Integrating psychological and cognitive factors in the association between self-reported and objective sleep measures among healthy older adults: a community-based study

Abstract

<p><strong>Background:</strong> Aging disrupts sleep quality, producing fragmented sleep and altered circadian rhythms. Aligning self-reported sleep assessments with objective metrics in older adults is especially important for mental health. This study examined relationships between the Pittsburgh Sleep Quality Index (PSQI), polysomnography (PSG), and psychological outcomes such as distress, loneliness, and cognition to identify objective or emotional-cognitive factors explaining subjective sleep complaints and determine which PSQI subscales best reflected sleep perception.</p><p><strong>Methods:</strong> In this cross-sectional study, participants aged ≧ 60 years were recruited between September 2019 and October 2020. Each completed the PSQI, underwent PSG, and received assessments of psychological distress, loneliness, and cognition. Spearman correlations tested associations between PSQI subscales and PSG indices. Logistic regression identified influencing indices of poor subjective sleep, and stepwise regression determined which PSQI components were most related to objective and emotional-cognitive indicators, adjusting for demographic and psychological factors.</p><p><strong>Results:</strong> Data from 89 participants (mean age 73.35 years (± 6.99), 50 women, 56.1%) were analyzed. PSQI subscales correlated with PSG metrics, particularly sleep efficiency, wake after sleep onset, and N2 duration. Regression identified PSG sleep efficiency (SE), sleep onset latency (SoL), wake after sleep onset (WASO), and depression as main influencing indices, with PSQI latency, quality, and disturbance components explaining variance.</p><p><strong>Conclusion:</strong> PSG SE, SoL, WASO, and depression were dominant influencing indices of subjective poor sleep. Specific PSQI subscales aligned with these indicators, underscoring overlap between subjective and objective measures and the influence of emotional and demographic factors on perceived sleep quality in older adults.</p>