Validation of the Pittsburgh Sleep Quality Index and the Epworth Sleepiness Scale in older black and white women

Sherry A. Beaudreau, Adam P. Spira, Anita Stewart, Eric J. Kezirian, Li Yung Lui, Kristine Ensrud, Susan Redline, Sonia Ancoli-Israel, Katie L. Stone

Research output: Contribution to journalArticlepeer-review

184 Scopus citations


Objectives: Despite routine use with older adults, the Pittsburgh Sleep Quality Index (PSQI) and Epworth Sleepiness Scale (ESS) have not been adequately validated in older samples, particularly those from diverse racial backgrounds. The objective of this study was to determine the reliability and validity of and to provide normative data for these questionnaires in community-dwelling older women. Methods: Participants were 306 black and 2662 white women aged ≥70 from the Study of Osteoporotic Fractures. Participants completed the PSQI and ESS; provided self-reported assessments of mood, cognition and functioning; and underwent wrist actigraphy for sleep-wake estimation. Results: Good internal consistency in both black and white women was demonstrated for the PSQI and ESS. Two PSQI subscales, however, were found to have inadequate reliability (Medications and Daytime Dysfunction). Both the PSQI and ESS were associated with theoretically similar measures in the expected directions. The PSQI also differentiated participants with no reported sleep disorder from those reporting at least one sleep disturbance, such as insomnia, sleep apnea and restless legs. The ESS only differentiated women reporting no sleep disorder from those reporting insomnia. Conclusion: In general, findings suggest that the PSQI and ESS are internally consistent, valid measures of self-reported sleep problems in older women. Additional research is required to evaluate the impact of removing the Medications and Daytime Dysfunction PSQI subscales on this measure's internal consistency in older women.

Original languageEnglish (US)
Pages (from-to)36-42
Number of pages7
JournalSleep Medicine
Issue number1
StatePublished - Jan 2012

Bibliographical note

Funding Information:
This was not an industry-supported study. Portions of this work were performed at each author’s institution. Financial conflicts of interest: Adam Spira received honoraria in his role as a clinical editor for the International Journal of Sleep and Wakefulness—Primary Care, which receives industry support for continuing education content. Eric Kezirian is a Consultant for AthroCare, Medtronic, Pavad Medical and Medical Advisory Board and a Consultant for Apnex Medical. Sonia Ancoli-Israel serves as a Consultant for Ferring Pharmaceuticals Inc., GlaxoSmithKline, Merck, NeuroVigil, Inc., Neurocrine Biosciences, Pfizer, Philips Respironics,Sanofi-Aventis, Sepracor Inc., and Schering-Plough, and receives grant support from Litebook Inc.

Funding Information:
Dr. Spira is supported by a Mentored Research Scientist Development Award (K01AG033195) from the National Institute on Aging. Dr. Kezirian is currently supported by a career development award from the National Center for Research Resources (NCRR) of the National Institutes of Health and a Triological Society Research Career Development Award of the American Laryngological, Rhinological and Otological Society. The content of this article is solely the responsibility of the authors and does not necessarily represent the official views of the National Institute on Aging, the National Center for Research Resources or the National Institutes of Health. The project was supported by NIH/NCRR/OD UCSF-CTSI Grant No. KL2 RR024130 and National Institutes of Health Grant Nos. AG021918 , AG026720 , AG05394 , AG05407 , AG08415 , AR35582 , AR35583 , AR35584 , R01 AG005407 , R01 AG027576-22 , 2 R01 AG00539422A1 , 2 R01 AG027574-22A1 , HL40489 , T32 AG000212-14 .


  • Actigraphy
  • Aged
  • Geriatric assessment
  • Oldest old
  • Sleep
  • Women


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