Dear Editor,

We would like to comment on Shantakumari et al,1 published article in the March 2024 issue of the Oman Medical Journal. The authors utilized the Pittsburgh Sleep Quality Index (PSQI) instrument and found that 57.2% of undergraduate students at Ajman University, UAE, had irregular bedtimes. There was a positive association between the global PSQI score and the frequency of irregular bedtimes (p < 0.010).

In addition to the study limitations stated by Shantakumari et al,1 we would like to present an additional limitation. The PSQI instrument is widely used to assess sleep quality for clinical and research purposes. To increase the PSQI's applicability and proficiency, translation, cultural adaptation, and validation for the specific population under study are essential. Several population-specific versions of the PSQI have demonstrated acceptable reliability and validity in assessing sleep dysfunction in both research and clinical settings.2–4

Notably, a validated, culturally-adapted, psychometric Arabic version of the PSQI instrument has been developed for adolescents and young adults. Factor analysis showed that a single factor could explain 30.3% of the overall variance, yielding favorable factor loadings for all PSQI elements and confirming construct validity. Reliability analysis also indicated acceptable internal consistency (Cronbach's alpha = 0.6).5

Although Shantakumari et al,1 did not specify the version of the PSQI instrument used, we believe that the use of a non-Arabic version could raise questions about the study's findings. Regardless of this limitation, the reported prevalence of irregular bedtimes among the study population (57.2%) is alarmingly high. There is a need to implement tailored measures to promote healthy sleep habits among university students, which would improve their academic environment, enhance academic performance, and support a better quality of life.

references

1. 1. Shantakumari N, Elawaddlly SH, Kanawati AJ, Abufanas AS, Dakak A, Ibham FM, et al. Sleep quality and its daytime effects among university students in the UAE. Oman Med J 2024 Mar;39(2):e612.
2. 2. Setyowati A, Chung MH. Validity and reliability of the Indonesian version of the Pittsburgh sleep quality index in adolescents. Int J Nurs Pract 2021 Oct;27(5):e12856.
3. 3. Kmetec S, Fekonja Z, Davey A, Mlinar Reljić N, Lorber M. Development of a slovenian version of the Pittsburgh sleep quality index (PSQI-SLO) for use with older adults. Int J Older People Nurs 2022 Jan;17(1):e12411.
4. 4. Ørskov PT, Norup A. Validity and reliability of the Danish version of the Pittsburgh sleep quality index. Scand J Public Health 2023 Dec;51(8):1182-1188.
5. 5. Ben Letaifa S, Charfi F, Ben Hamouda A, Khmekhem R, Hadj Amor S, Fakhfakh R. Validation of Tunisian Arabic version of Pittsburgh sleep quality index in non-clinical adolescents. Tunis Med 2024 May;102(5):278-283.