Psychometric properties of the Turkish version of the Sleep Hygiene Index in clinical and non-clinical samples

A randomized controlled trial of effects of sleep hygiene training and progressive muscle relaxation training in children with ADHD

OBJECT

Sleep problems often accompany ADHD and negatively affect ADHD symptoms, however, there are not enough intervention studies on sleep interventions in children with ADHD. The present study investigated the effects of sleep hygiene training (SH) and progressive muscle relaxation exercises (PMR) in children with ADHD.

METHOD

57 children aged 6-12 years with ADHD were randomly assigned to the SH and SH + PMR groups and completed the intervention consisting of group training and eight weeks of telephone interviews. The effects of both intervenitons were evaluated via parent, child and clinician report scales and neuropsychological tests.

RESULTS

Both interventions resulted in significant positive changes in child sleep, ADHD symptoms, functioning, neuropsychological tests and parental sleep quality. Significant differences were found between the interventions in selective attention, peer problems and anxiety scores in favor of the SH + PMR group.

CONCLUSION

SH may have positive effects on various clinical parameters as well as sleep problems in children with ADHD. Addition of PMR to SH may lead to further improvements in anxiety, peer problems and selective attention. SH and PMR may be a useful tool in the clinical management of children with ADHD with sleep problems.

Effects of Chronotype and Social Jet-Lag on Neurocognitive Functioning

The chronotype, which reflects the circadian rhythm preferences of individuals in their daily activities and sleep-wake cycles, can be considered on a dimension of extreme morningism and extreme eveningism. Individuals with extreme morning and extreme evening chronotypes face many physical and psychological dangers due to accumulated sleep debt, short total sleep time and insufficient sleep efficiency. In extreme chronotypes, especially in extreme evening people, the social jet-lag effect due to the mismatch between social and circadian clocks is thought to exacerbate these dangers. More recent studies have suggested that social jet-lag and chronotype have many negative effects on cognitive functioning. The aim of this article is to review the impact of social jet-lag and chronotype on cognitive functioning.

Hospital-acquired insomnia scale: A validity and reliability study

BACKGROUND

Sleep breathing, one of the basic human needs, is a physiological need that affects cardiac functions, body temperature, daily vitality, muscle tone, hormone secretion, blood pressure, and many more. In the international literature, studies reported that patients have had sleep problems in the hospital since the 1990s, but no measurement tool has been developed to determine the causes of hospital-acquired insomnia in individuals. These findings suggest that sleep remains in the background compared to activities such as nutrition and breathing. Although patients generally experience hospital-acquired sleep problems, there is no measurement tool to determine hospital-acquired sleep problems. These features show the originality of the research.

AIM

To develop a measurement tool to determine the sleep problems experienced by patients in the hospital.

METHODS

A personal information form, hospital-acquired insomnia scale (HAIS), and insomnia severity index (ISI) were used to collect research data. The study population consisted of patients hospitalized in the internal and surgical clinics of a research hospital in Turkey between December 2021 and March 2022. The sample consisted of 64 patients in the pilot application stage and 223 patients in the main application stage. Exploratory factor analysis and confirmatory factor analysis (CFA) analyses were performed using the SPSS 20 package program and the analysis of moment structure (AMOS) package program. Equivalent forms method used.

RESULTS

The HAIS consisted of 18 items and 5 subscales. The Cronbach alpha values of the subscales ranged between 0.672 and 0.842 and the Cronbach alpha value of the overall scale was 0.783. The scale explained 58.269% of the total variance. The items that constitute the factors were examined in terms of content integrity and named as physical environmental, psychological, safety, socioeconomic, and nutritional factors. CFA analysis of the 5-factor structure was performed in the AMOS package program. The fit indices of the obtained structure were examined. It was determined that the values obtained from the fit indices were sufficient. A significant correlation was determined between the HAIS and the ISI, which was used for the equivalent form method.

CONCLUSION

The HAIS is a valid and reliable measurement tool for determining patients’ level of hospital-acquired insomnia. It is recommended to use this measurement tool to determine the insomnia problems of patients and to adapt it in other countries.

Type D personality to insomnia: Sleep reactivity, sleep effort, and sleep hygiene as mediators

Background

Insomniacs are heterogenous group with very diverse personalities. We aimed to investigate the mediating role of sleep reactivity (SR), sleep hygiene (SH), and sleep effort (SE) in the relationship between Type D personality and insomnia.

Materials and methods

We conducted a cross-sectional survey among 474 participants. The survey comprised the sociodemographic data form, Insomnia Severity Index (ISI), D Type Personality Scale (DS-14), Ford Insomnia Response to Stress Test (FIRST), Glasgow Sleep Effort Scale (GSES), and Sleep Hygiene Index (SHI). We conducted hierarchical multiple regression analysis to identify the associations between age, sex, SR, Type D personality traits, SE, SH, and insomnia severity. We subsequently conducted mediation analyses to examine whether SR, SH, and SE mediated the relationship between Type D personality and insomnia.

Results

ISI, DS-14, FIRST, SHI, and GSES scores were significantly higher in individuals with Type D personality. Female sex, SR, Type D personality traits, SE, and SH explained 45% of the variance in insomnia severity. When age, sex, insomnia response to stress, and Type D personality traits were controlled, SE and SH significantly explained 25% of the variance in insomnia severity (R ² = 0.45, R ² change = 0.25, F (6.474) = 65.58, p < 0.001). SR, SE, and SH each played a partial mediating role between Type D personality and insomnia.

Conclusion

The findings showed that individuals with Type D personality had high SR and that individuals with a higher number of these personality traits exhibited more severe insomnia symptoms through high SR, greater SE, and worse SH.

Kalça ve Diz Osteoartritli Hastalarda Huzursuz Bacak Sendromunun Yaygınlığı ve Şiddeti

Amaç: Huzursuz bacak sendromunun (HBS) prevalansı, şiddeti, ağrı düzeyleri, uyku hijyeni ve yaşam kalitesinin kalça ve diz osteoartriti (OA) arasında farklılık gösterip göstermediğini araştırmak. Gereç ve Yöntem: 2 Ocak 2020 - 2 Haziran 2020 tarihleri arasında 55-75 yaşları arasında diz OA'sı olan 103 ve kalça OA'si olan 98 hasta dahil edilme ve dışlama kriterlerine göre kaydedildi. Ağrı şiddeti için visüel ağrı skalası (VAS), OA şiddeti için Lequesne şiddet indeksi, HBS semptomlarının sıklığı ve şiddeti ve uyku davranışları için Uyku Hijyeni İndeksi ve genel sağlığın değerlendirilmesi için Nottingham Sağlık Profili (NSP) kullanıldı. Bulgular: HBS semptom şiddeti, HBS süresi, VAS genel ve gece, uyku hijyen indeksi ve NSP uyku, enerji ve NSP Bölüm 1 ve Bölüm 2 parametreleri Diz OA'sında kalça OA'ya göre anlamlı olarak daha yüksekti. HBS şiddeti ile HBS süresi,vücut kitle indeksi ve Leq Hip skorları arasında güçlü bir pozitif korelasyon saptandı; ancak gece VAS'ı, uyku NSP'si ve fiziksel NSP parametreleri arasında zayıf bir korelasyon tespit edildi. HBS süresi ile uyku NSP'si, Leq diz OA şiddeti ve derecesi arasında güçlü bir pozitif korelasyon saptandı. Sonuç: HBS’li hastaların tedavi ve takibinde hastaların kilo kontrolü ile birlikte kalça ve diz OA tedavisinin de göz önünde bulundurularak takip edilmesinin hastaların yaşam kalitelerinin artırılmasına yardımcı olacağı öngürülmektedir.

Yaşlı depresyon hastalarında uykusuzluk tedavisinde kullanılan uyku ilaçları ve uyku hijyeninin rolü

Amaç: Bu araştırma, Yaşlı Depresyon Hastaları’nda (YDH) uykusuzluk tedavisinde kullanılan uyku haplarını belirlemeyi ve uyku hijyeninin uykusuzluk şiddeti üzerindeki rolünü araştırmayı amaçlamıştır. Yöntemler: Bu çalışmaya uykusuzluk için uyku ilacı kullanmakta olan 120 YDH dahil edildi. Katılımcıların uykusuzluk için kullandıkları uyku hapları belirlendi. Uyku Hijyeni İndeksi (UHİ), Uykusuzluk Şiddeti İndeksi (UŞİ), Pittsburgh Uyku Kalitesi İndeksi (PUKİ), Beck Depresyon Ölçeği (BDÖ) ve Beck Anksiyete Ölçeği (BAÖ) kullanılarak hastaların uyku hijyeni, uyku kalitesi, uykusuzluk şiddeti, depresyon ve anksiyetey seviyeleri değerlendirildi. Bulgular: YDH’da ketiapin, mirtazapin ve trazodon en sık kullanılan uyku haplarıydı. Uyku hijyeni genel olarak uykusuzluk şiddeti ile korelasyon göstermekteydi, ve klinik uykusuzluk seviyesi daha yüksek olan grupta daha yüksek seviyelerdeydi. Çoklu doğrusal regresyon analizleri sonuçları uykusuzluk şiddetinin; öznel uyku kalitesi (%21) ve uyku hijyeni (%4) ile depresyon ve anksiyete’den bağımsız olarak tahmin edildiğini gösterdi. Sonuç: Kullanılan uyku hapları benzer olmasına rağmen uyku hijyeni açısından uykusuzluk şiddetinin farklılaşması tedavi sürecinde uyku hijyeninin önemini göstermektedir. Basit çevresel ve davranışsal etkilerin uykusuzluk semptomları üzerindeki etkisini araştıran boylamsal çalışmalara ihtiyaç vardır.

Validity and reliability of the Turkish version of the Glasgow Sleep Effort Scale

OBJECTIVE

We aimed to assess the validity and reliability of a Turkish adaptation of the Glasgow Sleep Effort Scale (GSES).

METHODS

We randomly divided the data into two: one set (n = 374) was used for exploratory factor analysis (EFA) and the other (n = 373) for confirmatory factor analysis (CFA). The psychometric properties were assessed using the item response theory approach. Reliability analyses were assessed. Convergent validity of the GSES with the Dysfunctional Beliefs and Attitudes About Sleep Scale-16 (DBAS-16), Pittsburgh Sleep Quality Index (PSQI), Insomnia Severity Index (ISI), and Depression Anxiety Stress Scale-21 (DASS-21) were explored. For the predictive validity, we used an independent-samples t-test for comparing the total score of the GSES between poor sleepers and good sleepers following the PSQI, and between clinical insomnia and non-clinical insomnia groups according to the ISI. The cut-off score of the GSES was examined.

RESULTS

A single factor structure explaining 49.2% of the total variance was detected using the EFA. The CFA also found single-factor good fit indices. Cronbach's alpha and omega values were 0.82 and 0.83, respectively. There were statistically significant correlations between the GSES and DBAS-16, ISI, PSQI, and DASS-21 in convergent validity. In the Graded Response Model, the GSES was more efficient and provided reasonable information at the -0.75 to 2.25 theta level. The GSES cut-off score was 6 points for clinical insomnia and 3 points for poor sleepers.

CONCLUSIONS

The GSES is valid and reliable for measuring sleep effort among Turkish university students.

Evaluation of the sleep hygiene index and physical activity states of the elderly living in nursing homes

The aim: the sleep quality and physical performance play a vital role in older adults’ well-being to maintain good overall health. Therefore, the parameters that have a role in sleep and physical capacity are crucial to achieve a healthy aging outcome. In this study, we aimed at comparing the quality of sleep and physical activity state of the elderly living in 5 nursing homes. Methods: the 181 elderly individuals living in 5 nursing homes were included in this cross-sectional study. Physical activity, sleep hygiene index and demographics were analysed using SPPS 23.0. Results: overall, 68.5 % of the participants were male, and 31.5 % were female. There was no significant correlation between the sleep hygiene scores and physical activity states (p >0.05). Those who were divorced, those who were on at least one type of medication, those who smoked and those with poor perception of health had statistically significant difference in terms of the Sleep Hygiene Index (p<0.05). Conclusion: other than findings of the presented study that influence sleep and physical activity, the many other factors in different geographical areas or cultures could be a reason that is interrelated with sleep quality and physical performance of older adults. In this study, for primary care and family physicians to boost the sleep quality of the elderly, we recommend improving their health perception, quitting smoking, discontinuing unnecessary medications, and increasing their social interactions

Does smoking impair sleep hygiene?

BACKGROUND

Sleep architecture and sleep hygiene might be disrupted by several pathogenetic mechanisms, and the effect of smoking has not been evaluated.

OBJECTIVE

To investigate the effect of smoking on sleep hygiene behaviors that might be associated with the deterioration of quality-of-life (QoL) parameters.

METHODS

In a prospective cross-sectional study, smokers (n=114) and nonsmokers (n=119) were included. The Pittsburgh Sleep Quality İndex (PSQI), the Epworth Daytime Sleepiness Scale (ESS), the Sleep Hygiene Index (SHI), and the Short Form-36 quality of life scale (SF-36) were applied.

RESULTS

We found that none of the components, as well as the PSQI total score were affected in smokers compared with the nonsmoker controls (65.5% of smokers had poor sleep compared to 62.5% of nonsmokers). Although smokers tend to get out of bed at different times from day to day and do important work before bedtime (components of the SHI) more often than non-smokers, no significant differences were detected between groups in any component and SHI total score (27.91±6.72 for smokers and 29.23±8.0 for non-smokers). ESS, depression and anxiety symptoms, and SHI scores in smokers with poor sleep quality were significantly different compared with smokers that had normal sleep quality. Both PSQI and SHI scores were inversely associated with QoL parameters.

CONCLUSIONS

Our results suggest that smoking by itself is not associated with poor sleep hygiene or sleep quality. It can be concluded that worse SHI and quality of sleep negatively affect QoL, depression, and anxiety in smokers.

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.

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

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

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

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

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

Psychometric properties of the Sleep Hygiene Index in a large Italian community sample

OBJECTIVE/BACKGROUND

Poor sleep hygiene is considered an exacerbating and perpetuating factor of sleep disturbances and is also associated with poor mental health. The Sleep Hygiene Index (SHI) is a self-report measure assessing adherence to sleep hygiene practices. The aim of this study was to estimate the psychometric properties of the SHI in an Italian representative sample of the general population, following a formative measurement approach.

PATIENTS/METHODS

Participants (n = 6276; M = 33.62, SD = 13.45) completed the SHI alongside measures of sleep disturbance, depression, anxiety, and stress. To consider the item formative nature, sets of item-composites weighted by means of canonical correlation analysis was created and a confirmatory factor analysis (CFA) was implemented. Factorial invariance tests were computed considering both presence of sleep problems and presence of emotional distress symptoms as grouping variables.

RESULTS AND CONCLUSIONS

CFA confirmed the unidimensional structure of SHI. Internal consistency was acceptable (ω = 0.752). Test-retest reliability at 8-10 months presented an ICC of 0.666. SHI significantly correlated with sleep, depression, anxiety and stress symptoms (r range from 0.358 to 0.500). Configural and metric invariance were reached for both grouping variables. Partial scalar invariance was obtained only across emotional distress groups. People with emotional symptoms reported higher latent means on the sleep hygiene dimension. Findings support the validity and reliability of the Italian version of the SHI. Importantly, the SHI showed robust psychometric properties both in healthy individuals and in individual reporting mental health symptoms. Thus, it is advisable to use this version of the SHI in both research and clinical practice.

Magnitude and correlates of sleep quality among undergraduate medical students in Ethiopia: cross –sectional study

Purpose

Poor quality of sleep has a negative effect on academic performance of medical students. Quantity and quality of sleep in addition to average sleep time are strongly linked with students’ learning abilities, poor academic performance and poor interpersonal relationship which predispose them to mental illnesses. This study is aimed to assess magnitude and correlates of sleep quality among medical students in Ethiopia.

Method

An institutional based cross-sectional study was conducted among 576 undergraduate medical students. Data was collected by using interviewer administered structured questionnaires. Pittsburgh Sleep Quality Index (PSQI) was used to assess sleep quality. The collected data were entered in to Epi-data version 3.1and analyzed using SPSS version 20. Logistic regression was used to identify the potential determinants of quality of sleep among undergraduate medical students. P-values less than 0.05 were considered statistically significant and strength of the association was presented by adjusted odds ratio with 95% C.I.

Result

The prevalence of poor sleep quality among undergraduate medical students was 62% (95%CI, 57.9, 65.3). The mean age (±SD) of the respondents was 21.5(±2.4), with age ranging from 18 to 28 and about 310 (53.8%) were males. Factors like, being depressed (AOR = 1.92,95%CI 1.16,3.19), poor social support (AOR = 5.39,95%CI 2.33,2.49), being stressed (AOR = 2.04,95%CI 1.26,3.31), and poor sleep hygiene (AOR = 3.01,95%CI 1.75,5.18) were associated with poor sleep quality at p-value < 0.05. Findings also showed that, one unit increase in grade point average was associated with 81.5% decrease (AOR = 0.185, 95%CI 0.13, 0.28) in poor sleep quality.

Conclusion

A substantial proportion of medical students are affected by poor sleep quality. Routine screening of sleep quality, sleep hygiene, depression and stress is warranted. Moreover, it is better to educating medical students about proper sleep hygiene and the consequences of poor sleep.

Magnitude of Poor Sleep Hygiene Practice and Associated Factors among Medical Students in Ethiopia: A Cross-Sectional Study

Background

Good sleep hygiene plays an important role in human health. Medical students are notorious for insufficient and irregular sleep habits which are linked with students' learning abilities, poor academic performance, and poor interpersonal relationship which predispose them to mental illnesses. However, it has not been studied among medical students in Ethiopia.

Method

This institution-based cross-sectional study was conducted among 576 undergraduate medical students selected by using a stratified sampling technique. Sleep hygiene (SHI) was assessed by a 13-item sleep hygiene questionnaire. Binary logistic regression was used to identify the potential determinants of poor sleep hygiene among undergraduate medical students. Variables with p values less than 0.05 were considered statistically significant, and the strength of the association was presented by adjusted odds ratio with 95% C.I.

Result

The prevalence of poor sleep hygiene practice among undergraduate medical students was 48.1% (95% 43.7, 52.1). After adjusting for the possible confounders, being female (AOR = 1.53, 95% CI 1.03, 2.26), having depressive symptoms (AOR = 3.55, 95% CI 2.26, 5.59), with stress symptoms (AOR = 2.41, 95% CI 1.61, 3.60), and having anxiety symptoms (AOR = 2.2, 95% CI 1.42, 3.31) were associated with poor sleep hygiene practice at p value < 0.05.

Conclusion

Almost half of the medical students had poor sleep hygiene practice. Routine screening of depressive and stress symptoms and education about sleep hygiene are warranted among medical students.

Turkish reliability and validity study of the medical outcomes study (MOS) sleep scale in patients with obstructive sleep apnea

Background/aim

The purpose of the present study was to evaluate the Turkish reliability and validity of the medical outcomes study (MOS) sleep scale in patients who have obstructive sleep apnea.

Materials and methods

The data of the study were collected from 120 adult patients with obstructive sleep apnea and from 90 healthy individuals between March 04 and May 31, 2019.

Results

The Cronbach’s α internal consistency reliability coefficient of the MOS sleep scale was found as 0.82. The test-retest reliability was acceptable (r = 0.76-0.94). Six factors were identified by the factor analysis. These were the same as those in the original MOS-Sleep. The correlations between the MOS-Sleep and other instruments administered in this study provided evidence for structural validity. A significant relation was determined between MOS sleep scale and obstructive sleep apnea syndrome (OSAS) severity and the healthy group ( P < 0.05). In addition, the Cronbach α internal consistency reliability coefficient of the healthy group in MOS sleep scale was found as 0.78. The items of the six factors that were obtained with the confirmatory factor analysis for the MOS sleep scale of the healthy group were found to be the same as in the original MOS-Sleep.

Conclusion

Turkish MOS sleep scale is a measurement tool that consists of 12 items and 6 subdimensions with adequate validity and reliability indicators.

The Association of Insomnia with Depression and Anxiety Symptoms in Patients Undergoing Noncardiac Surgery

OBJECTIVE

Insomnia is common in patients undergoing surgery. It can increase the rate of postoperative complications, interfere with patient recovery, and decrease hospital satisfaction. However, there are few studies on perioperative insomnia. This study was conducted to investigate the differences in the demographic, health status, and clinical characteristics of patients with and without insomnia postoperatively, and to identify the potential risk factors of insomnia.

METHODS

There were 299 non-cardiac surgery patients, 165 females, and 134 males, with a mean age of 55 years, enrolled in the study. The Insomnia Severity Index (ISI), Patient Health Questionnaire-9 (PHQ-9), Generalized Anxiety Disorder 7 (GAD-7), and Montreal Cognitive Assessment (MoCA) were administered to all the patients preoperatively. The Visual Analogue Scale (VAS) was used preoperatively, and at the end of the surgery, and then one day, two days, and three days after surgery. The PHQ-9, the GAD-7, and the ISI were repeated three days after surgery. Insomnia was diagnosed by the ISI as being a score of 8-28 (mild: 8-14; moderate-severe: 15-21; severe: 22-28). The patients were divided into group A (with insomnia, N=78) and group B (without insomnia, N=221) according to their ISI score three days after surgery. The general clinical data of the two groups were analyzed first, and then binary logistic regression analysis was conducted to assess the risk factors of insomnia.

RESULTS

A total of 299 non-cardiac surgery patients with a mean age of 55 years were enrolled in the study. Of the included patients, the number of females was 165 and the number of the male was 134. The incidence of insomnia at 3 days postoperatively was 26.1% (78/299). The average points that group A patients scored in the ISI, PHQ-9, and the GAD-7 were significantly higher than those in group B. The VAS score three days after surgery was significantly higher in group A. The PHQ-9 and the GAD-7 three days after surgery showed significantly higher depression and anxiety scores in group A. Logistic regression showed that the ISI (p<0.001, 95% CI=1.218-1.500) and the GAD-7 (p=0.003, 95% CI=1.041-1.218) preoperatively, and the PHQ-9 postoperatively (p<0.001, 95% CI=1.226-1.555), were risk factors of insomnia.

CONCLUSION

Insomnia is common and can worsen after surgery. The present study suggests that depression and anxiety are risk factors for insomnia after surgery. There is a need for further research and the development of strategies for depression and anxiety management to ensure better sleep quality for patients, which will be of significant benefit to their health.

CLINICAL TRIAL REGISTRATION

The study was registered at clinical trial (NCT04027751); Trial registration: clinical trial, NCT04027751. Registered 22 July 2019; https://clinicaltrials.gov/ct2/show/NCT04027751?cond=NCT04027751&cntry=CN&draw=2&rank=1.

The effect of circadian preferences on insomnia severity and depressive symptoms via sleep hygiene in older adults with depression and healthy controls

BACKGROUND

The elderly population is increasing globally. Thus, researches focus on the causes and treatment of insomnia, a noteworthy ageing problem. This study aims to investigate the relationship between chronotype and insomnia and whether sleep hygiene mediates this relationship in older adults with depression (OAD).

METHODS

We assessed subjective insomnia severity, sleep hygiene, chronotype, depressive symptoms, and anxiety symptoms of 82 OAD and 70 healthy controls using the Sleep Hygiene Index (SHI), Insomnia Severity Index (ISI), Morningness-Eveningness Questionnaire (MEQ), Beck Depression Inventory (BDI), and Beck Anxiety Inventory (BAI).

RESULTS

The mediation effect of SHI and ISI scores were evaluated in the relationship between MEQ and BDI total scores in OAD. The results showed that MEQ performed its effect on BDI through ISI with full mediation (effect = -0.16, SE: 0.07, 95% CI: -0.3230 to -0.0336). The mediation effect of SHI and BDI scores were evaluated in the relationship between MEQ and ISI total scores in OAD. In this model, it was found that MEQ significantly performed its effect on ISI through SHI and BDI. BDI and SHI predicted the ISI variable as partial mediators (respectively, effect = -0.05, SE: 0.03, 95% CI: -0.1073 to -0.0100; effect = -0.06, SE: 0.02, 95% CI: -0.1051 to -0.0129).

CONCLUSIONS

Sleep hygiene practices could be essential for the natural functioning of the biological clock and the interrelation of depression and insomnia. Longitudinal follow-up studies of structured sleep hygiene approaches are needed in terms of cost-effectiveness, in OAD.

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.

The effect of computer game playing habits of university students on their sleep states

OBJECTIVE

The aim of this study is to evaluate the effect of computer game playing habits of university students on their sleep states.

DESIGN AND METHODS

The study was conducted cross-sectionally with the online survey method.

FINDING

In this study, it was determined that the students who played games for an average of ≥2 hours per day had later bedtime and later wake-up time, poorer sleep quality, and higher daytime sleepiness. It was found that as the level of game addiction increased, sleep quality decreased, the severity of daytime sleepiness increased, and the wake-up time shifted to a later time.

PRACTICE IMPLICATIONS

Nurses should develop effective intervention strategies involving technology management and sleep hygiene studies to reduce game-playing time of students.

The Brazilian-Portuguese version of the Sleep Hygiene Index (SHI): validity, reliability and association with depressive symptoms and sleep-related outcomes

Objective

To translate the Sleep Hygiene Index (SHI) to Brazilian Portuguese, to describe its psychometric properties and to show its association with sleep quality, daytime sleepiness, risk for sleep apnea and depressive symptoms.

Methods

Thirty subjects participated in the cultural adaptation and the item clarity evaluation. Twenty subjects answered the instrument in three different time-points for test-retest reliability. Eighty adult workers completed the SHI, the Pittsburgh Sleep Quality Index (PSQI), the Epworth Sleepiness Scale (ESS), the Beck Depression Inventory (BDI) and the STOP-BANG (S-B).

Results

SHI shows an acceptable internal consistency (Cronbach's α=0.75), as well as a high reproducibility (intraclass correlation=0.972, p<0.01). The three final factors of confirmatory factor analysis extract an average of 48.22% of the total sample variance. Worse sleep hygiene (higher SHI score) correlated with poor sleep quality (r=0.398, p<0.001), excessive daytime sleepiness (r=0.406, p<0.001) and depressive symptoms (r=0.324, p=0.003). No correlations with S-B were found.

Conclusions

SHI presents satisfactory-to-optimal psychometric properties. This instrument is useful for treatment planning and management of sleep hygiene practices. Thus, it represents a reliable way of assessing sleep hygiene quantitatively in both research and clinical settings.

Psychometric properties of sleep hygiene index in Indonesian adolescents

Background: Sleep is associated with some behavioral factors such as maladaptive, which tend to disrupt its normal mechanism, therefore, a tool is needed to measure maladaptive sleep hygiene. This study aims to assess the psychometric properties of sleep hygiene index (SHI), translation, factor structure, validity, and reliability. Design and Methods: Data were collected from 101 Indonesia adolescents in junior high school, with SHI-Indonesia translated based on WHO guideline. The obtained data were analyzed using varimax rotation, while the convergent validity was evaluated by calculating the correlation between the item and total score. In addition, the Cronbach's alpha was computed to investigate internal consistency, and two-week interval test-retest was conducted to assess reliability. Results: SHI is a unidimensional factor structure with an excellent test-retest reliability of P<0.001 at 0.618, and a positive convergent validity correlation between each item and the total score. Conclusions: The SHI Bahasa translation is a reliable and valid tool to assess maladaptive sleep hygiene among Indonesia Adolescents.

Pediatric Sleep Tools: An Updated Literature Review

Since a thorough review in 2011 by Spruyt, into the integral pitfalls of pediatric questionnaires in sleep, sleep researchers worldwide have further evaluated many existing tools. This systematic review aims to comprehensively evaluate and summarize the tools currently in circulation and provide recommendations for potential evolving avenues of pediatric sleep interest. 144 "tool"-studies (70 tools) have been published aiming at investigating sleep in primarily 6-18 years old per parental report. Although 27 new tools were discovered, most of the studies translated or evaluated the psychometric properties of existing tools. Some form of normative values has been established in 18 studies. More than half of the tools queried general sleep problems. Extra efforts in tool development are still needed for tools that assess children outside the 6-to-12-year-old age range, as well as for tools examining sleep-related aspects beyond sleep problems/disorders. Especially assessing the validity of tools has been pursued vis-à-vis fulfillment of psychometric criteria. While the Spruyt et al. review provided a rigorous step-by-step guide into the development and validation of such tools, a pattern of steps continue to be overlooked. As these instruments are potentially valuable in assisting in the development of a clinical diagnosis into pediatric sleep pathologies, it is required that while they are primary subjective measures, they behave as objective measures. More tools for specific populations (e.g., in terms of ages, developmental disabilities, and sleep pathologies) are still needed.

Construct Validation and Reliability Assessment of Tamil Version of Epworth Sleepiness Scale to Evaluate Daytime Sleepiness among Adolescents in Rural Puducherry, South India

Background:

Epworth sleepiness scale (ESS) has been used widely in the assessment of daytime sleepiness for research and clinical purposes. Hence, this study was done to translate the ESS in Tamil and to assess the construct validity and reliability of the Tamil version among adolescents in rural Puducherry, South India.

Materials and Methods:

Translation of the ESS by native language experts and pilot tested with subsample of adolescents. Final Tamil version was administered among 789 Tamil-speaking adolescents in the selected villages of rural Puducherry (union territory in South India). Construct validity was assessed by exploratory factor analysis through principal component method. Confirmatory factor analysis was done to obtain the goodness-of-fit. Reliability of questionnaire was assessed through Cronbach's alpha coefficient.

Results:

Two factor structures were obtained with Eigenvalues of 3.49 and 1.09, respectively. Both factors accounted for about 57.4% of the variance. Two-factor model assessed by confirmatory factor method found Chi-square value of 215.57 (P < 0.001). Goodness-of-fit revealed acceptable comparative fit indices (0.91). The reliability coefficient (Cronbach's alpha) for complete ESS was 0.81. Factor-based analysis showed that the Cronbach's reliability coefficient was 0.83 and 0.75 for the first and second factor, respectively.

Conclusion:

Our study concludes that the ESS questionnaire is internally valid and consistent with good reliability coefficient for application in Tamil-speaking rural adolescents. However, further research can be done to content validate the questionnaire with standard diagnostic tool.

Psychometric Analysis Of The Sleep Hygiene Index And Correlation With Stress And Anxiety Among Saudi University Students

AIMS

This study aimed to assess the psychometric properties of the Sleep Hygiene Index (SHI) instrument in screening poor sleep hygiene practices among Saudi university students. As a secondary goal, the association of sleep hygiene practices with stress and anxiety scores were assessed.

METHODS

Two-hundred and four healthy college and university students aged 18 to 25 years participated in this cross-sectional questionnaire-based survey. Participants were asked to complete the English version of the SHI instrument, the Perceived Stress Scale (PSS-10), the Generalized Anxiety Disorder (GAD-7) scale, and to provide demographic details.

RESULTS

The average scores for the SHI, the GAD-7, and the PSS-10 were 6.6, 5.3, and 16.2, respectively. The internal consistency of the SHI was adequate (McDonald's Omega 0.76). The corrected item-total correlations for all the items were fair (range, 0.31-0.50). A statistically significant positive correlation/association of the SHI scores with the PSS score, GAD-7, and self-reported poor sleep were obtained in this sample of Saudi university students. Factor analysis favored a 4-factor model of the SHI in the study sample.

CONCLUSION

The SHI scale demonstrated an adequate level of internal consistency as a self-reported instrument in the assessment of sleep hygiene among Saudi university students. In addition, poor sleep hygiene was correlated with stress and anxiety scores.

An Evaluation of the Quality of Sleep Before and After Surgical Treatment of Patients with Cervical Disc Herniation

Objective

It has been reported in recent studies that 50-80% of patients with cervical disc hernia have concomitant sleep disorders. The aim of this study was to evaluate the quality of sleep before and after surgical treatment in patients with cervical disc hernia and to assess the effects on treatment.

Methods

The study included 32 patients performed discectomy and fusion with an intervertebral cage through the right anterior cervical approach. Oswestry Disability Index (ODI), Visual Analog Scale (VAS) and Pittsburgh Sleep Quality Index (PSQI) were applied to all patients preoperatively and at one month postoperatively.

Results

The postoperative PSQI total points and all the PSQI subscale points, the ODI and VAS scores were significantly reduced compared to the preoperative values. A positive correlation was determined between the preoperative ODI points and the PSQI total points and sleep duration, sleep latency and daytime functional loss subscale points. A positive correlation was also found between preoperative ODI points and VAS points. A positive correlation was determined between the preoperative VAS points and and the PSQI total points and sleep duration, and sleep latency subscale points. A negative correlation was determined between the postoperative ODI and the daytime functional loss subscale points.

Conclusion

The results of the study showed that in patients with cervical disc hernia, sleep quality and daytime functionality were negatively affected by severity of pain that limited daily activities. Bringing the pain under control with surgical treatment was observed to increase sleep quality. It can be concluded that when planning treatment for these patients, it should be taken into consideration that there could be a sleep disorder in addition to the complaints and symptoms such as pain, hypoestesia and loss of strength.

Impact of a sleep course on sleep, mood and anxiety symptoms in college students: A pilot study

OBJECTIVE

To examine the impact of a sleep course on sleep-related behaviors, mood, and anxiety in college students.

PARTICIPANTS

Participants were 145 students enrolled in either the sleep course (n = 70) or a psychology course (n = 75); data were collected in September 2014, November 2014, and February 2015.

METHODS

Sleep characteristics and symptoms of depression and anxiety were assessed using validated questionnaires and sleep logs. Linear, logistic and proportional odds regression models were used to test course effects.

RESULTS

In November, sleep course students reported significant differences in sleep hygiene (SHI; p < .001), perceived sleep latency (PSQI; p < .05), and circadian sleep phase (MEQ; p < .05), compared to controls. In February, the sleep course students maintained most of the aforementioned gains and reported fewer symptoms of depression (CES-D; p = .05) and anxiety (BAI; p < .05).

CONCLUSIONS

These positive preliminary results indicate that focused education has the potential to improve sleep among college students.

Psychometric Properties of the Persian Version of Sleep Hygiene Index in the General Population

BACKGROUND

Inadequate sleep hygiene may result in difficulties in daily functioning; therefore, reliable scales for measuring sleep hygiene are important.

OBJECTIVES

The purpose of this study was to assess the psychometric properties of the Persian version of the Sleep Hygiene Index (SHI).

MATERIALS AND METHODS

From April 2014 to May 2015, 1280 subjects, who were selected by cluster random sampling in Kermanshah province, filled out the SHI, Pittsburgh sleep quality index (PSQI), Epworth sleepiness scale (ESS), and insomnia severity index (ISI). A subset of the participants (20%) repeated the SHI after a four to six-week interval to measure test-retest reliability. Then, we computed the Pearson product-moment correlation coefficients of SHI against PSQI, ESS and ISI, to demonstrate the construct validity of the SHI. The factor structure of the SHI was evaluated by explanatory factor analysis.

RESULTS

The interclass correlation coefficient was 0.89, and SHI was found to have good test-retest reliability (r = 0.89, P < 0.01). The SHI was positively correlated with the total score of the PSQI (r = 0.60, P < 0.01), ESS (r = 0.62, P < 0.01) and ISI (r = 0.60, P < 0.01). Exploratory factor analysis extracted three factors, namely "sleep-wake cycle behaviors" (four items), "bedroom factors" (three items), and "behaviors that affect sleep" (six items).

CONCLUSIONS

The Persian version of the SHI can be considered a reliable tool for evaluating sleep hygiene in the general population.

Sleep Hygiene Pattern and Behaviors and Related Factors among General Population in West Of Iran

INTRODUCTION

Sleep hygiene was found as an important predictor for sleep quality. People's sleep hygiene can have a major role in their daily function. The purpose of the study was to determine sleep hygiene patterns and sleep hygiene behaviors and factors affecting them in the general population of Kermanshah, Iran.

MATERIAL & METHODS

In this cross-sectional study, 1829 men and 1262 women were selected randomly from 50 clusters of different parts of the city. The inclusion criteria were age between 12 and 65 years and living in Kermanshah. The exclusion criteria were psychiatric disorder and known general medical conditions that affecting sleep. The data collection instruments were demographic questionnaire and Sleep Hygiene Questionnaire, consisted of 13 items about biological rhythm and bed room environment and behaviors that affecting sleep. Data were analyzed by using SPSS version 16 software.

RESULTS

The highest percentage was obtained for irregular woke and went up from day to day or at weekend and holidays (74.8%). Only 213 (6.9%) participants were classified as having good sleep hygiene (score 12-14). The mean age of very poor, poor, moderate, and good sleepers was 34.8 ± 14.4, 33.7 ± 17.4, 36.5 ± 13.8, and 35 ± 13.7years, respectively. There were significant differences between the age of poor and moderate sleepers and also sleep hygiene patterns with respect to sex, education level and job.

CONCLUSION

Poor sleep hygiene were more frequent in Iranian peoples and the major problem in sleep hygiene in our study was inappropriate sleep schedule.