Psychometric Properties of the Pittsburgh Sleep Quality Index in People Receiving Hemodialysis

Abstract

Rationale and Objective: Sleep is an important outcome for people with chronic kidney disease (CKD) undergoing hemodialysis. However, the applicability of commonly used instruments for assessing sleep quality in this population remains unclear. We evaluated the validity and reliability of the Pittsburgh Sleep Quality Index (PSQI) in a cohort of hemodialysis patients. Study Design: Observational cross-sectional study. Survey data were collected using QuestionPro online survey software or paper forms from a convenience sample of individuals receiving hemodialysis. Setting and Population: Adults aged 18 or older with CKD who were receiving hemodialysis in health facilities across three states in Australia during the study period from August 2024 to March 2025 were included. Exposures: Testing of 7 components of the PSQI. Outcome(s): Reliability and validity of PSQI. Analytical Approach: Exploratory factor analysis (EFA) and confirmatory factor analysis (CFA) to assess validity, and Cronbach's alpha (alpha) to assess internal consistency. Result(s): Of 107 participants, the mean age was 61 years, 72% males, and the majority received dialysis three times a week (84%). Reliability data indicated good internal consistency (alpha = 0.72). EFA revealed the multidimensionality of the PSQI: sleep disruptions, sleep medication, and sleep regulation, collectively accounting for 72% variance. CFA confirmed the two-factor model, with sleep disruption and sleep regulation as the best-fitting model. Limitation(s): Small sample size, lack of international representation, and test-retest reliability data. Conclusion(s): This study demonstrated the PSQI's strong psychometric properties and reliability as a screening tool for sleep disturbances in the hemodialysis population. While the overall scale is robust, the sleep medication component may be less applicable in this population. Additional research is needed to establish the appropriateness of the short version of PSQI excluding sleep medication questions. Future studies should also validate the test-retest reliability of the PSQI to determine its consistency over time. Copyright © 2026 Ginger Chu et al. International Journal of Nephrology published by John Wiley & Sons Ltd.