匹兹堡睡眠质量指数（PSQI）英文版

 

RPA Sleep Health and Respiratory Support Clinic

 

11 West, Royal Prince Alfred Hospital

 

Missenden RD, Camperdown NSW 2050

 

Ph: 9515 6655 Fax: 9515 8196

 

PITTSBURGH SLEEP QUALITY INDEX (PSQI)

 

Name_________________ ID#_________ Date________ Age________

 

Instructions:

 

The following questions relate to your usual sleep habits during the past month ONLY. Your answers should indicate the most accurate reply for the majority of days and nights in the past month.

 

Please answer all questions.

 

1. During the past month, when have you usually gone to bed at night?

 

USUAL BED TIME_________________________

 

2. During the past month, how long (in minutes) has it usually taken you to fall asleep each night?

 

NUMBER OF MINUTES_____________________

 

3. During the past month, when have you usually gotten up in the morning?

 

USUAL GETTING UP TIME__________________

 

4. During the past month, how many hours of actual sleep did you get at night? (This may be different than the number of hours you spend in bed.)

 

HOURS OF SLEEP PER NIGHT________________

 

For each of the remaining questions, check the one best response. Please answer all questions.

 

5. During the past month, how often have you had trouble sleeping because you……..

 

(a) cannot get to sleep within 30 minutes

 

Not during the Less than Once or Three or more

 

past month_____ once a week_____ twice a week_____ times a week_____

 

(b) Wake up in the middle of the night or early morning

 

Not during the Less than Once or Three or more

 

past month____ once a week_____ twice a week_____ times a week_____

 

(c) Have to get up to use the bathroom.

 

Not during the Less than Once or Three or more

 

past month_____ once a week_____ twice a week_____ times a week_____

 

(d) Cannot breathe comfortably.

 

Not during the Less than Once or Three or more

 

past month_____ once a week_____ twice a week_____ times a week____

 

(e) Cough or snore loudly.

 

Not during the Less than Once or Three or more

 

past month_____ once a week_____ twice a week_____ times a week_____

 

(f) Feel too cold.

 

Not during the Less than Once or Three or more

 

past month_____ once a week_____ twice a week_____ times a week_____

 

(g) Feel too hot.

 

Not during the Less than Once or Three or more

 

Past month_____ once a week_____ twice a week_____ times a week____

 

(h) Had bad dreams.

 

Not during the Less than Once or Three or more

 

Past month_____ once a week_____ twice a week_____ times a week____

 

(i) Have pain.

 

Not during the Less than Once or Three or more

 

Past month_____ once a week_____ twice a week_____ times a week____

 

(j) Other reason(s), please describe______________________________

 

________________________________________________________

 

How often during the past month have you had trouble sleeping because of this?

 

Not during the Less than Once or Three or more

 

Past month____ once a week_____ twice a week_____ times a week____

 

6. During the past month, how would you rate your sleep quality overall?

 

Very good _____________

 

Fairly good _____________

 

Fairly bad _____________

 

Very bad _____________

 

7. During the past month, how often have you taken medicine (Prescribed or "over the counter") to help you sleep?

 

Not during the Less than Once or Three or more

 

Past month_____ once a week_____ twice a week_____ times a week_____

 

8. During the past month, how often have you had trouble staying awake while driving, eating meals, or engaging in social activity?

 

Not during the Less than Once or Three or more

 

Past month_____ once a week_____ twice a week_____ times a week____

 

9. During the past month, how much of a problem has it been for you to keep up enough enthusiasm to get things done?

 

No problem at all _________

 

Only a very slight problem _________

 

Somewhat of a problem _________

 

A very big problem _________

 

10. Do you have a bed partner or share a room?

 

No bed partner or do not share a room _________

 

Partner/ flatmate in other room _________

 

Partner in same room, but not same bed _________

 

Partner in same bed _________

 

11. If you have a bed partner or share a room, ask him/her how often in the past month you have had………

 

(a) Loud snoring.

 

Not during the Less than Once or Three or more

 

Past month_____ once a week_____ twice a week_____ times a week____

 

(b) Long pauses between breaths while asleep.

 

Not during the Less than Once or Three or more

 

Past month_____ once a week____ twice a week_____ times a week____

 

(c) Legs twitching or jerking while you sleep.

 

Not during the Less than Once or Three or more

 

Past month_____ once a week_____ twice a week_____ times a week_____

 

(d) Episodes of disorientation or confusion during sleep.

 

Not during the Less than Once or Three or more

 

Past month_____ once a week_____ twice a week_____ times a week_____

 

(e) Other restlessness while you sleep: please describe_________________

 

__________________________________________________________

 

Not during the Less than Once or Three or more

 

Past month_____ once a week_____ twice a week_____ times a week____

 

[Buysse DJ, Reynolds CF, Monk TH, Berman SR, DJ Kupfer (1989) The Pittsburgh Sleep Quality Index: A New

 

Instrument for Psychiatric Practice and Research, Psychiatry Research, 28: 193-213].

来源：无忧睡眠网(http://www.51sleep.com/)
作者：无忧睡眠网
原文：匹兹堡睡眠质量指数（PSQI）英文版(http://www.51sleep.com/h/html/32829.html)