT model persons with an expected sleep quality score ≤ 6.5 will be defined as good sleep quality pattern.

•

Almost 42.9% and 0.2% had poor and very poor sleep quality.

•

Sleep quality, and habitual sleep efficiency components had the highest value of discrimination parameter.

•

Component 6 and 7 play the lowest role in assessing sleep quality in the general population.

Randomized controlled trial of acupuncture for anxiety and depression in patients with chronic insomnia

BACKGROUND

Acupuncture treatment of chronic insomnia (CI) was effective. Anxiety and depression symptoms of the CI patients were improved to varying degrees after acupuncture treatment. Corticosterone (CORT) and 5-hydroxytryptamine (5-HT) are involved in the occurrence and development of comorbidity of insomnia, anxiety, and depression. Whether acupuncture can treat insomnia and accompany anxiety and depression symptoms by regulating CORT and 5-HT is still unclear.

METHODS

This was a randomized, single-blind (participant), parallel, placebo-controlled trial. Sixty CI patients were randomly divided into acupuncture and sham acupuncture groups, with 30 patients in each group. In the acupuncture group, acupuncture was applied at Baihui (GV20), Yintang (GV29), Shenmen (HT7, bilateral), and Sanyinjiao (SP6, bilateral), while in the sham acupuncture group, superficial needles were used on non-disorder-related acupoints. Both groups were treated 3 times a week (once every other day) for 4 weeks and at the 3-month follow-up. The patients were assessed using the Pittsburgh Sleep Quality Index (PQSI), Hamilton Anxiety Rating Scale (HAMA), and Hamilton Depression Rating Scale (HAMD). The serum concentrations of CORT and 5-HT were also measured before and after treatment.

RESULTS

After treatment, the decrease in serum CORT and the increase in serum 5-HT were significantly greater in the acupuncture group than in the sham acupuncture group. At follow-up, the PSQI, HAMA, and HAMD scores in the acupuncture group were significantly lower than those in the sham acupuncture group.

CONCLUSIONS

Elevated serum CORT and decreased serum 5-HT levels may be associated with mood regulation disorders in CI patients. Acupuncture can significantly improve the sleep quality, efficiency, and latency of CI patients, and it can alleviate anxiety and depression in such patients. Compared with the sham acupuncture group, the acupuncture group showed a stable long-term efficacy.

TRIAL REGISTRATION

Chinese Clinical Trials Register ChiCTR1800020298.

Structural validity of the Insomnia Severity Index: A systematic review and meta-analysis

The factor structure of the Insomnia Severity Index (ISI) is discussed, with examples being drawn from about 13 disparate reported models. A systematic appraisal of procedural details of studies investigating the dimensionality of the ISI was performed. The databases CINAHL, Cochrane Library, Embase, Medline, and PsycINFO were searched thoroughly, and all articles in English, published, and/or available online as of 14th March 2019, were included. Meta-analyses of Cronbach's alpha and structural validity measures were performed. Several inadequacies or omissions were found in analyses using the three groups of measures. Fifteen out of 20 studies did not employ either EFA or CFA, 10 studies did not report CFA, while five did not report EFA. The most common omissions related to multivariate normality, final model selection based on consideration of fit indices, parsimony, and failure to consider the theoretical construct in the final model selection. Meta-analysis showed that CFA outcome is more robust compared to EFA, two-factor solution is the vigorous presentation of dimensionality compared to a three-factor solution, and ISI has a high pooled Cronbach's alpha. Further validation of the disparate models of the ISI is needed with more comprehensive reporting guidelines, such as the one suggested in the present review.

Reliability and Validity of the Czech Version of the Pittsburgh Sleep Quality Index in Patients with Sleep Disorders and Healthy Controls

Objectives

Psychometric properties of the Czech version of the Pittsburgh Sleep Quality Index (PSQI-CZ) have been evaluated only in patients with chronic insomnia, and thus, it is unclear whether PSQI-CZ is suitable for use in other clinical and nonclinical populations. This study was aimed at examining the validity and reliability of the PSQI-CZ and at assessing whether the unidimensional or multidimensional scoring of the instrument would be recommended.

Methods

A total of 524 adult subjects from the Czech population participated in the study. The internal consistency of PSQI was evaluated using Cronbach's alpha. The known-group validity was tested using the Kruskal-Wallis H test to verify the difference between patients with sleep disorders and healthy control sample. For testing the structural validity, a cross-validation approach was used with both exploratory factor analysis (EFA) and confirmatory factor analysis (CFA). For EFA, the maximum likelihood method with direct oblimin rotation and parallel analysis was used.

Results

The internal consistency of PSQI-CZ items was moderate (α = 0.75). Receiver operating characteristic (ROC) curve analysis showed high specificity (0.79) and moderate sensitivity (0.64) using an optimal cut-off score of 10. The EFA revealed a 3-factor structure with factors labelled as “sleep duration and efficiency,” “sleep disturbances and quality,” and “sleep latency.” The CFA showed that the emerged 3-factor model had a partly acceptable fit, which was better than other previously supported models.

Conclusions

A high cut-off score of 10 is recommended to define poor sleep quality. Given the inconsistency of structural analyses, alternative scoring was not recommended. However, the individual components in addition to a total score should be interpreted when assessing sleep quality. We recommend editing and verifying the PSQI-CZ translation.

Psychometric properties of the Chinese version of the Pittsburgh Sleep Quality Index (PSQI) among Hong Kong Chinese childhood cancer survivors

Background

Sleep disruption is a prevalent symptom reported by survivors of childhood cancer. However, there is no validated instrument for assessing this symptom in this population group. To bridge the literature gap, this study translated and adapted the Pittsburgh Sleep Quality Index (PSQI) for Hong Kong Chinese cancer survivors and examined its psychometric properties and factor structure.

Methods

A convenience sample of 402 Hong Kong Chinese childhood cancer survivors aged 6–18 years were asked to complete the Chinese version of the PSQI, Center for Epidemiologic Studies Depression Scale for Children (CES-DC), Fatigue Scale-Child (FS-C)/Fatigue Scale-Adolescent (FS-A), and Pediatric Quality of Life Inventory (PedsQL). To assess known-group validity, 50 pediatric cancer patients and 50 healthy counterparts were recruited. A sample of 40 children were invited to respond by phone to the PSQI 2 weeks later to assess test–retest reliability. A cutoff score for the translated PSQI used with the survivors was determined using receiver operating characteristic analysis.

Results

The Chinese version of the PSQI had a Cronbach alpha of 0.71, with an intraclass correlation coefficient of 0.90. Childhood cancer survivors showed significantly lower mean PSQI scores than children with cancer, and significantly higher mean scores than healthy counterparts. This reflected that childhood cancer survivors had a better sleep quality than children with cancer, but a poorer sleep quality than healthy counterparts. We observed positive correlations between PSQI and CES-DC scores and between PSQI and FS-A/FS-C scores, but a negative correlation between PSQI and PedsQL scores. The results supported that the Chinese version of the PSQI showed convergent validity. Confirmatory factor analysis showed that the translated PSQI data best fit a three-factor model. The best cutoff score to detect insomnia was 5, with a sensitivity of 0.81 and specificity of 0.70.

Conclusion

The Chinese version of the PSQI is a reliable and valid instrument to assess subjective sleep quality among Hong Kong Chinese childhood cancer survivors. The validated PSQI could be used in clinical settings to provide early assessments for sleep disruption. Appropriate interventions can therefore be provided to minimize its associated long-term healthcare cost.

Trial registration This study was registered in ClinicalTrials.gov with the reference number NCT03858218.

Racial Discrimination and Depressive Symptoms among Latina/o College Students: The Role of Racism-Related Vigilance and Sleep

INTRODUCTION

Latinx college students are at high risk of suffering from depressive symptoms. A factor posited to influence depressive symptoms among Latinx college students is racial/ethnic discrimination. However, the mechanisms which link racial/ethnic discrimination to depressive symptoms are not well understood. This study examined the mediating role of racism-related vigilance and sleep-related factors (i.e., sleep quality, sleep efficiency) on the relationship between perceived intergroup racial/ethnic discrimination and depressive symptoms.

METHODS

Participants were 194 Latinx college students enrolled at a Midwestern university designated as a Hispanic-Serving Institution. Path analysis was conducted to investigate whether racism-related vigilance and sleep-related factors (i.e. sleep quality, sleep efficiency) are potential pathways in the relationship between intergroup racial/ethnic discrimination and depressive symptoms.

RESULTS

Path analysis revealed that racism-related vigilance and sleep quality sequentially mediated the effect of perceived intergroup racial/ethnic discrimination on depressive symptoms. Sleep efficiency did not mediate the relationship between racial/ethnic discrimination and depressive symptoms.

DISCUSSION

This study is among the first to document that intergroup racial/ethnic discrimination is negatively related to mental health through both cognitive and behavioral mechanisms. This research has important implications for understanding how discrimination may influence mental health outcomes among Latinx college students.

Experiment in a Box (XB): An Interactive Technology Framework for Sustainable Health Practices

This paper presents the Experiment in a Box (XB) framework to support interactive technology design for building health skills. The XB provides a suite of experiments—time-limited, loosely structured evaluations of health heuristics for a user-as-experimenter to select from and then test in order to determine that heuristic’s efficacy, and to explore how it might be incorporated into the person’s life and when necessary, to support their health and wellbeing. The approach leverages self-determination theory to support user autonomy and competence to build actionable, personal health knowledge skills and practice (KSP). In the three studies of XB presented, we show that with even the short engagement of an XB experiment, participants develop health practices from the interventions that are still in use long after the intervention is finished. To situate the XB approach relative to other work around health practices in HCI in particular, we contribute two design continua for this design space: insourcing to outsourcing and habits to heuristics. From this analysis, we demonstrate that XB is situated in a largely under-explored area for interactive health interventions: the insourcing and heuristic oriented area of the design space. Overall, the work offers a new scaffolding, the XB Framework, to instantiate time-limited interactive technology interventions to support building KSP that can thrive in that person, significantly both post-interventions, and independent of that technology.

High-quality nursing intervention can improve negative emotions, quality of life and activity of daily living of elderly patients with Parkinson's disease

OBJECTIVE

This study was designed to determine the effect of high-quality nursing intervention on negative emotions, quality of life and activities of daily living (ADL) of elderly patients with Parkinson's disease (PD).

METHODS

Totally 115 elderly PD patients treated in our hospital from March 2018 to September 2019 were selected as the research participants. According to different nursing intervention methods, they were divided into two groups. The research group (RG) (65 cases) received high-quality nursing intervention, while the control group (CG) (50 cases) received routine nursing intervention. The adverse reactions, negative emotions, quality of life, ADL, PSQI, MDRSPD scores and nursing satisfaction were compared between the two groups.

RESULTS

After nursing intervention, the incidence of adverse reactions in the RG was dramatically lower than that in the CG. Before nursing intervention, there was no marked difference in the scores of quality of life, ADL and MDRSPD between the two groups. But after nursing, those scores in the RG were markedly higher than those in the CG. Before nursing intervention, there was no remarkable difference in SAS, SDS and PSQI scores between both groups, but after that, the scores of the RG were obviously lower than those of the CG. After nursing intervention, the nursing satisfaction of patients in the RG was dramatically higher than that in the CG.

CONCLUSION

High-quality nursing intervention for elderly PD patients can dramatically improve their negative emotions, quality of life and ADL, and promote recovery of motor function.

Effect of high-quality nursing intervention on psychological emotion, life quality and nursing satisfaction of patients with nasopharyngeal carcinoma undergoing radiotherapy

OBJECTIVE

This study was designed to investigate the effect of high-quality nursing (HQN) intervention on psychological emotion, quality of life (QOL) and nursing satisfaction of patients with nasopharyngeal carcinoma (NPC) undergoing radiotherapy.

METHODS

Fifty-eight NPC patients receiving radiotherapy in our hospital between August 2017 and February 2019 were selected and divided into two groups according to different nursing intervention models. Among them, the control group (CG; 28 cases) was given routine nursing intervention, while the research group (RG; 30 cases) was treated with HQN intervention. The efficacy and the incidence of adverse reactions of the two groups were evaluated. Health knowledge awareness rate, psychological mood, QOL, sleep quality and nursing satisfaction were compared between CG and RG.

RESULTS

RG presented significantly higher efficacy and notably lower incidence of adverse reactions than CG after 3 months of nursing intervention. Patients in RG acquired evidently higher knowledge awareness rate regarding radiotherapy, dietary, adverse reaction prevention, self-care and functional exercise than those in RG (P < 0.05). In comparison with CG, the scores of Self-rating Anxiety Scale (SAS) and Self-rating Depression Scale (SDS) as well as Pittsburgh Sleep Quality Index (PSQI) in RG were evidently lower, while the Short-Form 36 Item Health Survey (SF-36) scores and nursing satisfaction were statistically higher.

CONCLUSIONS

HQN intervention is high-performing in NPC patients undergoing radiotherapy, which can effectively improve the curative effect, reduce the incidence of adverse reactions, enhance patients' health knowledge awareness rate while relieving their bad emotions and improving their QOL, sleep quality and nursing satisfaction.

The effectiveness of a 17-week lifestyle intervention on health behaviors among airline pilots during COVID-19

PURPOSE

The aim of this study was to evaluate the efficacy of a 17-week, 3-component lifestyle intervention for enhancing health behaviors during the coronavirus disease 2019 (COVID-19) pandemic.

METHODS

A parallel-group (intervention and control) study was conducted amongst 79 airline pilots over a 17-week period during the COVID-19 pandemic. The intervention group (n = 38) received a personalized sleep, dietary, and physical activity (PA) program. The control group (n = 41) received no intervention. Outcome measures for sleep, fruit and vegetable intake, PA, and subjective health were measured though an online survey before and after the 17-week period. The changes in outcome measures were used to determine the efficacy of the intervention.

RESULTS

Significant main effects for time × group were found for International Physical Activity Questionnaire-walk (p = 0.02) and for all other outcome measures (p < 0.01). The intervention group significantly improved in sleep duration (p < 0.01; d = 1.35), Pittsburgh Sleep Quality Index score (p < 0.01; d = 1.14), moderate-to-vigorous PA (p < 0.01; d = 1.44), fruit and vegetable intake (p < 0.01; d = 2.09), Short Form 12v2 physical score (p < 0.01; d = 1.52), and Short Form 12v2 mental score (p < 0.01; d = 2.09). The control group showed significant negative change for sleep duration, Pittsburgh Sleep Quality Index score, and Short Form 12v2 mental score (p < 0.01).

CONCLUSION

Results provide preliminary evidence that a 3-component healthy sleep, eating, and PA intervention elicit improvements in health behaviors and perceived subjective health in pilots and may improve quality of life during an unprecedented global pandemic.

Association between sleep quality and subjective cognitive decline: evidence from a community health survey

OBJECTIVES

Little is known concerning whether subjective cognitive decline (SCD) is associated with sleep quality. This study aimed to identify the association between self-reported quality of sleep and SCD in a large population of middle-aged and older adults in Korea.

METHODS

We conducted this study based on data collected from the 2018 Korean Community Health Survey. Individuals aged 40 years and older who responded to the Behavioral Risk Factor Surveillance System (BRFSS) and Pittsburgh Sleep Quality Index (PSQI) assessments and did not lack data about multiple covariates were included. A total of 37,712 respondents with SCD and 135,119 those without SCD were included. Sleep quality was estimated using the PSQI, which includes seven self-reported components for sleep health assessment. SCD was assessed using the BRFSS. Logistic regression models adjusted for confounders were used to examine whether each component of the sleep quality index was related to SCD. Additional analysis of the correlation between quantified scores for each component and SCD-related functional limitations as ordinal variables was performed.

RESULTS

The mean age was 62.7 years in the SCD group and 56.4 years in the control group. In total, 13,777 (28.9%) respondents were male in the SCD group and 62,439 (50.7%) in the control group. The adjusted odds ratios of SCD were 1.25 for very bad sleep quality, 1.26 for long sleep latency, 1.16 for <5 h of sleep duration, 1.08 for <65% habitual sleep efficiency, 2.29 for high sleep disturbance, 1.26 for use of sleep medication ≥3 times a week, and 2.47 for high daytime dysfunction due to sleep problems compared to good sleep conditions. Furthermore, a higher score for each component of the sleep quality index correlated with greater SCD-related functional limitations.

CONCLUSIONS

Our study provides evidence that poor sleep quality is closely related to both SCD and SCD-related functional limitations.

The Pittsburgh Sleep Quality Index: Reliability, Factor Structure, and Related Clinical Factors among Children, Adolescents, and Young Adults with Chronic Pain

This study is aimed at assessing the psychometric properties and the factorial structure of the Pittsburgh Sleep Quality Index (PSQI) in a clinical sample of children, adolescents, and young adults with chronic pain. Data of 482 participants (aged 8-21 years) from two crosssectional studies and a chronic pain services outpatient clinic were analyzed. Exploratory and confirmatory factor analysis and reliability analysis of PSQI component scores were performed. Relationships between the PSQI global score and various clinical measures were investigated to assess external validity. The findings exhibit the reliability and validity of a single-factor model of the PSQI in a clinical sample of youth with chronic pain and support the relationship in this specific population between poor sleep quality and important clinical measures of well-being. These results support an informed decision regarding its use with this specific population and underscore the clinical relevance of assessing sleep quality.

The association between depressive symptoms and self-reported sleep difficulties among college students: Truth or reporting bias?

The strong association between self-reported sleep difficulties and depressive symptoms is well documented. However, individuals who suffer from depressive symptoms could potentially interpret the values attached to a subjective scale differently from others, making comparisons of sleep difficulties across individuals with different depressive symptoms problematic. The objective of this study is to determine the existence and magnitude of reporting heterogeneity in subjective assessment of sleep difficulties by those who have depressive symptoms. We implement an online survey using Visual Analogue Scales and anchoring vignettes to study the comparability of subjective assessments of sleep difficulties among college students in Switzerland (N = 1, 813). Using multivariate linear regressions and double-index models, our analysis shows that reporting heterogeneity plays only a marginal role in moderating the association between sleep difficulties and depression, irrespective of the severity of the depressive symptoms of the individuals. This suggests that unadjusted comparisons of self-reported sleep difficulties between college students are meaningful, even among individuals with depressive symptoms.

Predicting subretinal fluid absorption with machine learning in patients with central serous chorioretinopathy

Background

Machine learning was used to predict subretinal fluid absorption (SFA) at 1, 3 and 6 months after laser treatment in patients with central serous chorioretinopathy (CSC).

Methods

The clinical and imaging data from 480 eyes of 461 patients with CSC were collected at Zhongshan Ophthalmic Center (ZOC) and Xiamen Eye Center (XEC). The data included clinical features from electronic medical records and measured features from fundus fluorescein angiography (FFA), indocyanine green angiography (ICGA), optical coherence tomography angiography (OCTA), and optical coherence tomography (OCT). A ZOC dataset was used for training and internal validation. An XEC dataset was used for external validation. Six machine learning algorithms and a blending algorithm were trained to predict SFA in patients with CSC after laser treatment. The SFA results predicted by machine learning were compared with the actual patient prognoses. Based on the initial detailed investigation, we constructed a simplified model using fewer clinical features and OCT features for convenient application.

Results

During the internal validation, random forest performed best in SFA prediction, with accuracies of 0.651±0.068, 0.753±0.065 and 0.818±0.058 at 1, 3 and 6 months, respectively. In the external validation, XGBoost performed best at SFA prediction with accuracies of 0.734, 0.727, and 0.900 at 1, 3 and 6 months, respectively. The simplified model showed a comparable level of predictive power.

Conclusions

Machine learning can achieve high accuracy in long-term SFA predictions and identify the features relevant to CSC patients’ prognoses. Our study provides an individualized reference for ophthalmologists to treat and create a follow-up schedule for CSC patients.

Effects of sleep disturbance on functional and physiological outcomes in collegiate athletes: A scoping review

OBJECTIVE

To investigate sleep disturbances and circadian timing changes on functional and physiological correlates specifically in collegiate athletes.

DESIGN

Scoping Review.

DATA SOURCES

PubMed MEDLINE, SPORT-Discus, CINAHL, ERIC ProQuest, Web of Science.

ELIGIBILITY CRITERIA

Articles in English, studying college athletes 18-24 years old, employing a sleep measurement, and a comparison measure of cognitive, academic performance, athletic performance, injury rate, biomarkers and physiological measures, or imaging.

RESULTS

Thirty articles met inclusion criteria. There was wide range of study design, sport studied, modality used to measure sleep, frequency of sleep measurements, and functional and physiological outcomes across studies. Sleep measurements varied greatly in frequency of data collection and type of measurement tool, with the majority using a sleep questionnaire. While all variables of interest were represented within the review, most had a focus on cognitive performance, athletic performance, or injury rate as a function of sleep. Studies using biomarkers and physiological measures or imaging were largely underrepresented. Few studies used biomarkers and physiological measures, and one study used imaging measures. Most studies in this review reported negative cognitive and academic outcomes with worse sleep quality and quantity.

CONCLUSIONS

Sleep is critical to maintaining optimal health and collegiate athletes represent a unique population given their unique time constraints, stresses, and sleep behaviors. Findings on athletic performance and injury rate as a function of sleep were mixed. Employing standardized objective methodologies in future work will allow for better understanding of the influence of sleep on the overall well-being and performance of college athletes.

Measuring Subjective Sleep Quality: A Review

Sleep quality is an important clinical construct since it is increasingly common for people to complain about poor sleep quality and its impact on daytime functioning. Moreover, poor sleep quality can be an important symptom of many sleep and medical disorders. However, objective measures of sleep quality, such as polysomnography, are not readily available to most clinicians in their daily routine, and are expensive, time-consuming, and impractical for epidemiological and research studies., Several self-report questionnaires have, however, been developed. The present review aims to address their psychometric properties, construct validity, and factorial structure while presenting, comparing, and discussing the measurement properties of these sleep quality questionnaires. A systematic literature search, from 2008 to 2020, was performed using the electronic databases PubMed and Scopus, with predefined search terms. In total, 49 articles were analyzed from the 5734 articles found. The psychometric properties and factor structure of the following are reported: Pittsburgh Sleep Quality Index (PSQI), Athens Insomnia Scale (AIS), Insomnia Severity Index (ISI), Mini-Sleep Questionnaire (MSQ), Jenkins Sleep Scale (JSS), Leeds Sleep Evaluation Questionnaire (LSEQ), SLEEP-50 Questionnaire, and Epworth Sleepiness Scale (ESS). As the most frequently used subjective measurement of sleep quality, the PSQI reported good internal reliability and validity; however, different factorial structures were found in a variety of samples, casting doubt on the usefulness of total score in detecting poor and good sleepers. The sleep disorder scales (AIS, ISI, MSQ, JSS, LSEQ and SLEEP-50) reported good psychometric properties; nevertheless, AIS and ISI reported a variety of factorial models whereas LSEQ and SLEEP-50 appeared to be less useful for epidemiological and research settings due to the length of the questionnaires and their scoring. The MSQ and JSS seemed to be inexpensive and easy to administer, complete, and score, but further validation studies are needed. Finally, the ESS had good internal consistency and construct validity, while the main challenges were in its factorial structure, known-group difference and estimation of reliable cut-offs. Overall, the self-report questionnaires assessing sleep quality from different perspectives have good psychometric properties, with high internal consistency and test-retest reliability, as well as convergent/divergent validity with sleep, psychological, and socio-demographic variables. However, a clear definition of the factor model underlying the tools is recommended and reliable cut-off values should be indicated in order for clinicians to discriminate poor and good sleepers.

Effect of a Multi-Layer, Extended-Release Methylphenidate Formulation (PRC-063) on Sleep in Adults with ADHD: A Randomized, Double-Blind, Forced-Dose, Placebo-Controlled Trial Followed by a 6-month Open-Label Extension

BACKGROUND

The effects of stimulant treatment on sleep in adults with attention-deficit/hyperactivity disorder (ADHD) are complex and varied, with some individuals experiencing worsening of sleep but others experiencing improvement.

METHODS

Data from previously reported trials of the clinical efficacy and safety of the long-acting methylphenidate formulation PRC-063 (Adhansia XR^® in the USA; Foquest^® in Canada) in adults with ADHD were used to evaluate patient-reported sleep outcomes, as captured using the Pittsburgh Sleep Quality Index (PSQI) and adverse events of insomnia. The trials comprised 4 weeks of randomized, forced-dose PRC-063 treatment at a dose of 0 (placebo), 25, 45, 70, or 100 mg/day followed by an optional 6 months of open-label PRC-063 treatment at an individually optimized dose of 25-100 mg/day.

RESULTS

At the end of double-blind treatment, PRC-063 (all doses combined; N = 297) showed no significant difference versus placebo (N = 78) in least squares mean change in global PSQI score from baseline (- 0.7 vs. - 1.3; P = 0.0972) or in scores for each of the seven subscales of the PSQI. For patients enrolled in the open-label extension (N = 184), mean ± standard deviation global PSQI score improved from 7.8 ± 3.55 at the end of double-blind treatment to 5.8 ± 3.11 at 1 month and 5.4 ± 3.21 at 6 months (P < 0.0001). A greater proportion of patients were good sleepers (global PSQI score ≤ 5) at the end of the open-label extension (57.3%) than at baseline (20.9%) or at the end of double-blind treatment (26.0%). In a logistic regression analysis, baseline global PSQI score (odds ratio 1.491; P < 0.0001), but not randomized study treatment (P = 0.1428), was a significant predictor of poor sleep (global PSQI score > 5) at the end of double-blind treatment. Adverse event rates for insomnia (15.8 vs. 3.8%) and initial insomnia (6.1 vs. 1.3%) during double-blind treatment were higher for PRC-063 (all doses combined) than for placebo. Two patients receiving PRC-063 in the double-blind study and one patient in the open-label study were withdrawn because of insomnia adverse events.

CONCLUSIONS

Our findings indicate that, on average, PRC-063 had no significant impact on overall sleep quality in adults with ADHD. Although insomnia was observed as an adverse event, when sleep was measured over time as an outcome in its own right for patients receiving dose-optimized PRC-063 open-label, more patients showed improvement in sleep than deterioration. CLINICALTRIALS.

GOV IDENTIFER

NCT02139124 and NCT02168127.

Obstructive sleep apnea screening in young people: Psychometric validation of a shortened version of the STOP-BANG questionnaire using categorical data methods

BACKGROUND:

The STOP-BANG is an easily administrable questionnaire for the screening of obstructive sleep apnea in adults, which may be adapted for use by young people. Here, we assessed the psychometric properties of the STOP-BN, a shortened version of the STOP-BANG questionnaire, using categorical data methods.

METHODS:

Four hundred and three young people (age 20.71 ± 1.93 years) were selected by random sampling to participate in this cross-sectional study. Participants completed the STOP-BN, a tool for recording social and demographic characteristics, and the Epworth Sleepiness Scale (ESS), a measure of daytime sleepiness. The obtained data were analyzed using categorical data methods.

RESULTS:

A two-factor model was identified for the STOP-BN, using the Kaiser's criteria (eigenvalue >1) and the screen test. However, the parallel analysis based on minimum rank, and the cumulative variance criteria (>40%) identified an one-factor model. Factor loadings ranged from 0.364 to 0.745. The identified two-factor model showed acceptable fit as the reported goodness of fit index and weighted root mean square residual were in the ideal range, and the comparative fit index was close to the ideal range. Greatest lower bound to reliability for two factors of the STOP-BN was 0.67 and 0.67, indicating an acceptable internal consistency. A weak to a nonsignificant correlation between the ESS and the STOP-BN score was demonstrated, favoring STOP-BN's divergent validity.

CONCLUSION:

Categorical methods support the psychometric validity of the STOP-BN in the study population.

Psychometric Properties of the General Anxiety Disorders-7 Scale Using Categorical Data Methods: A Study in a Sample of University Attending Ethiopian Young Adults

BACKGROUND

Few studies have investigated the psychometric validation of the General Anxiety Disorders-7 Scale (GAD-7) using appropriate data assumptions. This study examined the reliability, factorial validity, divergent validity, and item analysis of the GAD-7 using categorical data methods in a sample of Ethiopian young adults.

METHODS

A sample of 270 students in the age group (18-20 years) was recruited during February-May of 2017 in this cross-sectional study using simple random sampling. The participants completed a tool for socio-demographic details, the GAD-7, and the Perceived Stress Scale-10 (PSS-10).

RESULTS

The cumulative variance rule (> 40%), the scree test, Kaiser's criteria (Eigenvalues > 1), and the parallel analysis found a 1-factor model for the GAD-7 (factor loadings, 0.38 to 0.63). Fit indices suggested a 1-factor model: the tests applied included the weighted root mean square residual (0.030), comparative fit index (1.000), the goodness of fit index (1.00), root mean square error of approximation (0.037) and the non-normed fit index (1.00). McDonald's Omega (0.772) implied that the scores had adequate internal consistency. Divergent validity was supported by significant but weak correlations that were found between the GAD-7 and PSS-10 scores (r = 0.11 to 0.25, p<0.05).

CONCLUSION

The psychometric validity of the GAD-7 in Ethiopian university attending young adults was supported by the categorical data method.

Differences of Sleep Disorders Between Vestibular Migraine and Benign Paroxysmal Positional Vertigo

Introduction: Sleep disorders can affect the overall health and quality of life of patients. This study was conducted to compare the differences of sleep disorders in vestibular migraine (VM) patients and benign paroxysmal positional vertigo (BPPV) patients. Methods: VM patients, BPPV patients, and healthy controls (HCs) were recruited. Pittsburgh sleep quality index and polysomnography monitoring were used as subjective and objective, respectively, evaluation methods to evaluate the sleep quality of participants in the latest month. Results: Fifty-seven BPPV patients, 48 VM patients, and 42 HCs were included in this study. There were 79.16% VM patients, 54.39% BPPV patients, and 14.28% HCs with sleep disorders. The difference in the incidence rate of sleep disorders was significant between VM patients and BPPV patients (p = 0.008) and significantly higher in both the VM group (p < 0.00001) and BPPV group (p = 0.00004) than in the HC groups (14.28%). Compared with BPPV patients, the VM patients had the significantly lower sleep efficiency (p < 0.001) and N3 (p < 0.001) and the significantly higher time of wake-up after sleep onset (p < 0.001), N1 (p < 0.001), and N2 (p < 0.001). Meanwhile, the VM patients had significantly higher incidence rates of severe obstructive sleep apnea hypoventilation syndrome (p = 0.001) and periodic leg movement in sleep (p = 0.016). Conclusion: The incidence rate of sleep disorders was significantly higher in both VM and BPPV patients than in the HC groups. To improve the curative effects, clinicians should pay more attention to the comorbidity of sleep disorders in treating VM and BPPV.

Are Reallocations between Sedentary Behaviour and Physical Activity Associated with Better Sleep in Adults Aged 55+ Years? An Isotemporal Substitution Analysis

Physical activity has been proposed as an effective alternative treatment option for the increasing occurrence of sleep problems in older adults. Although higher physical activity levels are associated with better sleep, the association between specific physical activity intensities and sedentary behaviour (SB) with sleep remains unclear. This study examines the associations of statistically modelled time reallocations between sedentary time and different physical activity intensities with sleep outcomes using isotemporal substitution analysis. Device-measured physical activity data and both objective and subjective sleep data were collected from 439 adults aged 55+ years. Replacing 30 min of SB with moderate to vigorous intensity physical activity (MVPA) was significantly associated with an increased number of awakenings. Moreover, a reallocation of 30 min between light physical activity (LPA) and MVPA was significantly associated with increased sleep efficiency. Furthermore, reallocating 30 min of SB to LPA showed a significant association with decreased sleep efficiency. There were no significant associations of time reallocations for wake time after sleep onset, length of awakenings, and sleep quality. These results improve our understanding of the interrelationships between different intensities of movement behaviours and several aspects of sleep in older adults.

Leeds sleep evaluation questionnaire in Jordanian university students. A psychometric investigation using comparative confirmatory factor analysis

Objectives:

To analyze the fit of different competing factor models (a one-factor model, 3 2-factor models, and 2 4-factor models) of the Leeds sleep evaluation questionnaire (LSEQ) in the data from a Jordanian student population.

Methods:

A cross-sectional study was conducted on university students, with 2 sleep-related tools - the LSEQ and the sleep hygiene index (SHI). The students (n=166) at Jordan University of Science and Technology, Irbid, Jordan participated in this study from January-April, 2019. A total of 12 LSEQ models (6 models with all 10-items, and 6 models with one item deleted) were evaluated by using confirmatory factor analysis. The summary statistics of correlation coefficients, descriptive measures of item analysis, the model fit, and Cronbach’s alpha were determined.

Results:

The findings show that a 4-factor correlated solution was a plausible model for the LSEQ with 9-items, compared to a one-factor, 2-factor, and other 4-factor variant models. The deletion of one item from the original LSEQ improved the data fit significantly in the studied population. Moreover, correlation analysis between the LSEQ and SHI confirmed the divergent validity of the LSEQ.

Conclusion:

The results support the validity of a 4-factor structure of the LSEQ with 9-items with adequate internal consistency and divergent validity.

Sleep dissatisfaction and insufficient sleep duration in the Italian population

To investigate the prevalence and possible determinants of sleep quality and quantity, we used data from a cross-sectional study conducted in 2019 on a sample of 3120 subjects, representative of the general Italian adult population. Sleep dissatisfaction was reported by 14.2% and insufficient sleep (duration) by 29.5% of adults. Sleep dissatisfaction and insufficient sleep were directly related with age (p for trend < 0.001), and inversely related with socioeconomic class (p for trend < 0.001) and income (p for trend < 0.001). Sleep dissatisfaction was higher among women (odds ratio, OR 1.30; 95% confidence interval, CI 1.05–1.60). Insufficient sleep was inversely related to education (p for trend < 0.001) and more frequent in current compared to never smokers (OR 1.32; 95% CI 1.08–1.61). Sleep dissatisfaction was higher among divorced/separated compared with married subjects (OR 1.75; 95% CI 1.20–2.58) and lower among subjects living with children aged 0–14 years (OR 0.48, 95% CI 0.33–0.70). Pet owners more frequently had sleep dissatisfaction (OR 1.35, 95% CI 1.08–1.68) and insufficient sleep (OR 1.46, 95% CI 1.23–1.73). In Italy, self-perceived sleep problems appear to be increasing. Sleep problems can contribute to aggravating health disparities in the society. The unfavourable relationship with pets (and the favourable ones with children) should be confirmed by longitudinal studies.

Efficacy and safety of electro-acupuncture (EA) on insomnia in patients with lung cancer: study protocol of a randomized controlled trial

BACKGROUND

Cancer-related insomnia (CRI) is one of the most prevalent complaints among cancer survivors and severely impairs patients' quality of life. As a popular non-pharmacological alternative treatment, acupuncture provides a good clinical curative effect on insomnia. The aim of this trial is to evaluate efficacy and safety of electro-acupuncture on insomnia in patients with lung cancer.

METHOD

This is a protocol for a multicenter randomized single-blinded sham-controlled trial. We will randomly assign 252 eligible patients with lung cancer-related insomnia into two groups at a ratio of 1:1, the treatment group (EA) and the control group (sham EA). All treatment will be given 3 times per week for 8 weeks, and a 12-week follow-up will be conducted. The primary outcome will be measured by the Pittsburgh Sleep Quality Index (PSQI). The secondary outcomes will include sleep parameters recorded from the actigraphy, scores from Quality of Life Questionnaire Core-30 (QLQ-C30), and Patient Health Questionnaire-9 (PHQ-9). All adverse effects during the trial will be assessed by the Treatment Emergent Symptom Scale (TESS). All analyses will be based on ITT principle and performed with the statistical software SPSS (version 24.0) by t test, rank-sum test, chi-square, and so on. A two-sided significance level will be set at 5%.

DISCUSSION

This large-sample trial protocol will evaluate the efficacy of electro-acupuncture on insomnia in patients with lung cancer. This protocol, if proven to be effective, will contribute to filling the gap in treatment options in the CRI field and provide a promising intervention for insomnia in lung cancer survivors.

TRIAL REGISTRATION

ChiCTR ChiCTR1900026395. Registered on 8 October 2019, http://www.chictr.org.cn/showproj.aspx?proj=44068.

Reliability, Validity, and Factor Structure of Pittsburgh Sleep Quality Index in Community-Based Centenarians

BACKGROUND

The Pittsburgh Sleep Quality Index (PSQI) is a widely used self-report questionnaire that measures general sleep quality in general populations. However, its psychometric properties have yet to be thoroughly examined in longevous persons.

OBJECTIVES

This study aimed to explore the reliability, validity and factor structure of the Chinese-language version of the PSQI in community-dwelling centenarians.

METHODS

A total of 958 centenarians (mean age = 102.8 years; 81.8% females) recruited from 18 regions in Hainan, China, completed the PSQI scale. Cronbach's alpha coefficient was used to measure the internal consistency. Exploratory factor analysis (EFA) and confirmatory factor analysis (CFA) were performed to explore the validity and factor structure of the PSQI in this sample. Correlations between the global PSQI score and physical function, depression symptoms, self-reported health status and subjective well-being were used to assess divergent validity.

RESULTS

The Cronbach's α coefficient of the PSQI was 0.68, and it increased to 0.78 after two components (medication use and daytime dysfunction) were removed. The Spearman correlation coefficients of the PSQI score with each component were statistically significant (P<0.01). EFA yielded a two-factor structure model of the original PSQI-7 and a one-factor structure model of the simplified PSQI-5. The one-factor model with five components (χ2/df =1.59, CFI=0.99, RMSEA=0.03) fit the data well and had good configural invariance across demographic characteristics (0.53<Δχ2<5.58, P>0.05).

CONCLUSIONS

The original PSQI showed acceptable applicability in Chinese community-dwelling centenarians, and its psychometric characteristics moderately improved after sleeping medication and daytime dysfunction were removed. Further validation studies on PSQI are needed among centenarians from varied backgrounds.

Tai Chi Chuan for Subjective Sleep Quality: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

Background

This review aims to investigate the efficacy of Tai Chi Chuan on subjective sleep quality among adults.

Methods

We systematically searched PubMed, Embase, Cochrane Library, Scopus, CNKI (China National Knowledge Infrastructure), and the Wanfang Database from their inception to August 2019 and identified 25 eligible studies that were published in both English and Chinese.

Results

24 out of 25 studies were identified to be high-quality studies according to the PEDro scale. The pooled results confirmed that Tai Chi Chuan elicited moderate improvements in subjective sleep quality (SMD = −0.512, 95% CI [−0.767, −0.257], P < 0.001). Notably, Tai Chi Chuan yielded more significant effects on sleep quality among the healthy population (SMD = −0.684, 95% CI [−1.056, −0.311], P < 0.001) than the clinical population (SMD = −0.395, 95% CI [−0.742, −0.047], P=0.026) and more benefits among the Asian population (SMD = −0.977, 95% CI [−1.446, −0.508], P < 0.001) than the American population (SMD = −0.259, 95% CI [−0.624, 0.105], P=0.164). After controlling the methodological quality of studies, it has been noted that Asians could achieve the most significant sleep-promoting benefit when Tai Chi Chuan was practiced between 60 and 90 min per session.

Conclusions

Available data implied that subjective sleep quality was improved via Tai Chi training, but more thorough studies must be executed to ascertain our findings and optimize Tai Chi practices accordingly toward various populations.

The examination of sleep quality for frontline healthcare workers during the outbreak of COVID-19

PURPOSE

Few studies have addressed the sleep disturbances of healthcare workers during crisis events of public health. This study aimed to examine the sleep quality of frontline healthcare workers (FLHCW) in Bahrain during the COVID-19 pandemic, and compare it with the sleep quality of non-frontline healthcare workers (NFLHCW).

METHODS

Healthcare workers (n = 280) from multiple facilities belonging to the Ministry of Health, Bahrain, were invited to participate in this cross-sectional study. An online questionnaire, including socio-demographics, the Pittsburgh Sleep Quality Index (PSQI), and the Perceived Stress Scale (PSS), was used to evaluate sleep disturbances and stress levels of healthcare workers. Poor sleep quality was defined as PSQI ≥ 5 and moderate-severe stress as PSS ≥ 14. Descriptive statistics were used to compare the scores of FLHCW and NFLHCW. Univariate and multivariate binary logistic regressions were used to identify predictors of poor sleep quality, moderate-severe stress, and the combined problem of poor sleep quality and moderate-severe stress.

RESULTS

A total of 257 participants (129 FLHCW and 128 NFLHCW) provided usable responses. The overall PSQI and PSS scores were 7.0 ± 3.3 and 20.2 ± 7.1, respectively. The FLHCW scored higher in the PSQI and PSS compared with the NFLHCW; however, the differences in the PSQI and PSS scores were not statistically significant. For the FLHCW, 75% were poor sleepers, 85% had moderate-severe stress, and 61% had both poor sleep quality and moderate-severe stress. For the NFLHCW, 76% were poor sleepers, 84% had moderate-severe stress, and 62% had both poor sleep quality and moderate-severe stress. Female sex and professional background were the predictors of poor sleep quality and stress.

CONCLUSIONS

Poor sleep quality and stress are common during the COVID-19 crisis. Approximately, 60% of both FLHCW and NFLHCW have poor sleep quality combined with moderate-severe stress.

Comparison between acupuncture and cognitive behavioral therapy for primary insomnia: A protocol for systematic review and network meta-analysis

BACKGROUND

Primary insomnia (PI) is a common disease affecting human health. As the side effects of drug therapy were revealed, people began to seek more safe and effective non-drug therapies. Cognitive behavioral therapy for insomnia (CBT-I) and acupuncture are 2 commonly used non-drug therapies. However, there are few comparative studies on the efficacy of these 2 therapies. Therefore, this study aims to compare the efficacy and safety of the 2 therapies through network meta-analysis.

METHODS

We will search the following electronic bibliographic databases: PubMed, EMBASE, The Cochrane Library, Web of Science, China National Knowledge Infrastructure, Chinese Biomedical Literature Database, Chongqing VIP database, and Wanfang database. Randomized controlled trials in which the intervention was acupuncture or CBT, and in which the control group was any of the above, western medicine or blank control, would be included. The primary outcome will be the changes of the Pittsburgh Sleep Quality Index, and the additional outcomes will include the changes in Insomnia Severity Index, quality of life, clinical effective rate and adverse events. Two independent authors will screen the literature in the above database, extract data and cross-check. Heterogeneity and inconsistencies are detected before using a network meta-analysis method based on frequency analysis. The risk of bias will be assessed in accordance with the Cochrane risk of bias tool, and the strength of the recommendations will be assessed by the Grading of Recommendations Assessment, Development and Evaluation.

ETHICS AND DISSEMINATION

This network meta-analysis will provide a reference for clinicians and PI patients to choose a more appropriate non-drug regimen among multiple kinds of acupuncture or CBT-I therapies. This review does not require ethical approval and will be reported in a peer-reviewed journal.

TRIAL REGISTRATION NUMBER

PROSPERO CRD42020155327.

Migraine screen questionnaire: further psychometric evidence from categorical data methods

BACKGROUND

Psychometric investigations of tools used in the screening of migraine including the migraine screen questionnaire (MS-Q), using an adequate statistical approach is needed. We assessed the psychometric properties of the migraine screen questionnaire (MS-Q) using categorical data methods.

MATERIAL AND METHODS

A total of 343 students at Mizan-Tepi University, Ethiopia, age range = 18-35 years were selected by a simple random sampling method to participate in a cross-sectional study. The respondents completed the MS-Q, a semi-structured socio-demographic questionnaire, and a visual analog scale for attention (VAS-A).

RESULTS

The cumulative variance rule (> 40%), the Kaiser's criteria (Eigenvalue> 1), the Scree test and, the parallel analysis (minimum rank) identified a 1-factor model for the MS-Q with the factor loadings in the range of 0.78 to 0.84. Fit indices favored a 1-factor model of the MS-Q as indicated by comparative fit index (0.993), weighted root mean square residual (0.048), root mean square error of approximation (0.067), the goodness of fit index (1.00), and non-normed fit index (0.987). The values of the Factor Determinacy Index (0.953), marginal reliability (0.909), H-latent (0.909), H-observed (0.727), explained common variance (0.906) and the mean item residual absolute loadings (0.225) further complimented finding of the 1-Factor model. McDonald's Omega (0.903) suggested adequate internal consistency. Discriminative validity was supported by significantly higher scores for the total and all the MS-Q items except one among those with complaints of attention.

CONCLUSION

The categorical methods support the psychometric validity of the MS-Q in the study population.

Psychometric Properties of the Athens Insomnia Scale in Occupational Computer Users

Background: Various studies have shown that insomnia is associated with computer use. The Athens Insomnia Scale (AIS) is an 8-item tool that has been widely used for screening insomnia. No studies have investigated the psychometric validity of AIS in occupational computer users. Objective: the current research aimed to test the psychometric properties of the AIS among occupational computer users. Materials and Methods: a sample of four hundred and twenty-four occupational computer users (age: 20-65 years and body mass index: 21.6 ± 3.5 kg/m2) completed an AIS and a socio-demographic questionnaire in this cross-sectional study. Results: a confirmatory factor analysis demonstrated that the three-factor model had an adequate fit (the goodness of fit index (0.95), incremental fit index (0.90) and χ2/df (2.61)). Evidence was found for configural, scalar and metric invariance of the 3-factor model across gender groups. A moderate level of internal consistency was implied by a Cronbach's alpha of 0.66. Conclusion: the findings of the present research support the validity of AIS for screening insomnia, as demonstrated by the scale's psychometric properties; its internal consistency, internal homogeneity, item discrimination, and factorial validity.

Comparison of the Sleep Problems Among Adolescents Who Attempted Suicide and Healthy Adolescents

The aim of this study was to compare sleep problems among adolescents who attempted suicide and healthy adolescents who never attempted suicide. Adolescents who attempted suicide (study group, n = 103) and healthy adolescents (control group, n = 59) completed a questionnaire prepared by researchers including demographic factors. In addition, the Pittsburgh Sleep Quality Index (PSQI) and the Epworth Sleepiness Scale (ESS) were administered to both groups. The median age was 16 years and 73% were girls, in both groups. The study group had lower rate of attending to school (88.3% vs. 100%; p = 0.001), academic achievement (45.7% vs. 83.1%; p = 0.001), higher rate of smoking (37.9% vs. 13.8%; p = 0.001), socializing problems (31.1% vs. 3.4%; p = 0.001), and appetite changes (57.3% vs. 39.7%; p = 0.032) than controls. The rate of those with PSQI scores 6 or higher was 53.4% in the attempted suicide group and 37.3% in the control group (p = 0.048). Adolescents, classified as sleepy according to the ESS, did not differ significantly between the groups (p = 0.214). Adolescents who attempted suicide had poor sleep quality. It is crucial to examine the kinds of sleep problems adolescents who have attempted suicide have experienced. Among adolescents attending outpatient clinics with poor sleep quality, PSQI can be a useful screening tool. Those with high scores should be evaluated for suicide risk.

Effectiveness of sleep surgery versus a mandibular advancement device for obstructive sleep apnea in terms of nocturnal cardiac autonomic activity

PURPOSE

Sleep surgery and mandibular advancement devices (MAD) are treatments for obstructive sleep apnea (OSA), but their comparative efficacy remains unclear. We compared their efficacy using various parameters.

METHODS

Subjects treated for OSA with sleep surgery or MAD (n = 30/group)-matched for sex, body mass index (BMI), and baseline apnea-hypopnea index (AHI)-were enrolled. The efficacy of these treatments according to polysomnographic parameters, sleep quality questionnaires, and heart rate variability (HRV) time- and frequency-domain parameters were compared between pre-treatment and 3-month post-treatment.

RESULTS

Polysomnographic and sleep quality questionnaire parameters improved significantly in both groups. In time-domain HRV analysis, average normal-to-normal intervals increased significantly in the surgery (942.2 ± 140.8 to 994.6 ± 143.1, P = 0.008) and MAD (901.1 ± 131.7 to 953.7 ± 123.1, P = 0.002) groups. Low frequency (LF) decreased significantly in the surgery group (P = 0.012); high frequency (HF) remained unchanged in both groups. The LF/HF ratio decreased in both groups (2.9 ± 1.8 to 2.3 ± 1.7, P = 0.017, vs. 3.0 ± 1.8 to 2.4 ± 1.4, P = 0.025). Normalized high frequency increased significantly in both groups (31.0 ± 13.2 to 36.8 ± 13.7, P = 0.009, vs. 29.1 ± 10.7 to 33.7 ± 12.5, P = 0.024), in contrast to normalized low frequency. However, no HRV parameter changes differed significantly between the groups after adjusting for age, BMI, and AHI.

CONCLUSION

Sleep surgery and MAD are equally effective treatments for OSA according to cardiac autonomic activity.

10-kHz High-Frequency Spinal Cord Stimulation for Adults With Chronic Noncancer Pain: A Health Technology Assessment

BACKGROUND

Chronic pain is costly for patients and for the health care system. It negatively affects people's physical, emotional, social, and mental health. We conducted a health technology assessment of 10-kHz high-frequency spinal cord stimulation (SCS) in adults with chronic noncancer pain that was refractory to medical management, which included an evaluation of effectiveness, safety, cost-effectiveness, the budget impact of publicly funding 10-kHz high-frequency SCS, and patient preferences and values.

METHODS

We performed a systematic literature search of the clinical evidence. We assessed the risk of bias of each included study using the Cochrane Risk of Bias and ROBINS-I tools and the quality of the body of evidence according to the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) Working Group criteria. We performed a systematic economic literature search. We analyzed the 5-year budget impact of publicly funding 10-kHz high-frequency SCS in Ontario for adults with chronic noncancer pain who had already tried other available SCS therapies (up to 1.2 kHz). To contextualize the potential value of 10-kHz high-frequency SCS, we spoke with people who had chronic noncancer pain.

RESULTS

We included 5 studies (7 publications) in the clinical evidence review. Overall, 10-kHz high-frequency SCS likely provides reductions in pain intensity and functional disability, and improvements in quality of life in people with chronic noncancer pain (GRADE: Moderate). As well, patients may reduce their opioid consumption with 10-kHz high-frequency SCS (GRADE: Low). The two included economic evaluations found that 10-kHz high-frequency SCS was cost-saving compared with conventional SCS, but neither was applicable to the Ontario context. Owing to limited evidence about the effectiveness of 10-kHz high-frequency SCS in people who have first tried and failed SCS at lower frequencies (up to 1.2 kHz), we did not conduct a cost-effectiveness analysis comparing this pathway of care and 10-kHz high-frequency SCS for Ontario. Publicly funding 10-kHz high-frequency SCS (using the Freedom SCS system) in Ontario over the next 5 years would lead to a total net cost savings of $0.73 million (ranging from about $0.10 million in year 1 to about $0.21 million in year 5). However, if the province outsourced this therapy using the Senza HF10 SCS system, the total 5-year budget impact would be about $8.76 million. The people we spoke with who had chronic noncancer pain reported that their pain had a substantial negative impact on their activities and emotional well-being. Their direct knowledge of different pain therapies allowed them to provide context and comparisons when they discussed the impact of SCS on their chronic pain.

CONCLUSIONS

For adults with chronic noncancer pain that was refractory to medical management, 10-kHz high-frequency SCS was effective in relieving pain, reducing disability, and improving quality of life. Because there was limited evidence about the effectiveness of 10-kHz high-frequency SCS in people who had first tried and failed SCS at lower frequencies (up to 1.2 kHz), we were unable to determine whether 10-kHz high-frequency SCS is cost-effective in the Ontario context. We estimate that publicly funding 10-kHz high-frequency SCS in Ontario would result in cost savings of about $0.10 million to $0.21 million per year, for a potential total 5-year net cost savings of about $0.73 million. Although people with chronic noncancer pain knew little about SCS before they received it, they reported that it reduced their level of chronic pain, leading to improvements in function and their ability to perform activities of daily living.

Racial/ethnic disparities in sleep duration and sleep disturbances among pregnant and non-pregnant women in the United States

Sleep disturbances among pregnant women are increasingly linked to suboptimal maternal/birth outcomes. Few studies in the USA investigating sleep by pregnancy status have included racially/ethnically diverse populations, despite worsening disparities in adverse birth outcomes. Using a nationally representative sample of 71,644 (2,349 pregnant) women from the National Health Interview Survey (2004-2017), we investigated relationships between self-reported pregnancy and six sleep characteristics stratified by race/ethnicity. We also examined associations between race/ethnicity and sleep stratified by pregnancy status. We used average marginal predictions from fitted logistic regression models to estimate prevalence ratios (PRs) and 95% confidence intervals (CIs) for each sleep dimension, adjusting for sociodemographic and health characteristics. Pregnant women were less likely than non-pregnant women to report short sleep (PR_Overall  = 0.75; 95% CI, 0.68-0.82) and more likely to report long sleep (PR_Overall  = 2.06; 95% CI, 1.74-2.43) and trouble staying asleep (PR_Overall  = 1.34; 95% CI, 1.25-1.44). The association between pregnancy and sleep duration was less pronounced among women aged 35-49 years compared to those <35 years. Among white women, sleep medication use was less prevalent among pregnant compared to non-pregnant women (PR_White  = 0.45; 95% CI, 0.31-0.64), but this association was not observed among black women (PR_Black  = 0.98; 95% CI, 0.46-2.09) and was less pronounced among Hispanic/Latina women (PR_{Hispanic/Latina}  = 0.82; 95% CI, 0.38-1.77). Compared to pregnant white women, pregnant black women had a higher short sleep prevalence (PR_Black  = 1.35; 95% CI, 1.08-1.67). Given disparities in maternal/birth outcomes and sleep, expectant mothers (particularly racial/ethnic minorities) may need screening followed by treatment for sleep disturbances. Our findings should be interpreted in the historical and sociocultural context of the USA.

Effects of physical activity programs on sleep outcomes in older adults: a systematic review

BACKGROUND

One in two older adults report sleep problems, which not only cause fatigue, but also negatively affect general functioning, activities of daily living, and physical and mental health. Although it is known that physical activity is positively associated with sleep in older adults, the effects of physical activity programs on sleep in older adults has not been reviewed. The aim of this systematic review was to systematically review the effects of physical activity programs on sleep in generally healthy older adults aged 60+ years.

METHODS

Searches were performed in PubMed, Embase, Web of Science, SPORTDiscus, PEDro and CINAHL. The methodological quality of the included studies was rated using the 'Quality Assessment Tool for Quantitative Studies'. Only studies of moderate and strong quality were included. This review was registered in PROSPERO (CRD42018094007).

RESULTS

Fourteen studies met the inclusion criteria (six randomised controlled trials and eight pretest-posttest studies). Of these studies, five were moderate and nine were strong quality studies. Mean age of study samples ranged from 64 to 76 years. Exercise programs included various activities aimed at improving mobility, endurance and strength. Intervention duration ranged from 2 weeks to 12 months. Eleven studies used subjective measures of sleep, two used objective measures and one used both. Sixteen different sleep outcomes were reported. All but one study, found at least one significant improvement on sleep outcomes. No significantly detrimental effects were reported. Effect sizes, calculated in ten studies, ranged from 0,34-1,55 and were substantial (≥0,8) in four studies.

CONCLUSIONS

This systematic review suggests that exercise programs positively affect various aspects of sleep in generally healthy older adults. More specifically, moderate intensity exercise programs, with a frequency of three times per week and a duration of 12 weeks up to 6 months, showed the highest number of significant improvements in different sleep outcomes in older adults. Furthermore, programs that offered single exercise types, such as Baduanjin, Tai chi and the silver yoga program, or a combination of exercises showed the highest proportion of significant versus reported effects on sleep outcomes.

Psychometric Analysis of the Perceived Stress Scale Among Healthy University Students

BACKGROUND

There is a gradual increase in the prevalence of stress during professional courses. Previous studies reported a high incidence of stress among university students. The psychometric properties of the perceived stress scale-10 (PSS-10) have been established in different populations. The current study aimed to assess psychometric properties of the PSS-10 in Saudi university students.

METHODS

Healthy university students (n= 192) participated in this cross-sectional study. All the participants were explained about the aim and procedures of the study. Participants were requested to complete the English version of the PSS, the generalized anxiety disorder-7 (GAD-7), the sleep hygiene index (SHI), and demographic details.

RESULTS

The range of the PSS-10 total score was 0-35; 1% reported minimum score of 0, but none reported maximum score of 40. Therefore, there was no issue of ceiling or floor effect in the PSS-10 total score. Positive and significant correlations of the PSS total and the PSS Factor-1 (distress perception) with the GAD-7 total score, SHI item-8 and SHI item-13 score support its convergent validity. Negative or no correlation of the PSS Factor-2 score (coping perception) with the GAD-7 total score, SHI item-8 and SHI item-13 scores demonstrate its divergent validity. The internal homogeneity test indicated moderate to strong positive correlations (r=0.60-0.82) between the PSS Factors and the items loading on them. The internal consistency test showed a good agreement for the PSS Factor-1 and the PSS Factor-2 scores (Cronbach's alpha 0.78 and 0.71, respectively), suggesting an acceptable level of consistency. Factor analysis favored a 2-Factor model of the PSS in the Saudi students.

CONCLUSION

The current study supported the use of the PSS-10 to assess the perceived stress among Saudi university students.

Measurement Invariance and Sleep Quality Differences Between Men and Women in the Pittsburgh Sleep Quality Index

STUDY OBJECTIVES

Previous research has reported mixed results in terms of sex differences in sleep quality. We conducted an analysis of measurement invariance of the Pittsburgh Sleep Quality Index (PSQI) between men and women to provide a necessary foundation for examining sleep differences.

METHODS

The sample included 861 adults (mean age = 52.73 years, 47.85% male) from the 2012-2016 wave of the Midlife in the United States (MIDUS) Refresher Biomarker survey. We randomly divided the sample into two half samples for exploratory factor analysis (EFA) and confirmatory factor analysis (CFA), respectively. We conducted EFA with a weighted least squares mean and variance adjusted (WLSMV) estimator and Geomin rotation to explore the underlying structure of the PSQI. We then employed multiple-group CFA with the WLSMV estimator and theta parameterization to examine measurement invariance between males and females.

RESULTS

EFA suggested a two-factor structure of the PSQI, and the two-factor CFA model fit the data well. The finding that the two-factor PSQI model was invariant between males and females on configuration, factor loadings, thresholds for all but one measure, and residual variances for all but one measure provided evidence that the two-factor PSQI model was partially invariant between men and women. Females had higher means on latent factors, suggesting worse self-reports of sleep among women.

CONCLUSIONS

Overall, the measure of the PSQI assesses the same factors in a comparable way among men and women. Women reported worse sleep than men.

Examining the Factor Structure of the Pittsburgh Sleep Quality Index in a Multi-Ethnic Working Population in Singapore

The Pittsburgh Sleep Quality Index (PSQI) is a widely used measure for assessing sleep impairment. Although it was developed as a unidimensional instrument, there is much debate that it contains multidimensional latent constructs. This study aims to investigate the dimensionality of the underlying factor structure of the PSQI in a multi-ethnic working population in Singapore. The PSQI was administered on three occasions (baseline, 3 months and 12 months) to full-time employees participating in a workplace cohort study. Exploratory factor analysis (EFA) investigated the latent factor structure of the scale at each timepoint. Confirmatory factor analysis (CFA) evaluated the model identified by EFA, and additionally evaluated it against a single factor and a three-factor model. The EFA identified a two-factor model with similar internal consistency and goodness-of-fit across each timepoint. In the CFA, the two- and three-factor models were both superior to the unidimensional model. The two- and three-factor models of the PSQI were reliable, consistent and provided similar goodness-of-fit over time, and both models were superior to the unidimensional measure. We recommend using the two-factor model to assess sleep characteristics in working populations in Singapore, given that it performs as well as the three-factor model and is simpler compared to the latter.