title: Identifying Insomnia in Early Pregnancy: Validation of the Insomnia Symptoms Questionnaire (ISQ) in Pregnant Women.
abstract: OBJECTIVE
  Although a substantial number of pregnant women report symptoms of insomnia, few studies have used a validated instrument to determine the prevalence in early gestation. Identification of insomnia in pregnancy is vital given the strong connection between insomnia and the incidence of depression, cardiovascular disease, or immune dysregulation. The goal of this paper is to provide additional psychometric evaluation and validation of the Insomnia Symptom Questionnaire (ISQ) and to establish prevalence rates of insomnia among a cohort of pregnant women during early gestation.
  
  
  METHODS
  The ISQ was evaluated in 143 pregnant women at 12 weeks gestation. The internal consistency and criterion validity of the dichotomized ISQ were compared to traditional measures of sleep from sleep diaries, actigraphy, and the Pittsburgh Sleep Quality Index using indices of sensitivity, specificity, positive and negative predictive value (PPV, NPV), and likelihood ratio (LR) tests.
  
  
  RESULTS
  The ISQ identified 12.6% of the sample as meeting a case definition of insomnia, consistent with established diagnostic criteria. Good reliability was established with Cronbach α = 0.86. The ISQ had high specificity (most > 85%), but sensitivity, PPV, NPV, and LRs varied according to which sleep measure was used as the validating criterion.
  
  
  CONCLUSIONS
  Insomnia is a health problem for many pregnant women at all stages in pregnancy. These data support the validity and reliability of the ISQ to identify insomnia in pregnant women. The ISQ is a short and cost-effective tool that can be quickly employed in large observational studies or in clinical practice where perinatal women are seen.
  
  
  CONCLUSIONS
  A commentary on this article appears in this issue on page 593.
authors.affiliation: School of Medicine, Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA.|University of Colorado, Colorado Springs, CO.
authors.forename: Michele L
authors.initials: ML
authors.lastname: Okun
authors.affiliation: School of Medicine, Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA.|Clinical and Translational Science Institute, University of Pittsburgh, Pittsburgh, PA.
authors.forename: Daniel J
authors.initials: DJ
authors.lastname: Buysse
authors.affiliation: School of Medicine, Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA.|Clinical and Translational Science Institute, University of Pittsburgh, Pittsburgh, PA.
authors.forename: Martica H
authors.initials: MH
authors.lastname: Hall
mesh_terms: D000293:Adolescent; D000328:Adult; D005260:Female; D006801:Humans; D008875:Middle Aged; D011247:Pregnancy; D011248:Pregnancy Complications / Q000175:diagnosis*; D011261:Pregnancy Trimester, First; D011594:Psychometrics; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index; D007319:Sleep Initiation and Maintenance Disorders / Q000175:diagnosis*; D011795:Surveys and Questionnaires / Q000592:standards*; D055815:Young Adult
keywords: actigraphy; insomnia; pregnancy; sleep; validity