Cited by 875Sleep and related disordersObstructive Sleep Apnea ResearchSleep and Work-Related Fatigue

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Quantification of Subjective Sleep Quality in Healthy Elderly Men and Women Using the Pittsburgh Sleep Quality Index (PSQI)

Daniel J. Buysse, Charles F. Reynolds, Timothy H. Monk, Carolyn C. Hoch, Amy L. Yeager, David J. Kupfer·1991·Sleep

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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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Crossref · 10.1093/sleep/14.4.331

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Self-citation
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iSleep
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Method
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Background
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Background
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BackgroundInfluential
The association between inadequate sleep and accelerated brain ageing
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“The patient answers questions about sleep over the past 3 months, such as: How long (in minutes) has it taken you to fall asleep each night? Scores on the Pittsburgh Sleep Quality Index can range from 1 to 21, with any score more than 5 indicating abnormal sleep.(56,57)”
Background
An evaluation of sleep quality and the prevalence of restless leg syndrome in vitamin D deficiency
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BackgroundMethod
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Background
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Effect of Music Therapy on Sleep Quality.
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Subjective sleep quality is poorly associated with actigraphy and heart rate measures in community-dwelling older men
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Mental status of patients with chronic insomnia in China during COVID-19 epidemic
Yang, L., Yu, Z., Xu, Y., Liu, W., Liu, L., & Mao, H. (2020) · International Journal of Social Psychiatry · doi:10.1177/0020764020937716 · Cited by 26
Footbath as a safe, simple, and non‐pharmacological method to improve sleep quality of menopausal women
Aghamohammadi, V., Salmani, R., Ivanbagha, R., Effati-Daryani, F., & Nasiri, K. (2020) · Research in Nursing & Health · doi:10.1002/nur.22082 · Cited by 28
Moderators of inflammation-related depression: a prospective study of breast cancer survivors
Manigault, A. W., Ganz, P. A., Irwin, M. R., Cole, S. W., Kuhlman, K. R., & Bower, J. E. (2021) · Translational Psychiatry · doi:10.1038/s41398-021-01744-6 · Cited by 29
“Of interest, high (+1 SD) levels of state anxiety, perceived stress and sleep disturbance correspond to probable clinical anxiety levels (>40) [64], moderate stress (14−26) [52], and clinically-relevant sleep disturbance (>5) [54].”
BackgroundMethodInfluential
Prevalence and Correlates of Sleep Problems in Adult Israeli Jews Exposed to Actual or Threatened Terrorist or Rocket Attacks
Palmieri, P. A., Chipman, K. J., Canetti, D., Johnson, R. J., & Hobfoll, S. E. (2010) · Journal of Clinical Sleep Medicine · doi:10.5664/jcsm.27989 · Cited by 28
Positive Affect Is Associated With Fewer Sleep Problems in Older Caregivers but not Noncaregivers
Fredman, L., Gordon, S. A., Heeren, T., & Stuver, S. O. (2013) · The Gerontologist · doi:10.1093/geront/gnt040 · Cited by 30
“19 in our sample reflects moderate sleep problems and is consistent with previous studies of older adults (Brummett et al., 2006; Buysse et al., 1991; Fonareva et al., 2011; Martin et al., 2011).”
Result
Sleep quality in patients with primary Sjögren's syndrome.
Priori, R., Minniti, A., Antonazzo, B., Fusconi, M., Valesini, G., & Curcio, G. (2016) · PubMed · Cited by 31
The effect of aircraft noise on sleep disturbance among the residents near a civilian airport: a cross-sectional study
Kwak, K., Ju, Y., Kwon, Y., Chung, Y. K., Kim, B. K., Kim, H., & Youn, K. (2016) · Annals of Occupational and Environmental Medicine · doi:10.1186/s40557-016-0123-2 · Cited by 28
“The sleep quality of the residents adjacent to the airport was evaluated by using the Pittsburgh Sleep Quality Index (PSQI) [32].”
Method
Breast Cancer Collaborative Registry informs understanding of factors predicting sleep quality
Berger, A. M., Kupzyk, K. A., Sass, D., & Cowan, K. H. (2018) · Supportive Care in Cancer · doi:10.1007/s00520-018-4417-5 · Cited by 28
Sleep habits, prevalence and burden of sleep disturbances among Japanese graduate students
Pallos, H., Yamada, N., Doi, Y., & Okawa, M. (2004) · Sleep and Biological Rhythms · doi:10.1111/j.1479-8425.2003.00061.x · Cited by 27
Does lunar cycle affect biological parameters in young healthy men?
Dergaa, I., Romdhani, M., Fessi, M. S., Ben Saad, H., Varma, A., Ben Salem, A., Gadhavi, B., Chaabane, M., Souissi, N., & Hammouda, O. (2021) · Chronobiology International · doi:10.1080/07420528.2021.1897609 · Cited by 27
“All participants did not show any sleep disturbance according to the Pittsburg Sleep Quality Index (PSQI) (Buysse et al. 1991).”
Method
Evaluation of restless legs syndrome and sleep disorders in patients with psoriatic arthritis
Sandıkçı, S. C., Çolak, S., Baykara, R. A., et al. (2018) · Zeitschrift für Rheumatologie · doi:10.1007/s00393-018-0562-y · Cited by 27
Impact of Diabetes on the Symptoms of Breast Cancer Survivors
Storey, S. (2019) · Oncology nursing forum · doi:10.1188/19.onf.473-484 · Cited by 27
“The Functional Assessment of Cancer Therapy– Fatigue (FACT-F) is a 13-item scale that measures participants’ self-reported energy for daily activities in the past four weeks (Cella et al., 1993).”
Background
Impaired sleep quality is associated with concurrent elevations in inflammatory markers: are post-menopausal women at greater risk?
D’Antono, B., & Bouchard, V. (2019) · Biology of Sex Differences · doi:10.1186/s13293-019-0250-x · Cited by 28
Epidemiological characteristics of subsyndromal depression in late life
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“In the elderly, regular alcohol consumption may reflect a healthy physical condition (Holdsworth et al., 2016) and may reduce the feeling of loneliness (Canham et al., 2016).”
Background
Long-term improvements in sleep, pain, depression, and fatigue in older adults with comorbid osteoarthritis pain and insomnia
Vitiello, M. V., Zhu, W., Korff, M. V., Wellman, R., Morin, C. M., Yeung, K., & McCurry, S. M. (2021) · SLEEP · doi:10.1093/sleep/zsab231 · Cited by 27
“Sleep Quality – Sleep quality was measured using the total score on the 19item Pittsburgh Sleep Quality Index (PSQI) (possible range 0–21; higher is worse).(15)”
Method
Sleep Perception in Non-Insomniac Healthy Elderly: A 3-Year Longitudinal Study
Martin, M., Sforza, E., Barthélémy, J., Thomas-Antérion, C., & Roche, F. (2014) · Rejuvenation Research · doi:10.1089/rej.2013.1457 · Cited by 24
“In addition, Buysse and colleagues 47 found that 68% of healthy older adults rated their subjective sleep as ‘‘good.’’”
Troubles psychiques des personnes âgées
Rigaud, A., Bayle, C., Latour, F., Lenoir, H., Seux, M., Hanon, O., Péquignot, R., Bert, P., Bouchacourt, P., Moulin, F., et al. (2005) · Encyclopédie médico-chirurgicale. Psychiatrie · doi:10.1016/j.emcps.2005.07.003 · Cited by 29
Differential effects of sleep on explicit and implicit memory for potential trauma reminders: findings from an analogue study
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“All interested students were asked to complete a screening questionnaire comprising measures of sleep quality (PSQI; Buysse et al., 1991),”
BackgroundMethod
Sleep continuity, stability and organization in good and bad sleepers
Conte, F., Cerasuolo, M., Fusco, G., Giganti, F., Inserra, I., Malloggi, S., Di Iorio, I., & Ficca, G. (2021) · Journal of Health Psychology · doi:10.1177/1359105320903098 · Cited by 26
“Despite its importance for general health and wellbeing (e.g. Cappuccio et al., 2011; Pilcher et al., 1997), the construct of sleep quality remains elusive and lacking a clear definition.”
Background
Discrepancy of subjective and objective sleep problems in Alzheimer’s disease and mild cognitive impairment detected by a home-based sleep analysis
Tadokoro, K., Ohta, Y., Hishikawa, N., Nomura, E., Wakutani, Y., Takao, Y., Omote, Y., Takemoto, M., Yamashita, T., & Abe, K. (2020) · Journal of Clinical Neuroscience · doi:10.1016/j.jocn.2020.01.085 · Cited by 25
Effects of Maintained Weight Loss on Sleep Dynamics and Neck Morphology in Severely Obese Adults
Hernandez, T. L., Ballard, R. D., Weil, K. M., Shepard, T. Y., Scherzinger, A. L., Stamm, E. R., Sharp, T. A., & Eckel, R. H. (2008) · Obesity · doi:10.1038/oby.2008.485 · Cited by 26
Duloxetine in Military Posttraumatic Stress Disorder
Villarreal, G., Cañive, J. M., Calais, L. A., Toney, G., & Smith, A. K. (2025) · Psychopharmacology Bulletin · doi:10.64719/pb.4300 · Cited by 26
Activity/rest cycle and disturbances of structural backbone of cerebral networks in aging
Baillet, M., Dilharreguy, B., Pérès, K., Dartigues, J., Mayo, W., & Catheline, G. (2016) · NeuroImage · doi:10.1016/j.neuroimage.2016.09.051 · Cited by 26
“Subjects included in our study were free of diagnosed sleep disorders and sleep medication explaining their relative preservation of activity/rest cycle (Dawson et al., 2008; Sadeh et al., 1995).”
Life is short, stay awake: Death anxiety and bedtime procrastination
Türkarslan, K., Okay, D., Çevrim, M., & Bozo, Ö. (2020) · The Journal of general psychology · doi:10.1080/00221309.2019.1633994 · Cited by 23
Sex, diabetes status and cognition: findings from the study of longevity in diabetes
Moran, C., Gilsanz, P., Beeri, M. S., Whitmer, R. A., & LACY, M. E. (2021) · BMJ Open Diabetes Research & Care · doi:10.1136/bmjdrc-2020-001646 · Cited by 25
Actigraphic assessment of sleep in chronic obstructive pulmonary disease
Nunes, D. M., de Bruin, V. M. S., Louzada, F. M., Peixoto, C. A. T., Cavalcante, A. G. M., de Castro‐Silva, C., & de Bruin, P. F. C. (2012) · Sleep And Breathing · doi:10.1007/s11325-012-0660-z · Cited by 25
“The same observation may apply to mean PSQI score in our control group, which is similar to the mean score for healthy 80-year-olds in a previous large cohort [55].”
Result

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
ORCID: Daniel J. Buysse
Charles F. Reynolds
Amy L. Yeager
David J. Kupfer
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
DOI: 10.1093/sleep/14.4.331
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 (medical) › 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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Quantification of Subjective Sleep Quality in Healthy Elderly Men and Women Using the Pittsburgh Sleep Quality Index (PSQI)

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