ArticleResearch square2025
Psychometric properties of the two-item Pittsburgh Sleep Quality Index (PSQI-2) in a cohort of community-dwelling older men.
Article in Research square, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Background: The full Pittsburgh Sleep Quality Index (PSQI) is a widely used measure of sleep quality, but can be impractical in large studies due to its length. The abbreviated two-item version (PSQI-2) is a promising alternative, yet its longitudinal psychometric properties remain underexplored in community-based cohorts of older adults. Objective: To comprehensively evaluate the cross-sectional and longitudinal validity of the PSQI-2 against the full PSQI in a cohort of older men. Methods: This longitudinal analysis utilized data from 2,911 participants in the Osteoporotic Fractures in Men (MrOS) Sleep Study with complete sleep data at two visits. Cross-sectional validity was assessed using mixed-effects regression and Bland-Altman analysis. Diagnostic accuracy for poor sleep quality (PSQI > 5, >7, and > 10) was evaluated with Receiver Operating Characteristic (ROC) curves. Longitudinal properties included test-retest reliability (Intraclass Correlation Coefficient, ICC), correlation of change scores (Δ), and the accuracy of the PSQI-2 in detecting clinically meaningful change (ΔPSQI > 3) using the area under the curve (AUC). Results: The PSQI-2 showed a strong cross-sectional association with the full PSQI (β = 2.08, p < 0.001), explaining 72% of its variance. For identifying poor sleep quality, the PSQI-2 demonstrated excellent accuracy (AUC = 0.89) with an optimal cutoff of ≥ 2 (sensitivity = 77.5%, specificity = 84.5%). Longitudinally, both instruments showed moderate test-retest reliability (PSQI-2 ICC = 0.579; PSQI ICC = 0.639). The correlation between their change scores was strong (r = 0.682, p < 0.001), and the PSQI-2 showed reasonable accuracy (AUC = 0.716) in detecting clinically meaningful change (PSQI > 3). Conclusion: The PSQI-2 is a valid and reliable tool for cross-sectional screening of poor sleep quality in older men at the cutoff of ≥ 2. It is also responsive to directional change over time and can identify individuals with clinically significant changes in sleep.
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