Reliability and construct validity of the Children's Sleep Habits Questionnaire in Chinese kindergartners

The Children's Sleep Habits Questionnaire (CSHQ) is widely used in clinical settings to screen for sleep problems in children aged 4-10 years. Existing studies on children in different cultures have included children across a wide age range and results have raised questions about CSHQ's psychometric quality. Our study addressed some of the limitations of existing studies by focusing on Chinese children within a much narrower age range of 4-5 years old. We tested the reliability and construct validity of the CSHQ in children living in Shanghai, China. Parents (mothers: 93%) of a random selected sample of kindergarten children aged 4-5 years (N=171; 46.8% boys; one target child per family) from Shanghai, China provided data on their children's sleep behaviors. CFA and EFA were conducted using Mplus 7.3. Weighted least squares with mean and variance adjusted (WLSMV) were used as the estimation method in Mplus, due to the ordinal nature of item responses. Our analyses showed that, similar to most existing studies, the eight subscales of CSHQ had low internal consistency, with Cronbach's alphas ranged from .11 (Night Waking) to .62 (Daytime Sleepiness). CFA failed to confirm the 8-factor structure. EFA suggested that a six-factor structure should be extracted. Subsequent CFA with a newly identified set of items from CSHQ led to the exclusion of two uninterpretable factors, leaving four factors with 28 items: Bedtime Behaviors (α=.59), Sleep Behaviors (α=.62), Morning Wakings (α=.69), and Daytime Sleepiness (α=.67). The four factors represented some improvement to the psychometric quality of the CSHQ. Based on our findings and those from other studies, we concluded that the CSHQ should be used with great caution.