Quantification of subjective sleep quality in healthy elderly men and women using the Pittsburgh sleep quality index (PSQI)
Abstract
Subjective sleep quality deteriorates with aging, but the extent to which this is a product of age itself, as opposed to the medical or psychiatric problems associated with aging, has not been carefully studied. To investigate this issue, we examined the subjective sleep quality of 44 healthy subjects over 80 years of age (20 men, 24 women), and 35 healthy subjects [corrected] between the ages of 20 and 30 (23 men, 12 women) using the Pittsburgh Sleep Quality Index (PSQI). All subjects underwent rigorous medical and psychiatric evaluations to verify that they were in excellent physical and psychological health. Significant age effects were noted for the global PSQI score and several PSQI component scores, but overall sleep quality for the majority (68.1%) of 80-yr-olds fell within a categorically defined range for "good" sleepers. Measures of habitual sleep quality did not correlate strongly with most polysomnographic sleep measures, number of medications used or circadian measures in elderly subjects. These results show that subjective sleep quality does deteriorate in the healthy elderly, but not to the level seen in patients with sleep disorders. Extremely healthy elderly subjects appear to adapt in their perception of objectively disturbed sleep.
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The PSQI has good reliability and validity in its English, Spanish, and Brazilian Portuguese versions.
“PSQI has good reliability and validity in its versions in English (Buysse et al., 1991), Spanish (Jiménez-Genchi et al., 2008), Brazilian Portuguese (Bertolazi et al., 2011) and following Zwart et al. (2018), the Dutch version provided by eProvide® will be used.”
From Internet-based self-administered intervention to reduce anxiety and depression symptomatology and improve well-being in 7 countries: protocol of a randomized control trial (2024) · cites this paper as Buysse et al., 1991
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Does tumor necrosis factor-alpha (TNF-α) play a role in post-chemotherapy cerebral dysfunction?
Ganz, P. A., Bower, J. E., Kwan, L. C., Castellon, S. A., Silverman, D. H. S., Geist, C. L., Breen, E. C., Irwin, M. R., & Cole, S. W. (2012) · Brain Behavior and Immunity · doi:10.1016/j.bbi.2012.07.015 · Cited by 156 · see citing works
“Subjective sleep quality was assessed with the Pittsburgh Sleep Quality Index (PSQI), a 19-item questionnaire with high internal consistency, test–retest reliability, and diagnostic validity with insomnia diagnosis (Buysse et al., 1991).”
MethodSleep quality in hospitalized patients
Doğan, O., Ertekin, S., & Doğan, S. (2005) · Journal of Clinical Nursing · doi:10.1111/j.1365-2702.2004.01011.x · Cited by 154 · see citing works
Association between Sleep Behavior and Sleep‐Related Factors among University Students in Hong Kong
Suen, L. K. P., Hon, K. E., & Tam, W. (2008) · Chronobiology International · doi:10.1080/07420520802397186 · Cited by 147 · see citing works
“Numerous studies using the PSQI support its high validity and reliability (Buysse et al., 1989, 1991; Morgan et al., 1988).”
MethodHamner, M. B., Deitsch, S. E., Brodrick, P. S., Ulmer, H. G., & Lorberbaum, J. P. (2003) · Journal of Clinical Psychopharmacology · doi:10.1097/00004714-200302000-00003 · Cited by 147 · see citing works
McCrae, C. S., Rowe, M., Tierney, C. G., Dautovich, N. D., DeFinis, A. L., & McNamara, J. P. H. (2005) · The Journals of Gerontology Series B · doi:10.1093/geronb/60.4.p182 · Cited by 145 · see citing works
Association Between Depressive Symptoms and Sleep Disturbances in Community‐Dwelling Older Men
Paudel, M. L., Taylor, B. C., Diem, S. J., Stone, K. L., Ancoli‐Israel, S., Redline, S. S., Ensrud, K. E., & for the Osteoporotic Fractures in Men Study Group (2008) · Journal of the American Geriatrics Society · doi:10.1111/j.1532-5415.2008.01753.x · Cited by 145 · see citing works
Sleep disturbances among Chinese clinical nurses in general hospitals and its influencing factors
Dong, H., Zhang, Q., Sun, Z., Sang, F., & Xu, Y. (2017) · BMC Psychiatry · doi:10.1186/s12888-017-1402-3 · Cited by 145 · see citing works
Self‐Reported Sleep and Nap Habits and Risk of Mortality in a Large Cohort of Older Women
Stone, K. L., Ewing, S. K., Ancoli‐Israel, S., Ensrud, K. E., Redline, S. S., Bauer, D. C., Cauley, J. A., Hillier, T. A., & Cummings, S. R. (2009) · Journal of the American Geriatrics Society · doi:10.1111/j.1532-5415.2008.02171.x · Cited by 142 · see citing works
Fatigue after breast cancer treatment: Biobehavioral predictors of fatigue trajectories.
Bower, J. E., Wiley, J. F., Petersen, L., Irwin, M. R., Cole, S. W., & Ganz, P. A. (2018) · Health Psychology · doi:10.1037/hea0000652 · Cited by 137 · see citing works
Shochat, T., Tzischinsky, O., Oksenberg, A., & Peled, R. (2007) · PubMed · Cited by 136 · see citing works
Socioeconomic Status Predicts Objective and Subjective Sleep Quality in Aging Women
Friedman, E., Love, G., Rosenkranz, M. A., Urry, H., Davidson, R., Singer, B., & Ryff, C. (2007) · Psychosomatic Medicine · doi:10.1097/psy.0b013e31814ceada · Cited by 145 · see citing works
“The PSQI has well-established reliability and validity for the assessment of sleep in younger and older adults (11,33,34) and is widely used in clinical research.”
MethodThe Relationship Between Lifestyle Regularity and Subjective Sleep Quality
Monk, T. H., Reynolds, C. F., Buysse, D. J., DeGrazia, J. M., & Kupfer, D. J. (2003) · Chronobiology International · doi:10.1081/cbi-120017812 · Cited by 132 · see citing works
“Subsequent studies in our institution have used the PSQI in studies of maintenance treatment response in late-life depression (Reynolds et al., 1997a,b), sleep disorders consequent upon bereavement (Pasternak et al., 1992), and the effects of aging (Buysse et al., 1991).”
MethodSelf-citationDepressive Symptoms and Subjective and Objective Sleep in Community‐Dwelling Older Women
Maglione, J. E., Ancoli‐Israel, S., Peters, K. W., Paudel, M. L., Yaffe, K. S., Ensrud, K. E., & Stone, K. L. (2012) · Journal of the American Geriatrics Society · doi:10.1111/j.1532-5415.2012.03908.x · Cited by 132 · see citing works
Kay, D. B., Buysse, D. J., Germain, A., Hall, M. H., & Monk, T. H. (2014) · Journal of Sleep Research · doi:10.1111/jsr.12220 · Cited by 130 · see citing works
Self-citationMcArdle, N., Kingshott, R., Engleman, H. M., Mackay, T. W., & Douglas, N. J. (2001) · Thorax · doi:10.1136/thorax.56.7.513 · Cited by 147 · see citing works
Testing the Reliability and Validity of DSM-IV-TR and ICSD-2 Insomnia Diagnoses
Edinger, J. D. (2011) · Archives of General Psychiatry · doi:10.1001/archgenpsychiatry.2011.64 · Cited by 130 · see citing works
Sleep compression and sleep education for older insomniacs: self-help versus therapist guidance.
Riedel, B. W., Lichstein, K., & Dwyer, W. (1995) · Psychology and Aging · doi:10.1037//0882-7974.10.1.54 · Cited by 146 · see citing works
Self-report measures of insomnia in adults: rationales, choices, and needs
Moul, D. E., Hall, M. H., Pilkonis, P. A., & Buysse, D. J. (2004) · Sleep Medicine Reviews · doi:10.1016/s1087-0792(03)00060-1 · Cited by 127 · see citing works
Self-citationGothe, N. P., Ehlers, D. K., Salerno, E. A., Fanning, J., Kramer, A. F., & McAuley, E. (2020) · Behavioral Sleep Medicine · doi:10.1080/15402002.2019.1690493 · Cited by 125 · see citing works
“A PSQI global score >5 is considered to be an indicator of sleep disturbance (Buysse et al., 1991).”
BackgroundSleep Habits and Insomnia in a Sample of Elderly Persons in China
Liu, X., & Liu, L. (2005) · SLEEP · doi:10.1093/sleep/28.12.1579 · Cited by 128 · see citing works
The Effect of Exercise on Sleep and Fatigue in Rheumatoid Arthritis: A Randomized Controlled Study
Durcan, L., Wilson, F., & Cunnane, G. (2014) · The Journal of Rheumatology · doi:10.3899/jrheum.131282 · Cited by 121 · see citing works
- Authors
- Buysse, D. J., Reynolds, C. F., Monk, T. H., Hoch, C. C., Yeager, A. L., & Kupfer, D. J.
- Affiliations
- University of Pittsburgh (US)
- Corresponding author
- Daniel J. Buysse
- Venue
- Sleep
- Publisher
- Oxford University Press (OUP)
- Published
- 1991-07-01
- Volume
- 14
- Issue
- 4
- Pages
- 331-8
- ISSN
- 0161-8105 (ISSN-L)
- 1550-9109
- OpenAlex
- W1704280769
- Cited by
- 874
- References
- 0
- Citations by year
- 2026: 7 · 2025: 34 · 2024: 61 · 2023: 53 · 2022: 62 · 2021: 61 · 2020: 63 · 2019: 36 · 2018: 50 · 2017: 32 · 2016: 27 · 2015: 31 · 2014: 42 · 2013: 32 · 2012: 33
- FWCI
- 4.23
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- SLEEP (publishedVersion)
- PubMed (publishedVersion)
- Funders
- National Institutes of Health (5p01ag006836-04)
- National Institute on Aging (AG 06836)
- National Institute of Mental Health (MH-00295, MH-37869, R01MH037869)
- Topics
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Sleep and related disorders
- Health Sciences › Medicine › Physiology › Obstructive Sleep Apnea Research
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Sleep and Work-Related Fatigue
- Keywords
- subjective sleep quality, aging, older adults, Pittsburgh Sleep Quality Index, healthy older adults, sleep perception, sleep disorders, circadian rhythm, medication use, sex differences
- MeSH terms
- Aged, Aged, 80 and over, Aging, Arousal, Attitude to Health, Circadian Rhythm, Female, Humans, Male, Personality Inventory, Psychometrics, Sleep Stages, Sleep, REM
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