Prevalence of Sleep Deficiency in Early Gestation and its Associations with Stress and Depressive Symptoms

Abstract

Objective: Sleep deficiency is an emerging concept denoting a deficit in the quantity or quality of sleep. This may be particularly salient for pregnant women since they report considerable sleep complaints. Sleep deficiency is linked with morbidity, including degradations in psychosocial functioning, (e.g., depression and stress), which are recognized risk factors for adverse pregnancy outcomes. We sought to describe the frequency of sleep deficiency across early gestation (10-20 weeks) and whether sleep deficiency is associated with reports of more depressive symptoms and stress. Methods: Pregnant women (N = 160) with no self-reported sleep or psychological disorder provided sleep data collected via diary and actigraphy during early pregnancy: 10-12, 14-16, and 18-20 weeks' gestation. Sleep deficiency was defined as short sleep duration, insufficient sleep, or insomnia. Symptoms of depression and stress were collected at the same three time points. Linear mixed effects models were used to analyze the data.Results: Approximately 28%-38% met criteria for sleep deficiency for at least one time point in early gestation. Women who were sleep deficient across all time points reported more perceived stress than those who were not sleep deficient ( p < 0.01). Depressive symptoms were higher among women with diary-defined sleep deficiency across all time points ( p = 0.02). Discussion: Sleep deficiency is a useful concept to describe sleep recognized to be disturbed in pregnancy. Women with persistent sleep deficiency appear to be at greater risk for impairments in psychosocial functioning during early gestation. These associations are important since psychosocial functioning is a recognized correlate of adverse pregnancy outcomes. Sleep deficiency may be another important risk factor for adverse pregnancy outcomes.

Mechanisms underlying the effects of prenatal psychosocial stress on child outcomes: beyond the HPA axis

“…Sleep disturbances are a common complaint of pregnant women [99] and the literature is acknowledging the role of disturbed sleep in adverse outcomes more and more, including in preeclampsia, labor duration, preterm birth and impaired glucose metabolism [100,101]. Sleep disturbances during pregnancy are also associated with perceived stress.…”

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

“…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.…”

“…1,50 The women were identified through self-referral, physician referral, local advertising, or enrollment in University research registries. Potential participants were excluded it they self-reported a diagnosis of a mental disorder, sleep disorder, had chronic diseases, including diabetes, human immunodeficiency virus, or uterine abnormalities, or were actively taking antidepressants or receiving other treatments for mental disorders, i.e., therapy.…”

“…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.…”

“…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.…”