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

K Y Ho, Katherine K W Lam, W Xia, J O K Chung, Ankie T Cheung, Laurie L K Ho, S Y Chiu, Godfrey C F Chan, William H C Li, K Y Ho, Katherine K W Lam, W Xia, J O K Chung, Ankie T Cheung, Laurie L K Ho, S Y Chiu, Godfrey C F Chan, William H C Li

Abstract

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.

Keywords: Assessment; Childhood cancer survivors; Psychometric properties; Sleep disruption.

Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
The estimated parameters of the Chinese version of the PSQI based on the three-factor model
Fig. 2
Fig. 2
The AUC of the Chinese version of the PSQI when compared with the DSM-5 diagnostic criteria for insomnia

References

    1. Children’s Cancer Foundation. Childhood Cancer Facts and Figures. . Accessed April 12, 2021.
    1. Hong Kong Cancer Registry. Hong Kong Cancer Registry 2015. . Accessed April 12, 2021.
    1. Berk L. Development through the lifespan. India: Pearson Education; 2017.
    1. Warner EL, Kirchhoff AC, Nam GE, Fluchel M. Financial burden of pediatric cancer for patients and their families. J Oncol Pract. 2015;11(1):12–18. doi: 10.1200/JOP.2014.001495.
    1. Howell D, Oliver TK, Keller-Olaman S, Davidson JR, Garland S, Samuels C, et al. Sleep disturbance in adults with cancer: a systematic review of evidence for best practices in assessment and management for clinical practice. Ann Oncol. 2014;25(4):791–800. doi: 10.1093/annonc/mdt506.
    1. Merz EL, Tomfohr-Madsen L. Sleep disruption in pediatric cancer survivors: conceptual framework and opportunities for clinical assessment and behavioral treatment. Am J Lifestyle Med. 2016;12(4):311–323. doi: 10.1177/1559827616681725.
    1. Mulrooney DA, Ness KK, Neglia JP, Whitton JA, Green DM, Zeltzer LK, et al. Fatigue and sleep disturbance in adult survivors of childhood cancer: a report from the childhood cancer survivor study (CCSS) Sleep. 2008;31(2):271–281. doi: 10.1093/sleep/31.2.271.
    1. Miaskowski C, Mastick J, Paul SM, Abrams G, Cheung S, Sabes JH, et al. Impact of chemotherapy-induced neurotoxicities on adult cancer survivors' symptom burden and quality of life. J Cancer Surviv. 2018;12(2):234–245. doi: 10.1007/s11764-017-0662-8.
    1. Cheung YT, Lim SR, Ho HK, Chan A. Cytokines as mediators of chemotherapy-associated cognitive changes: current evidence, limitations and directions for future research. PLoS ONE. 2013;8(12):e81234. doi: 10.1371/journal.pone.0081234.
    1. Balachandran DD, Faiz S, Bashoura L, Manzullo E. Cancer-related fatigue and sleep disorders. Sleep Med Clin. 2013;8(2):229–234. doi: 10.1016/j.jsmc.2013.02.005.
    1. Chung OKJ, Li HCW, Chiu SY, Ho KYE, Lopez V. The impact of cancer and its treatment on physical activity levels and behavior in Hong Kong Chinese childhood cancer survivors. Cancer Nurs. 2014;37(3):E43–E51. doi: 10.1097/NCC.0b013e3182980255.
    1. Brown LF, Kroenke K. Cancer-related fatigue and its associations with depression and anxiety: a systematic review. Psychosomatics. 2009;50(5):440–447. doi: 10.1016/S0033-3182(09)70835-7.
    1. Otte JL, Carpenter JS, Manchanda S, Rand KL, Skaar TC, Weaver M, et al. Systematic review of sleep disorders in cancer patients: can the prevalence of sleep disorders be ascertained? Cancer Med. 2015;4(2):183–200. doi: 10.1002/cam4.356.
    1. Mollayeva T, Thurairajah P, Burton K, Mollayeva S, Shapiro CM, Colantonio A. The Pittsburgh sleep quality index as a screening tool for sleep dysfunction in clinical and non-clinical samples: a systematic review and meta-analysis. Sleep Med Rev. 2016;25:52–73. doi: 10.1016/j.smrv.2015.01.009.
    1. Buysse DJ, Reynolds CF, 3rd, Monk TH, Berman SR, Kupfer DJ. The Pittsburgh Sleep Quality Index: a new instrument for psychiatric practice and research. Psychiatry Res. 1989;28(2):193–213. doi: 10.1016/0165-1781(89)90047-4.
    1. Beck SL, Schwartz AL, Towsley G, Dudley W, Barsevick A. Psychometric evaluation of the Pittsburgh Sleep Quality Index in cancer patients. J Pain Symptom Manage. 2004;27(2):140–148. doi: 10.1016/j.jpainsymman.2003.12.002.
    1. Fontes F, Gonçalves M, Maia S, Pereira S, Severo M, Lunet N. Reliability and validity of the Pittsburgh Sleep Quality Index in breast cancer patients. Support Care Cancer. 2017;25(10):3059–3066. doi: 10.1007/s00520-017-3713-9.
    1. Tietze AL, Zernikow B, Michel E, Blankenburg M. Sleep disturbances in children, adolescents, and young adults with severe psychomotor impairment: impact on parental quality of life and sleep. Dev Med Child Neurol. 2014;56(12):1187–1193. doi: 10.1111/dmcn.12530.
    1. de la Vega R, Tomé-Pires C, Solé E, Racine M, Castarlenas E, Jensen MP, et al. The Pittsburgh Sleep Quality Index: validity and factor structure in young people. Psychol Assess. 2015;27(4):e22–e27. doi: 10.1037/pas0000128.
    1. Raniti MB, Waloszek JM, Schwartz O, Allen NB, Trinder J. Factor structure and psychometric properties of the Pittsburgh Sleep Quality Index in community-based adolescents. Sleep. 2018 doi: 10.1093/sleep/zsy066.
    1. Gelaye B, Lohsoonthorn V, Lertmeharit S, Pensuksan WC, Sanchez SE, Lemma S, et al. Construct validity and factor structure of the Pittsburgh sleep quality index and epworth sleepiness scale in a multi-national study of African, South East Asian and South American college students. PLoS ONE. 2014;9(12):e116383. doi: 10.1371/journal.pone.0116383.
    1. Erwin AM, Bashore L. Subjective sleep measures in children: self-report. Front Pediatr. 2017;5:22. doi: 10.3389/fped.2017.00022.
    1. Kaleyias J, Manley P, Kothare SV. Sleep disorders in children with cancer. Semin Pediatr Neurol. 2012;19(1):25–34. doi: 10.1016/j.spen.2012.02.013.
    1. American Cancer Society. Targeted Therapy Side Effects. . Accessed 13 May 2021.
    1. American Cancer Society. Radiation Therapy Side Effects. . Accessed 13 May 2021.
    1. Cole JC, Motivala SJ, Buysse DJ, Oxman MN, Levin MJ, Irwin MR. Validation of a 3-factor scoring model for the Pittsburgh sleep quality index in older adults. Sleep. 2006;29(1):112–116. doi: 10.1093/sleep/29.1.112.
    1. Magee CA, Caputi P, Iverson DC, Huang XF. An investigation of the dimensionality of the Pittsburgh Sleep Quality Index in Australian adults. Sleep Biol Rhythms. 2008;6:222–227. doi: 10.1111/j.1479-8425.2008.00371.x.
    1. Queen Mary Hospital. Paediatrics & Adolescent Medicine. . Accessed 13 May 2021.
    1. Li HCW, Lopez V, Chung OKJ, Ho KY, Chiu SY. The impact of cancer on the physical, psychological and social well-being of childhood cancer survivors. Eur J Oncol Nurs. 2013;17(2):214–219. doi: 10.1016/j.ejon.2012.07.010.
    1. Ho KY, Lam KKW, Chung JOK, Xia W, Cheung AT, Ho LK, et al. Systematic review of the effectiveness of complementary and alternative medicine on nausea and vomiting in children with cancer: a study protocol. BMJ Open. 2019;9(10):e031834. doi: 10.1136/bmjopen-2019-031834.
    1. Lam KKW, Li WHC, Chiu SY, Chan GCF. The impact of cancer and its treatment on physical activity levels and quality of life among young Hong Kong Chinese cancer patients. Eur J Oncol Nurs. 2016;21:83–89. doi: 10.1016/j.ejon.2016.01.007.
    1. Nunnally JC. Pyschometric theory. New York: McGraw-Hill; 1978.
    1. Bracken BA, Barona A. State of the art procedures for translating, validating and using psychoeducational tests in cross-cultural assessment. Sch Psychol Int. 1991;12(1–2):119–132. doi: 10.1177/0143034391121010.
    1. Carpenter JS, Elam JL, Ridner SH, Carney PH, Cherry GJ, Cucullu HL. Sleep, fatigue, and depressive symptoms in breast cancer survivors and matched healthy women experiencing hot flashes. Oncol Nurs Forum. 2014;31(3):591–5598. doi: 10.1188/04.ONF.591-598.
    1. Li HC, Chung OK, Ho KY. Center for Epidemiologic Studies Depression Scale for Children: psychometric testing of the Chinese version. J Adv Nurs. 2010;66(11):2582–2591. doi: 10.1111/j.1365-2648.2010.05440.x.
    1. Ho KY, Li WHC, Lam KW, Chiu SY, Chan CFG. The psychometric properties of the Chinese Version of the Fatigue Scale for children. Cancer Nurs. 2016;39(5):341–348. doi: 10.1097/NCC.0000000000000297.
    1. Ho KY, Li WH, Lam KW, Chiu SY, Chan CFG. Psychometric properties of the Chinese version of the fatigue scale-adolescent. BMC Cancer. 2015;15:938. doi: 10.1186/s12885-015-1945-y.
    1. Chan LF, Chow SM, Lo SK. Preliminary validation of the Chinese version of the Pediatric Quality of Life Inventory. Int J Rehabil Res. 2005;28(3):219–227. doi: 10.1097/00004356-200509000-00004.
    1. Polit DF, Beck CT. The content validity index: are you sure you know what's being reported? Critique and recommendations. Res Nurs Health. 2006;29(5):489–497. doi: 10.1002/nur.20147.
    1. Byrne BM. Structural equation modelling with LISREL, PRELIS and SIMPLIS: Basic concepts, applications and programming. Mahwah: Lawrence Erlbaum; 1998.
    1. Li HC, Wong ML, Lopez V. Factorial structure of the Chinese version of the State Anxiety Scale for Children (short form) J Clin Nurs. 2008;17(13):1762–1770. doi: 10.1111/j.1365-2702.2008.02284.x.
    1. Browne MW, Cudeck R. Alternative ways of assessing model fit. In: Bollen KA, Long JS, editors. Testing structural equation models. Newbury Park: Sage Publications; 1993. pp. 136–162.
    1. MacCallum R. Model specification: procedures, strategies, and related issues. In: Hoyle RH, editor. Structural equation modeling: concepts, issues, and application. Thousand Oaks: Sage Publication; 1995. pp. 16–36.
    1. Hu L, Bentler PM. Cut-off criteria for fit indices in covariance structure analysis: conventional criteria versus new alternatives. Struct Equat Model. 1999;6:1–31. doi: 10.1080/10705519909540118.
    1. Cohen J. Statistical power analysis for the behavioral sciences. 2. Hillsdale: Lawrence Erlbaum Associates Publishers; 1988.
    1. Osher D, Kendziora, K, Spier E, Garibaldi ML. School influences on child and youth development. In: Sloboda Z, Petras H, editors. Advances in prevention science: Vol. 1. Defining prevention science. New York: Springer; 2014. p151–169.
    1. Zeltzer LK, Recklitis C, Buchbinder D, Zebrack B, Casillas J, Tsao JCI, et al. Psychological status in childhood cancer survivors: a report from the Childhood Cancer Survivor Study. J Clin Oncol. 2009;27(14):2396–2404. doi: 10.1200/JCO.2008.21.1433.
    1. Fortier-Brochu E, Beaulieu-Bonneau S, Ivers H, Morin CM. Relations between sleep, fatigue, and health-related quality of life in individuals with insomnia. J Psychosom Res. 2010;69(5):475–483. doi: 10.1016/j.jpsychores.2010.05.005.
    1. Manzar MD, BaHammam AS, Hameed UA, Spence DW, Pandi-Perumal SR, Moscovitch A, et al. Dimensionality of the Pittsburgh Sleep Quality Index: a systematic review. Health Qual Life Outcomes. 2018;16(1):89. doi: 10.1186/s12955-018-0915-x.
    1. Zhu B, Xie M, Park CG, Kapella MC. Adaptation of the Pittsburgh Sleep Quality Index in Chinese adults with type 2 diabetes. J Chin Med Assoc. 2018;81(3):242–247. doi: 10.1016/j.jcma.2017.06.021.
    1. Yung KP, Chung KF, Ho FY, Yeung WF, Ng THY. The Experience of chronic insomnia in Chinese adults: a study using focus groups and insomnia experience diaries. Behav Sleep Med. 2016;14(4):406–428. doi: 10.1080/15402002.2015.1017097.
    1. Liu Y, Zhang J, Lam SP, Yu MWM, Li SX, Zhou J, et al. Help-seeking behaviors for insomnia in Hong Kong Chinese: a community-based study. Sleep Med. 2016;21:106–113. doi: 10.1016/j.sleep.2016.01.006.
    1. Sarris J, Byrne GJ. A systematic review of insomnia and complementary medicine. Sleep Med Rev. 2011;15(2):99–106. doi: 10.1016/j.smrv.2010.04.001.
    1. Casement MD, Harrington KM, Miller MW, Resick PA. Associations between Pittsburgh Sleep Quality Index factors and health outcomes in women with posttraumatic stress disorder. Sleep Med. 2012;13(6):752–758. doi: 10.1016/j.sleep.2012.02.014.
    1. Carskadon MA, Harvey K, Duke P, Anders TF, Litt IF, Dement WC. Pubertalchanges in daytime sleepiness. Sleep. 1980;2:453–460. doi: 10.1093/sleep/2.4.453.
    1. Aloba OO, Adewuya AO, Ola BA, Mapayi BM. Validity of the Pittsburgh Sleep Quality Index (PSQI) among Nigerian university students. Sleep Med. 2007;8(3):266–270. doi: 10.1016/j.sleep.2006.08.003.
    1. Backhaus J, Junghanns K, Broocks A, Riemann D, Hohagen F. Test-retest reliability and validity of the Pittsburgh Sleep Quality Index in primary insomnia. J Psychosom Res. 2002;53(3):737–740. doi: 10.1016/S0022-3999(02)00330-6.
    1. Curcio G, Tempesta D, Scarlata S, Marzano C, Moroni F, Rossini PM, et al. Validity of the Italian version of the Pittsburgh Sleep Quality Index (PSQI) Neurol Sci. 2013;34(4):511–519. doi: 10.1007/s10072-012-1085-y.
    1. Okajima I, Komada Y, Nomura T, Nakashima K, Inoue Y. Insomnia as a risk for depression: a longitudinal epidemiologic study on a Japanese rural cohort. J Clin Psychiatry. 2012;73(3):377–383. doi: 10.4088/JCP.10m06286.
    1. Sohn SI, Kim DH, Lee MY, Cho YW. The reliability and validity of the Korean version of the Pittsburgh Sleep Quality Index. Sleep Breath. 2012;16(3):803–812. doi: 10.1007/s11325-011-0579-9.
    1. Zhou ES, Recklitis CJ. Insomnia in adult survivors of childhood cancer: a report from project REACH. Support Care Cancer. 2014;22(11):3061–3069. doi: 10.1007/s00520-014-2316-y.
    1. Garland SN, Johnson JA, Savard J, Gehrman P, Perlis M, Carlson L, et al. Sleeping well with cancer: a systematic review of cognitive behavioral therapy for insomnia in cancer patients. Neuropsychiatr Dis Treat. 2014;10:1113–1124.
    1. Waldron EA, Janke EA, Bechtel CF, Ramirez M, Cohen A. A systematic review of psychosocial interventions to improve cancer caregiver quality of life. Psychooncology. 2013;22(6):1200–1207. doi: 10.1002/pon.3118.

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