[논문]The Pittsburg Sleep Quality Index (PSQI) and Associated Factors in Middle-school Students: A Cross-sectional Study

Park, Bu Kyung

doi:10.4094/chnr.2020.26.1.55

The Pittsburg Sleep Quality Index (PSQI) and Associated Factors in Middle-school Students: A Cross-sectional Study 원문보기

CHNR : Child health nursing research, v.26 no.1, 2020년, pp.55 - 63

Park, Bu Kyung (College of Nursing, Kyungpook National University)

Abstract ▼ AI-Helper

Purpose: The purpose of this study was to evaluate the current level of sleep quality among Korean middle-school students using the Pittsburg Sleep Quality Index (PSQI), and to analyze the factors influencing sleep quality. Methods: The study used a descriptive cross-sectional design and a self-report questionnaire. The participants were 744 middle-school students. The questionnaire included the PSQI and health-related questions, such as the types of diseases they had been diagnosed with and the frequency of hospital admissions. The data were analyzed using the independent t-test, analysis of variance, Pearson correlation coefficients, and linear multiple regression. Results: The global PSQI score was 4.21, which indicated good sleep quality. The major factors that were associated with the sleep quality of middle-school students were the number of diseases they had been diagnosed with (β=.54, p=.001) and atopic dermatitis (β=.32, p=.001). In addition, asthma and the frequency of hospital admissions were significant factors influencing each component of the PSQI. Conclusion: The findings from this study suggest that sleep quality was associated with several health-related factors. Thus, nurses, school nurses, and nursing researchers may need to assess the health-related factors associated with adolescents' sleep quality as part of efforts to improve their sleep quality.

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문제 정의

If that was the case, the PSQI scores could have been biased towards better sleep quality. Nevertheless, despite these limitations, this study provides important fundamental information on sleep quality and associated health-related factors among middle-school students.
Apart from the previous study, limited research has been conducted on the association between sleep quality and number of diseases among adolescents. Therefore, to the best of our knowledge, this is the first study to identify an association between PSQI scores and the number of diseases that adolescents had been diagnosed with.
This study was conducted to explore the current level of sleep quality among middle-school students using the PSQI-K. This study also analyzed the factors that contributed to the students’ PSQI scores, and found that students’ global PSQI scores and individual PSQI component scores indicated satisfactory sleep levels, as a global PSQI score over 5 indicates poor sleep quality relative to clinical and laboratory measures [2].

제안 방법

Before conducting linear multiple regression, the researcher evaluated collinearity among the independent variables (e.g., grade, asthma, gastrointestinal disease, atopic dermatitis, the frequency of hospital admissions, and the number of diseases that participants had been diagnosed with). The ranges of tolerance and the variation inflation factor (VIF) were 0.
Participants’ characteristics, including sex, grade, frequency of hospital admissions, number of diseases that they had been diagnosed with, asthma, gastrointestinal diseases, scoliosis, atopic dermatitis, and allergies, were surveyed and included as independent variables.
An additional longitudinal study including other factors affecting sleep quality among adolescents is recommended to determine the directionality of relationships among the variables more clearly. Second, the researcher recruited samples from two middle schools in a single nation, and employed convenience sampling. Thus, the findings from this study might have limited generalizability.
The researcher used a descriptive, cross-sectional design to analyze data collected from January to March, 2017 as part of research on middle-school students’ health [19].
Therefore, this study evaluated the current level of sleep quality among Korean middle-school students using the PSQI, assessed the relationships of sleep quality with health-related factors (e.g., specific diagnosed diseases, number of diagnosed diseases, and the frequency of hospital admissions), and analyzed the key factors influencing sleep quality.
Thus, the findings from this study might have limited generalizability. Third, the questionnaire only asked about the frequency of admissions and the total number of diagnoses, but did not survey the reason for each admission or the entire list of diagnoses. The severity of a diagnosis and the reason for admission may affect quality of sleep.

대상 데이터

The researcher used a descriptive, cross-sectional design to analyze data collected from January to March, 2017 as part of research on middle-school students’ health [19]. Participants were recruited from two middle schools in Seoul metropolitan area using convenience sampling. Eligible participants were those who (1) currently attended middle school, (2) comprehended the purpose of the study and agreed to participate, and (3) received permission to participate from their parents.

데이터처리

The independent t-test, one-way analysis of variance, and the Bonferroni post-hoc test were used to analyze differences in global PSQI scores and each PSQI component score according to participants’ general characteristics and the types of diseases they had been diagnosed with. Correlations between the frequency of hospital admissions, the number of diseases participants had been diagnosed with, the global PSQI score, and each PSQI component score were all assessed using Pearson correlation coefficients. Linear multiple regression was conducted to identify factors influencing sleep quality among middle-school students.
The independent t-test, one-way analysis of variance, and the Bonferroni post-hoc test were used to analyze differences in global PSQI scores and each PSQI component score according to participants’ general characteristics and the types of diseases they had been diagnosed with.
Linear multiple regression was conducted to identify factors influencing sleep quality among middle-school students. The variables that showed a significant relationship with global PSQI score and/or each PSQI component scores through univariate analysis were included in the linear multiple regression analysis as independent variables. Thus, the independent variables included were grade, asthma, gastrointestinal diseases, atopic dermatitis, the frequency of hospital admissions, and the number of diseases participants had been diagnosed with.
Thus, multicollinearity was not found among the independent variables. To evaluate whether the assumption of independent errors was met, the Durbin-Watson statistic was calculated for the eight regression models, with values ranging from 1.99 to 2.04 (evaluation criterion: close to 2 or between 1 and 3).
To identify the major factors affecting sleep quality, linear multiple regression was conducted using the stepwise method with the global PSQI score and the seven PSQI component scores as dependent variables (Table 5). The results showed that the model predicting the global PSQI score was significant (F=39.

이론/모형

The sleep quality of middle-school students was measured using the PSQI [2], which was translated into Korean and evaluated for reliability and validity in its Korean form (PSQI-K) [22]. The PSQI-K consists of 19 questions distributed across the following seven components: sleep quality, sleep onset latency, sleep duration, sleep efficiency, sleep disturbances, use of sleeping medications, and daytime dysfunction.

성능/효과

A disease was considered to have been diagnosed if it (1) was a chronic condition, and (2) still affected a participant’s current health status in a way that required ongoing relevant treatment (e.g., taking any medication or having regular hospital visits due to the diagnosis) during the last 12 months.
In this study, 27.7% of the participants had atopic dermatitis, which was found to be a significant factor associated with sleep quality. The prevalence of atopic dermatitis among children and adolescents in Korea steadily increased from 1995 (7.
001) in a linear regression analysis [14]. Similarly, the results of this study also suggest that the global PSQI score and each component score (components 1, 2, 3, 4, 5, and 7) significantly increased as the number of diseases that participants had been diagnosed with increased. However, the participants of the previous study were middle-aged adults (mean age: 51.
Sleep quality among adolescents is important because it may affect their academic achievement and other daily functions. The findings from this study indicate that several health-related factors can affect the sleep quality of adolescents, such as the number of diseases diagnosed, the frequency of hospital admissions, atopic dermatitis, and asthma. The influence of some medical conditions on sleep quality have been well studied, but that of other conditions has not sufficiently been investigated.
The number of diseases that participants had been diagnosed with was positively correlated with the global PSQI score and each PSQI component score (r=.09~.34, p<.050), which means that participants with more diseases had worse sleep quality (Table 4).
The results showed that the model predicting the global PSQI score was significant (F=39.38, p<.001), with an adjusted R2 of .172, indicating that the model explained 17.2% of the variance in global PSQI scores.
This study also analyzed the factors that contributed to the students’ PSQI scores, and found that students’ global PSQI scores and individual PSQI component scores indicated satisfactory sleep levels, as a global PSQI score over 5 indicates poor sleep quality relative to clinical and laboratory measures [2].
Using the G*Power program for a post-hoc analysis using multiple linear regression, the sample size of this study reached a power (1-β) of 95% (calculated effect size of this study [f2]=.215, ⍺=.05) [20,21].

후속연구

Sleep hygiene and sleep quality may be associated with adolescents’ health conditions, as well as their academic achievement; therefore, further studies on these correlations among adolescents with diagnoses other than asthma are recommended.

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