Skip to main content
Top
Published in: Health and Quality of Life Outcomes 1/2014

Open Access 01-12-2014 | Research

Exploration of dimensionality and psychometric properties of the Pittsburgh Sleep Quality Index in cases with temporomandibular disorders

Authors: Ksenija Rener-Sitar, Mike T John, Dipankar Bandyopadhyay, Michael J Howell, Eric L Schiffman

Published in: Health and Quality of Life Outcomes | Issue 1/2014

Login to get access

Abstract

Background

This study assessed the dimensional structure of sleep quality with the Pittsburgh Sleep Quality Index (PSQI) and investigated its psychometric properties in cases with temporomandibular disorders (TMD).

Methods

A convenience sample of 609 TMD cases (age: 37.1 ± 13.1 yrs, 18–67 yrs, 85% female) of the multi-center Validation Project meeting Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD) and with sufficient PSQI data were included in this study. To investigate PSQI scores’ dimensionality, exploratory factor analysis was used. Factors were identified using the Scree plot. To investigate internal consistency, Cronbach’s alpha was calculated. Analyses were separately performed for TMD cases with (N = 496) and TMD cases withouta pain-related diagnosis (N = 113).

Results

The mean PSQI score for all TMD cases was 7.1 ± 4.0 units, range: 0–19. The exploratory factor analysis identified one factor for cases with at least one pain-related TMD diagnosis as well as one factor for cases with a pain-free TMD diagnosis that explained 41% of the variance in cases with pain-related TMD and 37% in cases with pain-free TMD. Internal consistency for PSQI scores was alpha of 0.75 in cases with pain-related TMD, alpha of 0.66 in cases with pain-free TMD and alpha = 0.75 for all TMD cases.

Conclusions

Sleep quality in TMD patients is a unidimensional construct and can therefore be represented by one summary score; a finding that is in line with previous reports in TMD patients.
Appendix
Available only for authorised users
Literature
1.
go back to reference Cole JC, Dubois D, Kosinski M: Use of patient-reported sleep measures in clinical trials of pain treatment: a literature review and synthesis of current sleep measures and a conceptual model of sleep disturbance in pain. Clin Ther 2007, 29: 2580–2588. 10.1016/j.clinthera.2007.12.005CrossRefPubMed Cole JC, Dubois D, Kosinski M: Use of patient-reported sleep measures in clinical trials of pain treatment: a literature review and synthesis of current sleep measures and a conceptual model of sleep disturbance in pain. Clin Ther 2007, 29: 2580–2588. 10.1016/j.clinthera.2007.12.005CrossRefPubMed
2.
go back to reference Yatani H, Studts J, Cordova M, Carlson CR, Okeson JP: Comparison of sleep quality and clinical and psychologic characteristics in patients with temporomandibular disorders. J Orofac Pain 2002, 16: 221–228.PubMed Yatani H, Studts J, Cordova M, Carlson CR, Okeson JP: Comparison of sleep quality and clinical and psychologic characteristics in patients with temporomandibular disorders. J Orofac Pain 2002, 16: 221–228.PubMed
3.
go back to reference Grossi ML, Goldberg MB, Locker D, Tenenbaum HC: Reduced neuropsychologic measures as predictors of treatment outcome in patients with temporomandibular disorders. J Orofac Pain 2001, 15: 329–339.PubMed Grossi ML, Goldberg MB, Locker D, Tenenbaum HC: Reduced neuropsychologic measures as predictors of treatment outcome in patients with temporomandibular disorders. J Orofac Pain 2001, 15: 329–339.PubMed
4.
go back to reference Devine EB, Hakim Z, Green J: A systematic review of patient-reported outcome instruments measuring sleep dysfunction in adults. Pharmacoeconomics 2005, 23: 889–912. 10.2165/00019053-200523090-00003CrossRefPubMed Devine EB, Hakim Z, Green J: A systematic review of patient-reported outcome instruments measuring sleep dysfunction in adults. Pharmacoeconomics 2005, 23: 889–912. 10.2165/00019053-200523090-00003CrossRefPubMed
5.
go back to reference Buysse DJ, Reynolds CFI, Monk TH, Berman SR, Kupfer DJ: The Pittsburgh Sleep Quality Index: a new instrument for psychiatric practice and research. Psychiatry Res 1989, 28: 385–396.CrossRef Buysse DJ, Reynolds CFI, Monk TH, Berman SR, Kupfer DJ: The Pittsburgh Sleep Quality Index: a new instrument for psychiatric practice and research. Psychiatry Res 1989, 28: 385–396.CrossRef
6.
go back to reference 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: 112–116.PubMed 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: 112–116.PubMed
7.
go back to reference Aloba OO, Adewuya AO, Ola BA, Mapayi BM: Validity of the Pittsburgh Sleep Quality Index (PSQI) among Nigerian university students. Sleep Med 2007, 8: 266–270. 10.1016/j.sleep.2006.08.003CrossRefPubMed Aloba OO, Adewuya AO, Ola BA, Mapayi BM: Validity of the Pittsburgh Sleep Quality Index (PSQI) among Nigerian university students. Sleep Med 2007, 8: 266–270. 10.1016/j.sleep.2006.08.003CrossRefPubMed
8.
go back to reference 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. 10.1111/j.1479-8425.2008.00371.xCrossRef 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. 10.1111/j.1479-8425.2008.00371.xCrossRef
9.
go back to reference Burkhalter H, Sereika SM, Engberg S, Wirz-Justice A, Steiger J, de Geest S: Structure validity of the Pittsburgh Sleep Quality Index in renal transplant recipients: A confirmatory factor analysis. Sleep Biol Rhythms 2010, 8: 274–281. 10.1111/j.1479-8425.2010.00473.xCrossRef Burkhalter H, Sereika SM, Engberg S, Wirz-Justice A, Steiger J, de Geest S: Structure validity of the Pittsburgh Sleep Quality Index in renal transplant recipients: A confirmatory factor analysis. Sleep Biol Rhythms 2010, 8: 274–281. 10.1111/j.1479-8425.2010.00473.xCrossRef
10.
go back to reference Mariman A, Vogelaers D, Hanoulle I, Delesie L, Tobback E, Pevernagie D: Validation of the three-factor model of the PSQI in a large sample of chronic fatigue syndrome (CFS) patients. J Psychosom Res 2012, 72: 111–113. 10.1016/j.jpsychores.2011.11.004CrossRefPubMed Mariman A, Vogelaers D, Hanoulle I, Delesie L, Tobback E, Pevernagie D: Validation of the three-factor model of the PSQI in a large sample of chronic fatigue syndrome (CFS) patients. J Psychosom Res 2012, 72: 111–113. 10.1016/j.jpsychores.2011.11.004CrossRefPubMed
11.
go back to reference de Leeuw R, Studts JL, Carlson CR: Fatigue and fatigue-related symptoms in an orofacial pain population. Oral Surg Oral Med O 2005, 99: 168–174. 10.1016/j.tripleo.2004.03.001CrossRef de Leeuw R, Studts JL, Carlson CR: Fatigue and fatigue-related symptoms in an orofacial pain population. Oral Surg Oral Med O 2005, 99: 168–174. 10.1016/j.tripleo.2004.03.001CrossRef
12.
go back to reference de Leeuw R, Bertoli E, Schmidt JE, Carlson CR: Prevalence of traumatic stressors in patients with temporomandibular disorders. J Oral Maxil Surg 2005, 63: 42–50.CrossRef de Leeuw R, Bertoli E, Schmidt JE, Carlson CR: Prevalence of traumatic stressors in patients with temporomandibular disorders. J Oral Maxil Surg 2005, 63: 42–50.CrossRef
13.
go back to reference Vazquez-Delgado E, Schmidt JE, Carlson CR, DeLeeuw R, Okeson JP: Psychological and sleep quality differences between chronic daily headache and temporomandibular disorders patients. Cephalalgia 2004, 24: 446–454. 10.1111/j.1468-2982.2004.00698.xCrossRefPubMed Vazquez-Delgado E, Schmidt JE, Carlson CR, DeLeeuw R, Okeson JP: Psychological and sleep quality differences between chronic daily headache and temporomandibular disorders patients. Cephalalgia 2004, 24: 446–454. 10.1111/j.1468-2982.2004.00698.xCrossRefPubMed
14.
go back to reference Lindroth JE, Schmidt JE, Carlson CR: A comparison between masticatory muscle pain patients and intracapsular pain patients on behavioral and psychosocial domains. J Orofac Pain 2002, 16: 277–283.PubMed Lindroth JE, Schmidt JE, Carlson CR: A comparison between masticatory muscle pain patients and intracapsular pain patients on behavioral and psychosocial domains. J Orofac Pain 2002, 16: 277–283.PubMed
15.
go back to reference Schiffman EL, Truelove EL, Ohrbach R, Anderson GC, John MT, List T, Look JO: The Research Diagnostic Criteria for Temporomandibular Disorders. I: overview and methodology for assessment of validity. J Orofac Pain 2010, 24: 7–24.PubMedCentralPubMed Schiffman EL, Truelove EL, Ohrbach R, Anderson GC, John MT, List T, Look JO: The Research Diagnostic Criteria for Temporomandibular Disorders. I: overview and methodology for assessment of validity. J Orofac Pain 2010, 24: 7–24.PubMedCentralPubMed
16.
go back to reference Dworkin SF, LeResche L: Research diagnostic criteria for temporomandibular disorders: review, criteria, examinations and specifications, critique. J Craniomandib Disord 1992, 6: 301–355.PubMed Dworkin SF, LeResche L: Research diagnostic criteria for temporomandibular disorders: review, criteria, examinations and specifications, critique. J Craniomandib Disord 1992, 6: 301–355.PubMed
17.
go back to reference Jensen MP: The validity and reliability of pain measures in adults with cancer. J Pain 2003, 4: 2–21. 10.1054/jpai.2003.1CrossRefPubMed Jensen MP: The validity and reliability of pain measures in adults with cancer. J Pain 2003, 4: 2–21. 10.1054/jpai.2003.1CrossRefPubMed
18.
go back to reference John MT, Reissmann DR, Schierz O, Allen F: No significant retest effects in oral health-related quality of life assessment using the Oral Health Impact Profile. Acta Odontol Scand 2008, 66: 135–138. 10.1080/00016350802077835CrossRefPubMed John MT, Reissmann DR, Schierz O, Allen F: No significant retest effects in oral health-related quality of life assessment using the Oral Health Impact Profile. Acta Odontol Scand 2008, 66: 135–138. 10.1080/00016350802077835CrossRefPubMed
19.
go back to reference Buysse DJ, Reynolds CF III, Monk TH, Berman SR, Kupfer DJ: Pittsburgh Sleep Quality Index. [PSQI]. In Handbook of Psychiatric Measures. 2nd edition. Edited by: Rush AJ, First MB, Blacker D. Washington DC: American Psychiatric Publishing; 2008:653–655. Buysse DJ, Reynolds CF III, Monk TH, Berman SR, Kupfer DJ: Pittsburgh Sleep Quality Index. [PSQI]. In Handbook of Psychiatric Measures. 2nd edition. Edited by: Rush AJ, First MB, Blacker D. Washington DC: American Psychiatric Publishing; 2008:653–655.
20.
go back to reference Shultz KS, Whitney DJ: Measurement Theory in Action: Patient Studies and Exercises. Thousand Oaks, CA: Sage Publications; 2005. Shultz KS, Whitney DJ: Measurement Theory in Action: Patient Studies and Exercises. Thousand Oaks, CA: Sage Publications; 2005.
21.
go back to reference Pett MA, Lackey NR, Sullivan JJ: Making Sense of Factor Analysis - The Use of Factor Analysis for Instrument Development in Health Care Research. Thousand Oaks, CA: Sage Publications; 2003. Pett MA, Lackey NR, Sullivan JJ: Making Sense of Factor Analysis - The Use of Factor Analysis for Instrument Development in Health Care Research. Thousand Oaks, CA: Sage Publications; 2003.
22.
go back to reference Cattell RB: The scree test for the number of factors. Multivar Behav Res 1966, 1: 245–276. 10.1207/s15327906mbr0102_10CrossRef Cattell RB: The scree test for the number of factors. Multivar Behav Res 1966, 1: 245–276. 10.1207/s15327906mbr0102_10CrossRef
23.
go back to reference Horn J: A rationale and test for the number of factors in factor analysis. Psychometrika 1965, 30: 179–185. 10.1007/BF02289447CrossRefPubMed Horn J: A rationale and test for the number of factors in factor analysis. Psychometrika 1965, 30: 179–185. 10.1007/BF02289447CrossRefPubMed
24.
go back to reference Christoffersson A: Two-step weighted least squares factor analysis of dichotomized variables. Psychometrika 1977, 42: 433–438. 10.1007/BF02293660CrossRef Christoffersson A: Two-step weighted least squares factor analysis of dichotomized variables. Psychometrika 1977, 42: 433–438. 10.1007/BF02293660CrossRef
25.
go back to reference Huber PJ: The behavior of maximum likelihood estimates under nonstandard conditions. In Proceedings of the Fifth Berkeley Symposium on Mathematical Statistics and Probability: 21 June -18 July 1965 and 27 December – 7 January 1966. Edited by: le Cam LM, Neyman J. Berkeley: University of California Press; 1967:221–233. Huber PJ: The behavior of maximum likelihood estimates under nonstandard conditions. In Proceedings of the Fifth Berkeley Symposium on Mathematical Statistics and Probability: 21 June -18 July 1965 and 27 December – 7 January 1966. Edited by: le Cam LM, Neyman J. Berkeley: University of California Press; 1967:221–233.
26.
go back to reference Kline RB: Principles and Practice of Structural Equation Modeling. New York: Guilford Press; 2010. Kline RB: Principles and Practice of Structural Equation Modeling. New York: Guilford Press; 2010.
27.
go back to reference Cronbach LJ: Coefficient alpha and the internal reliability of tests. Psychometrika 1951, 16: 297–334. 10.1007/BF02310555CrossRef Cronbach LJ: Coefficient alpha and the internal reliability of tests. Psychometrika 1951, 16: 297–334. 10.1007/BF02310555CrossRef
29.
go back to reference Clark LA, Watson D: Constructing validity: basic issues in objective scale development. Psychol Assess 1995, 7: 309.CrossRef Clark LA, Watson D: Constructing validity: basic issues in objective scale development. Psychol Assess 1995, 7: 309.CrossRef
30.
go back to reference Shrout PE, Fleiss JL: Intraclass correlations: uses in assessing rater reliability. Psychol Bull 1979, 86: 420–428.CrossRefPubMed Shrout PE, Fleiss JL: Intraclass correlations: uses in assessing rater reliability. Psychol Bull 1979, 86: 420–428.CrossRefPubMed
31.
go back to reference Bland JM, Altman DG: Statistical methods for assessing agreement between two methods of clinical measurement. Lancet 1986, 1: 307–310.CrossRefPubMed Bland JM, Altman DG: Statistical methods for assessing agreement between two methods of clinical measurement. Lancet 1986, 1: 307–310.CrossRefPubMed
32.
go back to reference Goldberg DP, Williams P: A User’s Guide to the General Health Questionnaire. Windsor, Berkshire, England: Nelson Publishing Company; 1988. Goldberg DP, Williams P: A User’s Guide to the General Health Questionnaire. Windsor, Berkshire, England: Nelson Publishing Company; 1988.
33.
go back to reference Cohen J: Statistical Power Analyses for the Behavioral Sciences. Hillsdale, NJ: Lawrence Erlbaum; 1988. Cohen J: Statistical Power Analyses for the Behavioral Sciences. Hillsdale, NJ: Lawrence Erlbaum; 1988.
34.
go back to reference Slade GD, Spencer AJ: Development and evaluation of the Oral Health Impact Profile. Community Dent Health 1994, 11: 3–11.PubMed Slade GD, Spencer AJ: Development and evaluation of the Oral Health Impact Profile. Community Dent Health 1994, 11: 3–11.PubMed
35.
go back to reference Herman CR, Schiffman EL, Look JO, Rindal DB: The effectiveness of adding pharmacologic treatment with clonazepam or cyclobenzaprine to patient education and self-care for the treatment of jaw pain upon awakening: a randomized clinical trial. J Orofac Pain 2002, 16: 64–70.PubMed Herman CR, Schiffman EL, Look JO, Rindal DB: The effectiveness of adding pharmacologic treatment with clonazepam or cyclobenzaprine to patient education and self-care for the treatment of jaw pain upon awakening: a randomized clinical trial. J Orofac Pain 2002, 16: 64–70.PubMed
36.
go back to reference Bertoli E, de Leeuw R, Schmidt JE, Okeson JP, Carlson CR: Prevalence and impact of post-traumatic stress disorder symptoms in patients with masticatory muscle or temporomandibular joint pain: differences and similarities. J Orofac Pain 2007, 21: 107–119.PubMed Bertoli E, de Leeuw R, Schmidt JE, Okeson JP, Carlson CR: Prevalence and impact of post-traumatic stress disorder symptoms in patients with masticatory muscle or temporomandibular joint pain: differences and similarities. J Orofac Pain 2007, 21: 107–119.PubMed
37.
go back to reference Abrahamsen R, Zachariae R, Svensson P: Effect of hypnosis on oral function and psychological factors in temporomandibular disorders patients. J Oral Rehabil 2009, 36: 556–570. 10.1111/j.1365-2842.2009.01974.xCrossRefPubMed Abrahamsen R, Zachariae R, Svensson P: Effect of hypnosis on oral function and psychological factors in temporomandibular disorders patients. J Oral Rehabil 2009, 36: 556–570. 10.1111/j.1365-2842.2009.01974.xCrossRefPubMed
38.
go back to reference Fillingim RB, Ohrbach R, Greenspan JD, Knott C, Dubner R, Bair E, Baraian C, Slade GD, Maixner W: Potential psychosocial risk factors for chronic TMD: descriptive data and empirically identified domains from the OPPERA patient-control study. J Pain 2011, 12: T46-T60. 10.1016/j.jpain.2011.08.007PubMedCentralCrossRefPubMed Fillingim RB, Ohrbach R, Greenspan JD, Knott C, Dubner R, Bair E, Baraian C, Slade GD, Maixner W: Potential psychosocial risk factors for chronic TMD: descriptive data and empirically identified domains from the OPPERA patient-control study. J Pain 2011, 12: T46-T60. 10.1016/j.jpain.2011.08.007PubMedCentralCrossRefPubMed
39.
go back to reference Porto F, de Leeuw R, Evans DR, Carlson CR, Yepes JF, Branscum A, Okeson JP: Differences in psychosocial functioning and sleep quality between idiopathic continuous orofacial neuropathic pain patients and chronic masticatory muscle pain patients. J Orofac Pain 2011, 25: 117–124.PubMed Porto F, de Leeuw R, Evans DR, Carlson CR, Yepes JF, Branscum A, Okeson JP: Differences in psychosocial functioning and sleep quality between idiopathic continuous orofacial neuropathic pain patients and chronic masticatory muscle pain patients. J Orofac Pain 2011, 25: 117–124.PubMed
40.
go back to reference Okeson JP: Bell’s Orofacial Pains: The Clinical Management of Orofacial Pain. Chicago: Quintessence Pub. Co; 2005. Okeson JP: Bell’s Orofacial Pains: The Clinical Management of Orofacial Pain. Chicago: Quintessence Pub. Co; 2005.
41.
go back to reference Millsap RE: Statistical Approaches to Measurement Invariance. New York: Routledge; 2011. Millsap RE: Statistical Approaches to Measurement Invariance. New York: Routledge; 2011.
Metadata
Title
Exploration of dimensionality and psychometric properties of the Pittsburgh Sleep Quality Index in cases with temporomandibular disorders
Authors
Ksenija Rener-Sitar
Mike T John
Dipankar Bandyopadhyay
Michael J Howell
Eric L Schiffman
Publication date
01-12-2014
Publisher
BioMed Central
Published in
Health and Quality of Life Outcomes / Issue 1/2014
Electronic ISSN: 1477-7525
DOI
https://doi.org/10.1186/1477-7525-12-10

Other articles of this Issue 1/2014

Health and Quality of Life Outcomes 1/2014 Go to the issue