The Role of Sleep Effort as a Mediator Between Anxiety and Depression.

Depression, anxiety, and insomnia are all conditions that share a complex bidirectional relationship. Sleep effort is a construct with cognitive and behavioral components that perpetuates insomnia. Although many studies have examined the associations between these three variables, no studies have yet examined sleep effort as a mediating variable between anxiety and depression and vice versa. Online versions of the Hospital Anxiety and Depression Scale and the Glasgow Sleep Effort Scale were administered to a sample of 1927 higher education students aged 18-40 years (75.9% women and 76% from 18 to 23 years old). As part of the survey, participants also completed a sociodemographic questionnaire. Mediation analysis indicated that sleep effort mediates the relationship between depression and anxiety, when the former was the predictor and the latter was the criterion. Moreover, sleep effort also mediated the relationship between anxiety and depression when the former was the predictor and the latter was the criterion, albeit in a lesser extent. Sleep effort appears to play a bidirectional mediational role between depression and anxiety, being a potential target for intervention.

The European Portuguese version of the insomnia severity index.

Insomnia is the most prevalent sleep complaint, but remains largely an unidentified public health issue. The Insomnia Severity Index (ISI) is a brief self-report questionnaire to assess insomnia, long-established both in clinical and research settings. The present study aimed to analyse the reliability, validity, and accuracy of the ISI European Portuguese version. After the translation protocol, 1,274 participants (65.54% female), with a mean (SD, range) age of 37.52 (16.82, 18-95) years, completed the ISI. This sample included 250 patients with insomnia from a Sleep Medicine Centre, presenting a diagnosis of insomnia disorder (Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition; International Classification of Sleep Disorders, Third Edition), and 1,024 individuals from the community. A group of 30 patients with obstructive sleep apnea (OSA) was also recruited. Cronbach's α was 0.88 (internal consistency), and corrected item-total correlations ranged from 0.56 to 0.83. An exploratory factor analysis (oblique rotation) revealed a two-factor solution for both clinical and community samples. The ISI total score significantly differentiated insomnia disorder, no insomnia, and OSA subgroups with a large effect size (η 2  = 0.42). The correlation between ISI and Pittsburgh Sleep Quality Index supported concurrent validity (0.82), and discriminant validity was confirmed by a moderate correlation between ISI and Beck Depression Inventory Second Edition (0.32). The area under the curve was 0.88, and the optimal cut-off to detect clinical insomnia was 14 (82.1% sensitivity, 79.5% specificity). In conclusion, the Portuguese version of the ISI is a reliable and valid measure of insomnia in clinical and non-clinical populations. Our present study also contributes to relevant data for the international literature regarding the cut-off score of the scale for the detection of clinical insomnia.

BaSIQS - basic scale on insomnia complaints and quality of sleep: reliability, norms, validity, and accuracy studies, based on clinical and community samples.

This research focused on the Basic Scale on Insomnia Symptoms and Quality of Sleep (BaSIQS), formerly validated in undergraduates using the Pittsburgh Sleep Quality Index (PSQI), and aimed to expand internal consistency analysis, examine thoroughly its validity, and determine its clinical accuracy. Considering objective and subjective measures, recruiting non-clinical and clinical samples, this research implemented a comprehensive approach to examine convergent and discriminant validity, confirmatory factor analyses, and the BaSIQS sensitivity and specificity. The BaSIQS was filled out along with the Insomnia Severity Index (ISI), questions on sleep-wake schedules, Composite Scale of Morningness (CSM) and Brief Symptom Inventory-18 (BSI-18) by 1198 adults, 18-64 years old, plus another 30 who wore actimeters, recruited in community settings. A clinical group of 30 chronic insomnia disorder patients also participated. Cronbach alpha coefficient was 0.80. A two-factor structure was confirmed. The association between BaSIQS and ISI was large, whereas actigraphy correlations were medium or small. Medium to non-significant correlations were found concerning conceptually different self-report measures. Comparing the clinic and control groups, the former showed poorer sleep, with a large effect size. Receiver operating characteristic analysis revealed an area under curve = 0.9, and an optimal cut-off score >15. In conclusion, results on reliability, validity, and accuracy provide support to the utility of the BaSIQS both in community and clinical settings, for research and practical purposes.

Pre-Sleep Arousal Scale (PSAS): psychometric study of a European Portuguese version.

OBJECTIVE/BACKGROUND: Pre-sleep arousal constitutes one of the major features of insomnia. As such, it is imperative to have adequate instruments to measure this construct in both clinical and research settings. The Pre-Sleep Arousal Scale (PSAS) is the most well-known measure to evaluate pre-sleep arousal. The current study aimed to examine some of the psychometric properties of a European Portuguese version of the scale. PARTICIPANTS/METHODS: For this purpose, data from 691 undergraduate students from a medical school were analyzed. Internal consistency indices and factor analysis were performed. In addition, the association between the PSAS and its subscales with other measures was also examined. Finally, PSAS scores of self-reported insomniacs were compared with those of self-reported non-insomniacs. RESULTS: The results indicated that the PSAS comprises a cognitive scale and a somatic scale, both with adequate internal consistency indices (α = 0.82 and 0.79, respectively). However, a three-factor solution also seemed plausible, suggesting that the original somatic arousal subscale might be divided into two subscales. Significant associations between the PSAS total score and its subscales were found with other concurrent measures such as sleep reactivity to stress, arousability and neuroticism. Self-defined insomniacs presented higher levels of cognitive and somatic arousal than healthy individuals. CONCLUSIONS: Further investigations of the PSAS are needed to refine its psychometric properties and explore its research and clinical utility in other populations.

Portuguese Version of the Arousal Predisposition Scale: Preliminary Evidence for a Two-Factor Structure in a Nonclinical Sample.

It is known that there is significant variability in arousal levels of the individuals. The Arousal Predisposition Scale (APS) is a questionnaire intended to measure individual differences in arousability. In the current work, our aim was to present the initial psychometric properties of the Portuguese version of the APS. Three hundred forty-five undergraduate medical students from both genders were enrolled. All participants filled out a set of questionnaires-which contained the APS-at the end of their lectures and out of the evaluation period. The APS showed good internal consistency (α = .85) and discriminated individuals with extreme scores. Further, in general, the scale discriminated as well both genders pertaining to the individual items and total score. In terms of scale structure, two related factors were extracted (F1 = emotional reactivity and F2 = trait anxiety). Significant associations among APS and other sleep and psychological self-report variables were also observed. The APS seems to be a reliable and valid instrument to assess self-reported physiological arousability, at least in a sample of young adults. The two-factor composition will require more studies to be replicated in similar groups and, particularly, in clinical samples.

Basic Scale on Insomnia complaints and Quality of Sleep (BaSIQS): reliability, initial validity and normative scores in higher education students.

Based on successive samples totaling more than 5000 higher education students, we scrutinized the reliability, structure, initial validity and normative scores of a brief self-report seven-item scale to screen for the continuum of nighttime insomnia complaints/perceived sleep quality, used by our team for more than a decade, henceforth labeled the Basic Scale on Insomnia complaints and Quality of Sleep (BaSIQS). In study/sample 1 (n = 1654), the items were developed based on part of a larger survey on higher education sleep-wake patterns. The test-retest study was conducted in an independent small group (n = 33) with a 2-8 week gap. In study/sample 2 (n = 360), focused mainly on validity, the BaSIQS was completed together with the Pittsburgh Sleep Quality Index (PSQI). In study 3, a large recent sample of students from universities all over the country (n = 2995) answered the BaSIQS items, based on which normative scores were determined, and an additional question on perceived sleep problems in order to further analyze the scale's validity. Regarding reliability, Cronbach alpha coefficients were systematically higher than 0.7, and the test-retest correlation coefficient was greater than 0.8. Structure analyses revealed consistently satisfactory two-factor and single-factor solutions. Concerning validity analyses, BaSIQS scores were significantly correlated with PSQI component scores and overall score (r = 0.652 corresponding to a large association); mean scores were significantly higher in those students classifying themselves as having sleep problems (p < 0.0001, d = 0.99 corresponding to a large effect size). In conclusion, the BaSIQS is very easy to administer, and appears to be a reliable and valid scale in higher education students. It might be a convenient short tool in research and applied settings to rapidly assess sleep quality or screen for insomnia complaints, and it may be easily used in other populations with minor adaptations.