The Pittsburgh Sleep Quality Index (PSQI)

By: Carole Smyth MSN, APRN, BC, ANP/GNP, Montefiore Medical Center

WHY: Sleep is an important aspect of maintaining the body’s circadian rhythm. Inadequate sleep contributes to heart disease, diabetes, depression, falls, accidents, impaired cognition, and a poor quality of life. While normal aging changes interfere with the quality of sleep, other disease conditions and medications used by older adults compromise sleep patterns. A nursing assessment of sleep begins with a comprehensive assessment of sleep quality and sleep patterns. The nurse may be able to improve the sleep problem immediately with interventions or work with the health care team to assess the sleep issue in greater depth.

BEST TOOL: The Pittsburgh Sleep Quality Index (PSQI) is an effective instrument used to measure the quality and patterns of sleep in the older adult. It differentiates “poor” from “good” sleep by measuring seven domains: subjective sleep quality, sleep latency, sleep duration, habitual sleep efficiency, sleep disturbances, use of sleep medication, and daytime dysfunction over the last month. The client self rates each of these seven areas of sleep. Scoring of the answers is based on a 0 to 3 scale, whereby 3 reflects the negative extreme on the Likert Scale. A global sum of “5”or greater indicates a “poor” sleeper. Although there are several questions that request the evaluation of the client’s bedmate or roommate, these are not scored, nor reflected in the attached instrument. An update to the scoring: if 5J is not complete or the value is missing, it now counts as a “0”. More information on administration and scoring is available at the University of Pittsburgh, Sleep Medicine Institute, Pittsburgh Sleep Quality Index (PSQI) website at http://www.sleep.pitt.edu/content.asp?id=1484&subid=2316.

TARGET POPULATION: The PSQI can be used for both an initial assessment and ongoing comparative measurements with older adults across the health care continuum.

VALIDITY AND RELIABILITY: The PSQI has internal consistency and a reliability coefficient (Cronbach’s alpha) of 0.83 for its seven components. Numerous studies using the PSQI in a variety of older adult populations internationally have supported high validity and reliability.

STRENGTHS AND LIMITATIONS: The PSQI is a subjective measure of sleep. Self reporting by clients though empowering, may can reflect inaccurate information if the client has difficulty understanding what is written, or cannot see or physically write out responses. The scale has been translated into over 56 languages. For those with visual impairments, the nurse can read the PSQI as written to the client.

MORE ON THE TOPIC:

Best practice information on care of older adults: www.ConsultGeriRN.org.

University of Pittsburgh, Sleep Medicine Institute, Pittsburgh Sleep Quality Index (PSQI). Available at http://www.sleep.pitt.edu/content.asp?id=1484&subid=2316.

Alessi, C.A., Martin, J.L., Webber, A.P., Alam, T., Littner, M.R., Harker, J.O., & Josephson, K.R. (2008). More daytime sleeping predicts less functional recovery among older people undergoing inpatient post-acute rehabilitation. Sleep 31(9), 1291-1300.

Buysse, D.J., Reynolds III, C.F., Monk, T.H., Berman, S.R., & Kupfer, D.J. (1989). The Pittsburgh Sleep Quality Index: A new instrument for psychiatric practice and research. Journal of Psychiatric Research, 28(2), 193-213.

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