Good sleep is necessary for good physical and mental health and a good quality of life. Insufficient sleep is a pervasive and prominent problem in the modern 24-h society. A considerable body of evidence suggests that insufficient sleep causes hosts of adverse medical and mental dysfunctions. An extensive literature search was done in all the major databases for “insufficient sleep” and “public health implications” in this review. Globally, insufficient sleep is prevalent across various age groups, considered to be a public health epidemic that is often unrecognized, under-reported, and that has rather high economic costs. This paper addresses a brief overview on insufficient sleep, causes, and consequences, and how it adds to the existing burden of diseases. Insufficient sleep leads to the derailment of body systems, leading to increased incidences of cardiovascular morbidity, increased chances of diabetes mellitus, obesity, derailment of cognitive functions, vehicular accidents, and increased accidents at workplaces. The increased usage of smart phones and electronic devices is worsening the epidemic. Adolescents with insufficient sleep are likely to be overweight and may suffer from depressive symptoms. The paper concludes by emphasizing sleep quality assessments as an important early risk indicator, thereby reducing the incidence of a wide spectrum of morbidities.

The Pittsburgh Sleep Quality Index (PSQI) dimensionality is much debated, with the greatest number of reported factor structures. Therefore, this review appraised the methodologies of studies investigating the factor structure of the PSQI. MEDLINE, PsycInfo, AJOL, BASE, Cochrane Library, Directory of Open Access Journals (Lund University), CINAHL, and Embase were searched systematically to include articles published till 23rd March, 2018. The articles with the objective of factor analysis of the PSQI (20 articles) or with a major section on the same subject (25 articles) were included. There was no limitation about participant characteristics. Descriptive analysis of articles for measures of the suitability of the data for factor analysis, details of the exploratory factor analysis (EFA) and details of the confirmatory factor analysis (CFA) was performed. The analysis used by the majority did not employ the simplest scheme for interpreting the observed data: the parsimony principle. Other shortcomings included under- or non-reporting of sample adequacy measures (11 out of 45 articles), non-use of EFA (20 out of 45 articles), use of EFA without relevant details, non-use of CFA (11 out of 45 articles), and use of CFA without relevant details. Overall, 31 out of 45 articles did not use either EFA or CFA. We conclude that the various PSQI factor structures for standard sleep assessment in research and clinical settings may need further validation. Not applicable because this was a review of existing literature.

Despite the demonstrated utility of the Pittsburgh Sleep Quality Index (PSQI) in various demographic groups, it has never been validated in a sample of Indian subjects. To extend and confirm the PSQI's applicability for South Asian subjects, this preliminary study aimed to assess its psychometric and diagnostic validity in a sample of university students. Forty-seven male students were recruited from Jamia Millia Islamia, a public central university in New Delhi, India. The mean age of the students was 23.4±3.9 years, and they had a mean body mass index (BMI) of 23.3±3.3kg/m(2). The PSQI was administered to all subjects and overnight polysomnographic testing was carried out as a concurrent validation measure. Cronbach's alpha for the questionnaire was found to be 0.736. Internal homogeneity was high, with the majority of correlations between questionnaire component scores and the summed global score being significant (p6 and was generated using receiver operating characteristic curve analysis. The area under the curve, sensitivity, specificity, positive and negative likelihood ratios at the cut-off score were 0.838 (p<0.0001), 75.0%, 88.9%, 6.75, and 0.280, respectively. The study found evidence that the PSQI had internal consistency, internal homogeneity, and diagnostic characteristics that compared well with PSG among a sample of young adult male students in India. This supports the applicability and certain aspects of the validity of the PSQI in the population.

The applicability of the Pittsburgh Sleep Quality Index (PSQI) in screening of insomnia is demonstrated in various populations. But, the tool has not been validated in a sample of Ethiopians. Therefore, this study aimed to assess its psychometric properties in community dwelling Ethiopian adults. Participants (n = 311, age = 25.5 ± 6.0 years and body mass index = 22.1 ± 2.3 kg/m2) from Mizan-Aman town, Southwest Ethiopia completed the PSQI and a semi-structured questionnaire for socio-demographics. Clinical interview for screening of insomnia according to the International Classification of Sleep Disorders was carried out as a concurrent validation measure. Overall, the PSQI scale did not have floor effect and ceiling effects. Moderate internal consistency (Cronbach’s alpha was 0.59) and sufficient internal homogeneity as indicated by correlation coefficient between component scores and the global PSQI score was found. The PSQI was of good value for screening insomnia with optimal cut-off scores of 5.5 (sensitivity 82%, specificity 56.2%) and the area under the curve, 0.78 (p < 0.0001). The PSQI has unidimensional factor structure in the Ethiopian community adults for screening insomnia. The PSQI has good psychometric validity in screening for insomnia among Ethiopians adults.

Background: There is a gradual increase in the prevalence of stress during professional courses. Previous studies reported a high incidence of stress among university students. The psychometric properties of the perceived stress scale-10 (PSS-10) have been established in different populations. The current study aimed to assess psychometric properties of the PSS-10 in Saudi university students. Methods: Healthy university students (n= 192) participated in this cross-sectional study. All the participants were explained about the aim and procedures of the study. Participants were requested to complete the English version of the PSS, the generalized anxiety disorder-7 (GAD-7), the sleep hygiene index (SHI), and demographic details. Results: The range of the PSS-10 total score was 0– 35; 1% reported minimum score of 0, but none reported maximum score of 40. Therefore, there was no issue of ceiling or floor effect in the PSS-10 total score. Positive and significant correlations of the PSS total and the PSS Factor-1 (distress perception) with the GAD-7 total score, SHI item-8 and SHI item-13 score support its convergent validity. Negative or no correlation of the PSS Factor-2 score (coping perception) with the GAD-7 total score, SHI item-8 and SHI item-13 scores demonstrate its divergent validity. The internal homogeneity test indicated moderate to strong positive correlations (r=0.60– 0.82) between the PSS Factors and the items loading on them. The internal consistency test showed a good agreement for the PSS Factor-1 and the PSS Factor-2 scores (Cronbach’s alpha 0.78 and 0.71, respectively), suggesting an acceptable level of consistency. Factor analysis favored a 2-Factor model of the PSS in the Saudi students. Conclusion: The current study supported the use of the PSS-10 to assess the perceived stress among Saudi university students.