Pittsburgh Sleep Quality Index (PSQI)

D. J. Buysse, C. F. Reynolds III, T. H. Monk, S. R. Berman, and D. J. Kupfer

Modified From: Rus J, e! al: Hand"ook of #sy$ia!ri$ Measures, %#%, &asin'!on DC, ()))
GOALS
Te #i!!s"ur' Sleep *uali!y Inde+ ,#S*I- ,Buysse e! al. ./0/a- 1as de2eloped !o measure sleep 3uali!y
durin' !e pre2ious mon! and !o dis$rimina!e "e!1een 'ood and poor sleepers. Sleep 3uali!y is a $omple+
penomenon !a! in2ol2es se2eral dimensions, ea$ of 1i$ is $o2ered "y !e #S*I. Te $o2ered domains
in$lude Su"4e$!i2e Sleep *uali!y, Sleep 5a!en$y, Sleep Dura!ion, Ha"i!ual Sleep 6ffi$ien$y, Sleep
Dis!ur"an$es, 7se of Sleep Medi$a!ions, and Day!ime Dysfun$!ion.
DESCRIPIO!
Te #S*I is $omposed of ./ self8ra!ed 3ues!ions and 9 3ues!ions ra!ed "y a "ed par!ner or roomma!e ,only
!e self8ra!ed i!ems are used in s$orin' !e s$ale-. Te self8adminis!ered s$ale $on!ains .9 mul!iple8$oi$e
i!ems !a! in3uire a"ou! fre3uen$y of sleep dis!ur"an$es and su"4e$!i2e sleep 3uali!y and : 1ri!e8in i!ems
!a! in3uire a"ou! !ypi$al "ed!ime, 1ake8up !ime, sleep la!en$y, and sleep dura!ion. Te 9 "ed par!ner
3ues!ions are mul!iple8$oi$e ra!in's of sleep dis!ur"an$e. %ll i!ems are "rief and easy for mos! adoles$en!s
and adul!s !o unders!and. Te i!ems a2e also "een adap!ed so !a! !ey $an "e adminis!ered "y a $lini$ian
or resear$ assis!an!. Sample self8ra!ed i!ems are pro2ided in 6+ample ;) <..
Te #S*I 'enera!es se2en s$ores !a! $orrespond !o !e domains lis!ed pre2iously. 6a$
$omponen! s$ore ran'es from ) ,no diffi$ul!y- !o ; ,se2ere diffi$ul!y-. Te $omponen! s$ores are summed
!o produ$e a 'lo"al s$ore ,ran'e of )<(.-. % #S*I 'lo"al s$ore =9 is $onsidered !o "e su''es!i2e of
si'nifi$an! sleep dis!ur"an$e. Cu!off s$ores are no! a2aila"le for $omponen! s$ales.
PRACICAL ISS"ES
I! !akes mos! pa!ien!s 9<.) minu!es !o $omple!e !e #S*I. >o !rainin' is needed !o adminis!er and s$ore i!.
S$orin' !ime is less !an 9 minu!es. Te s$ale and s$orin' ins!ru$!ions are a2aila"le in !e ori'inal
pu"li$a!ion ,Buysse e! al. ./0/a- or "y re3ues! from !e au!or:
Daniel J. Buysse, M.D.
&es!ern #sy$ia!ri$ Ins!i!u!e and Clini$
;0.. ?@Hara S!ree!
#i!!s"ur', #% .9(.;
PS#C$O%ERIC PROPERIES
Relia"ili!y
In!ernal $onsis!en$y 1as demons!ra!ed in a sample of eal!y $on!rol su"4e$!s ,n A 9(-, pa!ien!s 1i! sleep
disorders ,n A B(-, and depressed pa!ien!s ,n A ;:-C Cron"a$@s alpa 1as ).0; for !e 'lo"al s$ore.
Correla!ions "e!1een !e $omponen! s$ales and !e !o!al s$ore ran'ed from ).;9 !o ).DB. Correla!ions of
i!ems 1i! !e !o!al s$ore ran'ed from ).() !o ).BB. Tes!8re!es! relia"ili!y ,a2era'e in!er2al of (0 days- 1i!
a su"se! of /. of !e pa!ien!s and $on!rol su"4e$!s des$ri"ed earlier ,:; $on!rol su"4e$!s, (( depressed
pa!ien!s, and (B pa!ien!s 1i! sleep disorders- 1as ).09 for !e 'lo"al s$ore and ).B9<).0: for $omponen!
s$ales. % small sample of elderly pa!ien!s ,n A ./- e2alua!ed o2er an a2era'e in!er2al of ./ days re2ealed
similar findin's ,'lo"al relia"ili!y A ).0(C $omponen! s$ale s$ore A ).:9<).0:-.
Ealidi!y
#a!ien!s 1i! sleep disorders ,n A B(- or psy$ia!ri$ disorders asso$ia!ed 1i! sleep
dis!ur"an$es ,e.'., depressi2e and an+ie!y disorders- ,n A ;:- s$ored si'nifi$an!ly i'er !an eal!y
$on!rol su"4e$!s ,n A 9(- on 'lo"al and $omponen! s$ales. Componen! s$ales
si'nifi$an!ly differen!ia!ed dia'nos!i$ 'roups. % pos! o$ $u!off s$ore of 9 on !e #S*I produ$ed a
sensi!i2i!y of 0/.BF and a spe$ifi$i!y of 0B.9F of pa!ien!s 2ersus $on!rol su"4e$!s. Tis $u!off s$ore
$orre$!ly iden!ified 0:F of pa!ien!s 1i! disorders of ini!ia!in' or main!ainin' sleep, 0/F of pa!ien!s 1i!
disorders of e+$essi2e sleepiness, and /DF of depressed pa!ien!s. Group differen$es on !e #S*I "e!1een
pa!ien!s and $on!rol su"4e$!s 1ere su"s!an!ia!ed "y $ompara"le 'roup differen$es in polysomono'rapi$
measures for sleep la!en$y, sleep effi$ien$y, sleep dura!ion, and num"er of arousals. Ho1e2er, #S*I
$omponen! s$ale s$ores 1ere no! si'nifi$an!ly $orrela!ed 1i! $orrespondin' polysomno'rapi$ measures
,in !e same sample of .:0 pa!ien!s and $on!rol su"4e$!s-, 1i! !e e+$ep!ion of sleep la!en$y ,r A ).;;-.
Te 'lo"al #S*I s$ore 1as $orrela!ed 1i! sleep la!en$y ,r A ).()- "u! no! 1i! any o!er
polysomno'rapi$ measures.
In s!udies !a! $ompared pa!ien!s 1i! an+ie!y disorders 1i! $on!rol su"4e$!s, !ose 1i!
pani$ disorder and !ose 1i! so$ial po"ia e+$eeded !e $on!rol 'roup on 'lo"al #S*I s$ores and on
Su"4e$!i2e Sleep *uali!y, Sleep 5a!en$y, Sleep Dis!ur"an$es, and Day!ime Dysfun$!ion su"s$ales.
CLI!ICAL "ILI#
Te #S*I 1as desi'ned !o pro2ide a relia"le, 2alid, and s!andardiHed measure of sleep 3uali!y. #reliminary
resul!s 1i! !e s$ale su''es! !a! i! is su$$essful on all !ree $oun!s.
&i!in sleep disorder !rea!men! se!!in's, !e !es! sould "e useful in pro2idin' ini!ial inde+es of !e se2eri!y
and na!ure of sleep dis!ur"an$es. &i!in a 'eneral psy$ia!ri$ or medi$al se!!in', !e #S*I appears !o "e
useful as an ini!ial s$reen !o iden!ify 'ood and poor sleepers. Fur!ermore, al!ou' no! as
psy$ome!ri$ally sound as !e o2erall s$ore, !e $omponen! s$ales appear !o pro2ide preliminary si'ns of
spe$ifi$ !ypes of sleep dis!ur"an$e. %l!ou' in !eory !e #S*I sould "e useful in iden!ifyin' pa!ien!s for
1om polysomno'rapi$ e2alua!ion may "e ne$essary, i!s a$!ual performan$e as a s$reenin' !ool as no!
"een repor!ed ,i.e., false8posi!i2e and false8ne'a!i2e ra!es $ompared 1i! resul!s from !e polysomno'ram-.
Te #S*I $omponen! s$ales do no!, "y and lar'e, refle$! $orrespondin' polysomno'rapi$ findin's. In any
$ase, !e #S*I is no! suffi$ien! !o pro2ide a$$ura!e $lini$al dia'noses of sleep disorders. Fur!ermore, !ere
are no da!a es!a"lisin' i!s sensi!i2i!y !o $an'eC !us, i! is no! kno1n 1e!er !e s$ale is useful for
moni!orin' !rea!men! response.
RE&ERE!CES A!D S"GGESED READI!GS
Buysse DJ, Reynolds CF, Monk TH, e! al: #i!!s"ur' Sleep *uali!y Inde+: a ne1 ins!rumen! for psy$ia!ri$
pra$!i$e and resear$. #sy$ia!ry Res (0:./;<(.;, ./0/a
Buysse DJ, Reynolds CF, Monk TH, e! al: *uan!ifi$a!ion of su"4e$!i2e sleep 3uali!y in eal!y elderly men
and 1omen usin' !e #i!!s"ur' Sleep *uali!y Inde+. Sleep .::;;.<;;0, ./0/"
Gen!illi %, &einer DK, Ku$i"a!la M, e! al: Tes!8re!es! relia"ili!y of !e #i!!s"ur' Sleep *uali!y Inde+
in nursin' ome residen!s ,le!!er-. J %m Geria!r So$ :;:.;.D<.;.0, .//9
S!ein MB, Car!ier M, &alker JR: Sleep in nondepressed pa!ien!s 1i! pani$ disorder, I:
sys!ema!i$ assessmen! of su"4e$!i2e sleep 3uali!y and sleep dis!ur"an$e. Sleep .B:D(:<D(B, .//;
S!ein MB, Krof! CD5, &alker JR: Sleep impairmen! in pa!ien!s 1i! so$ial po"ia. #sy$ia!ry Res
:/:(9.<(9B, .//;
Rus J, e! al: Hand"ook of #sy$ia!ri$ Measures, %#%, &asin'!on DC, ()))