Comparison of three measures for insomnia in ischemic stroke patients: Pittsburgh sleep quality index, insomnia severity index, and Athens insomnia scale

Shuzhen Niu; Qian Wu; Silian Ding; Lingchun Wu; Li Wang; Yan Shi

doi:10.3389/fneur.2023.1118322

Comparison of three measures for insomnia in ischemic stroke patients: Pittsburgh sleep quality index, insomnia severity index, and Athens insomnia scale

Front Neurol. 2023 Aug 30:14:1118322. doi: 10.3389/fneur.2023.1118322. eCollection 2023.

Authors

Shuzhen Niu¹, Qian Wu¹, Silian Ding², Lingchun Wu³, Li Wang¹, Yan Shi¹

Affiliations

¹ Shanghai Tenth People's Hospital, School of Medicine, Tongji University, Shanghai, China.
² Shanghai Fourth People's Hospital, Shanghai, China.
³ Department of Nephrology, Shanghai Zhabei Central Hospital, Shanghai, China.

Abstract

Objective: This study investigated the consistency and determined the optimal threshold values of three scales in the diagnosis of insomnia of ischemic stroke (IS) patients.

Methods: Participants in this study consisted of 569 acute IS patients. All 569 patients completed the assessment of the three insomnia scales. Insomnia of IS patients were assessed by Pittsburgh sleep quality index (PSQI), Insomnia Severity Index (ISI), and Athens insomnia scale (AIS). Also, basic patient information, neurological function, and activities of daily living were assessed. General information was compared between the insomnia group and the no-insomnia group. Cronbach's α coefficients, Cohen's Kappa consistency, Receiver operating characteristic (ROC) curve and DeLong's test analysis were used to analyze the reliability and diagnostic validity of PSQI, ISI, and AIS.

Results: The PSQI and ISI showed high reliability with Cronbach's α of 0.875 and 0.858, respectively, while the AIS had an α coefficient of 0.734, demonstrating acceptable reliability. The PSQI, ISI, and AIS showed outstanding diagnostic ability with an AUC of 0.960 (95% CI: 0.946, 0.974), 0.911 (95% CI: 0.882, 0.941), and 0.876 (95% CI:0.837, 0.916). The best diagnostic cutoffs for PSQI, ISI, and AIS are ≥9, ≥15, and ≥8.

Conclusion: Each of the three questionnaires has advantages and disadvantages when assessing insomnia. In the evaluation of insomnia in IS patients, the best questionnaire selection should be made according to the purpose of clinical evaluation and considering the sensitivity and specificity.

Keywords: Athens insomnia scale (AIS); Pittsburgh sleep quality index (PSQI); diagnosis; insomnia; insomnia severity index (ISI); ischemic stroke.