Chronic sleep loss during pregnancy as a determinant of stress: impact on pregnancy outcome

Palagini, Laura; Gemignani, Angelo; Banti, S.; Manconi, Mauro; Mauri, Mauro; Riemann, Dieter

doi:10.1016/j.sleep.2014.02.013

Cited by 187 publications

(179 citation statements)

References 117 publications

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“…65 In summary, these data support and extend a growing literature linking poor maternal sleep to adverse perinatal health outcomes, including preterm birth but also fetal growth restriction, gestational diabetes, gestational hypertension, longer labor, increased cesarean delivery, and risk for postpartum depression. 57 This study provides novel evidence that the deleterious effects of sleep on length of gestation are more pronounced among African Americans versus European Americans. The role of race in the association between poor sleep and other adverse perinatal health outcomes should be considered in future studies.…”

Section: Discussionmentioning

confidence: 79%

“…Moreover, subjective reports of sleep quality and duration have strong predictive validity for a variety of health outcomes in pregnant as well as non-pregnant samples. [57][58][59][60] However, self-rated sleep quality is weakly and inconsistently associated with objective measures such as polysomnography and wrist actigraphy. 61 Objective versus subjective methods capture different and complementary aspects of poor sleep as a construct.…”

Section: Discussionmentioning

confidence: 99%

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Poor Sleep Quality and Associated Inflammation Predict Preterm Birth: Heightened Risk among African Americans

Blair

Porter

Leblebicioğlu

et al. 2015

Sleep

159

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1259Sleep and Preterm Birth-Blair et al. INTRODUCTIONIn the United States, preterm birth affects 11.5% of deliveries and is the underlying cause of more than one third of infant deaths.1 A high proportion of surviving preterm infants suffer from severe physical and cognitive consequences, potentially requiring intensive medical and/or educational support throughout the lifespan.2 The morbidity and mortality associated with preterm birth pose significant drains on the financial and emotional resources of afflicted families, and on the nation as a whole, costing more than $26 billion annually in the United States. 3Inflammation is a causal mechanism in the initiation of preterm as well as term labor. 4 Inflammatory mediators can initiate contractions, encourage cervical ripening, and cause rupture of the membranes.4,5 Via these mechanisms, inflammation induced by infection or psychological stress may trigger early parturition. 6,7Importantly, poor sleep promotes inflammation.8 For example, in a population-based cohort of more than 5,000 adults, shorter sleep duration was associated with elevations in Study Objectives: Poor sleep promotes inflammation. In turn, inflammation is a causal mechanism in term as well as preterm parturition. In the United States, a persistent racial disparity in preterm birth exists, with African Americans showing ~1.5 times greater risk. This study examined associations among sleep quality, serum proinflammatory cytokines, and length of gestation in a racially diverse sample of 138 pregnant women. Design: Observational. Measurements: Women completed the Pittsburgh Sleep Quality Index (PSQI) and other psychosocial and behavioral measures during midpregnancy. Serum levels of interleukin (IL)-6, IL-8, IL-1β, and tumor necrosis factor (TNF)-α were determined by high-sensitivity assays. Birth outcomes were determined via medical record review. Results: Among African American women (n = 79), shorter gestation was predicted by poorer overall sleep (r s = −0.35, P = 0.002) as well the following PSQI subscales: subjective sleep quality (r s = −0.34, P = 0.002), sleep latency (r s = −0.27, P = 0.02), and sleep efficiency (r s = −0.27, P = 0.02). African American women with poor sleep quality (PSQI > 5) had 10.2 times the odds of preterm birth compared to those with good sleep quality. In contrast, among European American women (n = 53), gestational length was not significantly predicted by sleep quality (Ps > 0.12). Bootstrapping analyses showed that, among African Americans, IL-8 significantly mediated the association between sleep quality and length of gestation (indirect effect estimate −0.029; 95% confidence interval −0.06, −0.002). Conclusions:The data provide novel evidence that African American women exhibit greater inflammation in response to sleep disturbance than European American women and these effects correspond with length of gestation. Racial differences in susceptibility to sleep induced immune dysregulation may contribute to marked racial disparities in preterm birth.

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Section: Discussionmentioning

confidence: 79%

Section: Discussionmentioning

confidence: 99%

Poor Sleep Quality and Associated Inflammation Predict Preterm Birth: Heightened Risk among African Americans

Blair

Porter

Leblebicioğlu

et al. 2015

Sleep

159

View full text Add to dashboard Cite

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“…27,28 Psychological factors, including pregnancy-related anxiety and distress, can also impair a woman's ability to effectively return to sleep. 1,29 We recently reported that about 30% of nondepressed pregnant women endorsed symptoms of insomnia at 20 w. 20 We believe that early pregnancy may be a critical period in which to identify insomnia, given the vast physiological adaptations that occur during this time, [30][31][32] as well as the links between symptoms of insomnia and adverse pregnancy outcomes. 33,34 Various symptom severity questionnaires have been incorporated into studies of sleep in pregnancy in order to assess the prevalence of insomnia.…”

Section: S C I E N T I F I C I N V E S T I G At I O N Smentioning

confidence: 99%

Identifying Insomnia in Early Pregnancy: Validation of the Insomnia Symptoms Questionnaire (ISQ) in Pregnant Women

Okun

Buysse

Hall

2015

Journal of Clinical Sleep Medicine

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Study Objectives: 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. Identifi cation 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, specifi city, positive and negative predictive value (PPV, NPV), and likelihood ratio (LR) tests. Results: The ISQ identifi ed 12.6% of the sample as meeting a case defi nition of insomnia, consistent with established diagnostic criteria. Good reliability was established with Cronbach α = 0.86. The ISQ had high specifi city (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. 1 Among the many sleep complaints associated with pregnancy, diffi culty initiating or maintaining sleep or unrefreshing sleep, are the most frequently reported issues .1,2 Collectively these sleep symptoms comprise only one aspect of clinical insomnia. According to diagnostic criteria for insomnia, one must have: (1) a diffi culty initiating or maintaining sleep, and/or unrefreshing sleep despite adequate opportunity for sleep; (2) the duration of the sleep complaint is at least 1 mo; and (3) complaints of significant impairment in social, occupational, or daily functioning. 3,4 Insomnia is associated with activation of the stress system resulting in autonomic hyperarousa l. 5,6 It is also linked to various morbidities including depressi on.7-12 Emerging evidence implicates autonomic hyperarousal as a pathway through which the risk of depression is augmen ted. 13 This association is particularly relevant for pregnant women because there is evidence that depression is associated with an increased risk for preterm birth ( PTB), 14 and prenatal depression negatively impairs maternal-child bonding and neurocognitive develo pment.14-17 Having a simple diagnostic tool to identify clinical insomnia in pregnant women could be a fi rst step in reducing the incidence of depression, autonomic hyperarousal, as well as adverse pregnancy outcomes, such as PT...

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“…[5][6][7] It has been hypothesized that chronic sleep loss during pregnancy can be both cause and effect of hyperarousal (i.e., increased physiological and psychological stress and reactivity), leading to stress responses that adversely affect pregnancy outcomes. 8 In addition, poor sleep hygiene and hyperarousal have been identified as potential intervention targets for improving sleep among pregnant women. 9 Despite the adverse consequences of poor sleep during pregnancy, relatively few interventions exist for improving sleep among pregnant women.…”

Section: Introductionmentioning

confidence: 99%

Sleep Enhancement Training for Pregnant Women

Lee¹,

Gay²,

Alsten³

2017

Obstetric Anesthesia Digest

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Objective-To evaluate the feasibility and efficacy of a home-based cognitive-behavioral training program for sleep during late pregnancy.Methods-A nonrandomized quasi-experimental sample of nulliparous women who received the intervention during pregnancy (n=25) was compared to two control groups (n=76 and n=48) from other intervention studies at similar postintervention time points: approximately 1 month before childbirth and 1-2 months after childbirth. The home-based Sleep Enhancement Training System for Pregnancy consisted of 4 weeks of sound-enhanced audio relaxation programs, readings, and daily sleep diaries. Both control groups received dietary recommendations for improving sleep. Sleep duration (total sleep time) and sleep disruption (wake after sleep onset) were measured using wrist actigraphy for a minimum of 48 hours on consecutive weekdays.Results-The intervention group had significantly longer sleep duration and less sleep disruption than both control groups, particularly at the postpartum assessment. Intervention participants slept an average of 430 (95% confidence interval [CI] 397-464) minutes during pregnancy, compared to 420 (95% CI 403-438) and 417 (95% CI 395-439) minutes for the two control groups. At the postpartum assessment, the intervention group slept 446 (95% CI 415-478) minutes compared to 390 (95% CI 373-408) and 370 (95% CI 348-393) minutes for controls. In terms of sleep disruption, the intervention group had 16.1% (95% CI 11.9-20.2%) wake after sleep onset during pregnancy, while controls had 13.4% (95% CI 11.2-15.5%) and 20.4% (95% CI 17.7-23.0%). Postpartum, the intervention group had 20.3% (95% CI 16.4-24.1%) wake after sleep onset compared to 26.6% (95% CI 24.5-28.8%) and 28.7% (95% CI 26.0-31.5%) among control. Participant feedback about the intervention was generally positive, although intervention adherence was variable.Conclusions-This study provides evidence of the feasibility and efficacy of the Sleep Enhancement Training System for Pregnancy intervention for enhancing sleep that typically worsens during late pregnancy and after childbirth. PrécisA cognitive-behavioral intervention that includes relaxation training demonstrates feasibility and efficacy for minimizing sleep disruption among women in late pregnancy and after childbirth.

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Chronic sleep loss during pregnancy as a determinant of stress: impact on pregnancy outcome

Cited by 187 publications

References 117 publications

Poor Sleep Quality and Associated Inflammation Predict Preterm Birth: Heightened Risk among African Americans

Poor Sleep Quality and Associated Inflammation Predict Preterm Birth: Heightened Risk among African Americans

Identifying Insomnia in Early Pregnancy: Validation of the Insomnia Symptoms Questionnaire (ISQ) in Pregnant Women

Sleep Enhancement Training for Pregnant Women

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