Sleep Complaints in Late Pregnancy and the Recurrence of Postpartum Depression

Okun, Michele L.; Hanusa, Barbara H.; Hall, Martica; Wisner, Katherine L.

doi:10.1080/15402000902762394

Cited by 114 publications

(108 citation statements)

References 43 publications

(71 reference statements)

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“…Our findings, along with those of Tsai, 25 support the notion that daytime naps only modestly impact nocturnal sleep duration, and do not impair sleep continuity or sleep quality. Given that poor sleep continuity and quality are important correlates of adverse pregnancy outcomes, 5 propose that a beneficial countermeasure to sleep disruption is daytime naps, which is in line with several other reports in non-pregnant cohorts. [9][10][11]41 Additional research is still needed to determine the effect of naps > 30 min on pregnant women.…”

supporting

confidence: 69%

“…As previously noted, this is an important association given the links between total sleep duration, sleep fragmentation, and sleep quality with maternal and birth outcomes. 5,8,[27][28][29] Given that women of childbearing age comprise about 32% of the world's population, 30 additional evidence concerning the length and frequency of naps is necessary to fully comprehend the impact of daytime naps on nocturnal sleep and pregnancy outcomes.…”

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%

“…[1][2][3] Emerging evidence indicates that insuffi cient quantity and poor sleep quality are associated with increased risk of mood dysregulation , 4,5 as well as adverse pregnancy outcomes, such as preterm birth and gestational diabete s. [6][7][8] When suffi cient nighttime sleep is not possible or unattainable, certain strategies can be implemented to counteract the negative effects of disturbed nocturnal sleep. One promising approach is to include daytime naps as part of a healthy sleep hygiene progra m. [9][10][11] There is limited information examining the effects of daytime naps on nocturnal sleep outcomes in non-pregnant populations.…”

mentioning

confidence: 99%

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Minimal Effect of Daytime Napping Behavior on Nocturnal Sleep in Pregnant Women

Ebert

Wood

Okun

2015

Journal of Clinical Sleep Medicine

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Study Objectives: To assess whether daytime naps negatively impact nocturnal sleep. Design: Longitudinal, prospective cohort design. Participants: 161 pregnant women recruited and evaluated in early gestation (10-20 weeks). Measurements and Results: Daily sleep information was collected in three 2-week periods (10-12, 14-16, and 18-20 weeks gestation) with a daily sleep diary and an actigraph. The average number of naps, as well as the average length of each nap, were calculated from sleep diaries. Women were categorized fi rst as non nappers (0 naps/2-week period), moderate nappers (1-3 naps/2-week period), or frequent nappers (≥ 4 naps/2-week period). Then, based on the average nap length, they were categorized as short (< 90 min) or long (≥ 90 min) nappers. Nocturnal sleep parameters included SOL, WASO, SE, and TST. SAS procedure MIXED was used for modeling the main effects of nap group and time, and time by nap group interactions. Women who took naps had a decrease in diary-assessed nocturnal TST, but not actigraphy-assessed TST. This observation was group-and time-specifi c. There were no other group differences. Women who napped ≥ 90 min had poorer diary-assessed SE and lower diary-assessed TST than those who took shorter naps. Length of nap was not associated with any other sleep measures. Conclusions:The number of daytime naps have minimal impact on nocturnal sleep parameters; however, long nappers did exhibit modestly impaired sleep continuity and sleep quality. Overall, we propose that daytime naps provide a benefi cial countermeasure to the sleep disruption commonly reported by pregnant women. This may be clinically benefi cial given that sleep continuity and quality are important correlates of pregnancy outcomes. T he majority of expectant women experience progressively disturbed, fragmented, and shortened nocturnal sleep as a result of normal physiological adaptations to the progressing pregnancy.1-3 Emerging evidence indicates that insuffi cient quantity and poor sleep quality are associated with increased risk of mood dysregulation , 4,5 as well as adverse pregnancy outcomes, such as preterm birth and gestational diabete s. 6-8When suffi cient nighttime sleep is not possible or unattainable, certain strategies can be implemented to counteract the negative effects of disturbed nocturnal sleep. One promising approach is to include daytime naps as part of a healthy sleep hygiene progra m. 9-11There is limited information examining the effects of daytime naps on nocturnal sleep outcomes in non-pregnant populations. The majority of evidence stems from examination of daytime naps in elderly or middle-aged individuals or children. The bulk, however, consider daytime naps as a positive health behavior (a "countermeasure") in that they can effectively combat subjectively reported poor sleep quality and decrease subjective daytime sleepiness by augmenting shortened nocturnal sleep durat ion.11-14 However, there is also a small literature that suggests that naps can be detrimental to nocturnal sleep and ne...

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supporting

confidence: 69%

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%

mentioning

confidence: 99%

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Minimal Effect of Daytime Napping Behavior on Nocturnal Sleep in Pregnant Women

Ebert

Wood

Okun

2015

Journal of Clinical Sleep Medicine

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“…[8][9][10][11][12][13][14][15][16][17][18] Though increasingly being used among pregnant women, 1,7,19 the psychometric properties of the PSQI has not been adequately assessed in this population. We are aware of only two published studies have evaluated the psychometric properties of the PSQI among pregnant women.…”

Section: Discussionmentioning

confidence: 99%

Psychometric Properties of the Pittsburgh Sleep Quality Index (PSQI) in a Cohort of Peruvian Pregnant Women

Zhong

Gelaye

Sánchez

et al. 2015

Journal of Clinical Sleep Medicine

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Study Objectives: We sought to evaluate the construct validity and factor structure of the Spanish-language version of the Pittsburgh Sleep Quality Index (PSQI) among pregnant Peruvian women. Methods: A cohort of 642 women were interviewed at ≤ 16 weeks of gestation. During interview, we ascertained information about lifestyles, demographics, sleep characteristics, and mood symptoms. Stress induced sleep disturbance, depressive symptoms, and anxiety symptoms were evaluated using the Ford Insomnia Response to Stress Test (FIRST), Patient Health Questionnaire-9 (PHQ-9), and Generalized Anxiety Disorder-7 (GAD-7) assessment scales, respectively. Consistency indices, exploratory and confi rmatory factor analyses, correlations, and logistic regressions were used. Results: Both exploratory and confi rmatory factor analyses indicated a three-factor solution: sleep quality, sleep effi ciency, and sleep medication. We observed signifi cantly positive correlations of the PSQI with the FIRST (0.42), the PHQ-9 (0.49), and the GAD-7 (0.46). Poor sleepers (PSQI global score > 5) had signifi cantly increased odds of experiencing stress-induced sleep disturbance (odds ratio, OR = 3.57; 95% CI: 2.40, 5.31), depression (OR = 5.48; 95% CI: 3.58, 8.37), and generalized anxiety disorder (OR = 4.57; 95% CI: 3.08, 6.76). Conclusions:The Spanish-language version of the PSQI instrument was found to have good construct validity among pregnant Peruvian women. Consistent with some other studies, the PSQI was found to have a three-factor structure. Further assessment and validation studies are needed to determine whether the three, factor-specifi c scoring of the PSQI is favored over the PSQI global score in diverse populations. A mong pregnant women, pregnancy-associated physiological and hormonal changes are known to contribute to increased prevalence and severity of sleep complaints and disorders.1,2 Sleep complaints and disorders experienced in early pregnancy have been linked to hyperemesis, cesarean delivery, preterm birth, gestational diabetes mellitus, fetal growth restriction, and preeclampsia.2-5 Of note, an emerging literature has suggested that sleep disorders and poor sleep quality predict an increased risk of mood disorders including depressive symptomatology in late pregnancy.6,7 However, despite these observations and their clinical implications, relatively little has been done to design and implement clinical protocols that may be used to reliably and validly assess sleep effi ciency and night and daytime disturbance among pregnant women.One widely used self-reported measure of sleep quality, the Pittsburgh Sleep Quality Index (PSQI), has been established as a valid scale with acceptable psychometric properties when used among men and non-pregnant women in diverse global settings. [8][9][10][11][12][13][14][15][16][17][18] Though increasingly being used among pregnant women, 1,7,19 the psychometric properties of the PSQI has not been adequately assessed in this population. We are aware of only two published studies have eva...

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“…[2][3][4][5][6][7][8] Disturbed sleep is also a major risk factor for depressed mood 9,10 and stress during pregnancy, 11 as well as a predictor of depression or depressive mood postpartum. [12][13][14] Studies indicate that depressed or stressed mothers are more likely to deliver preterm, deliver low birth weight babies ( < 2500 g), and increase the risk that their offspring will develop an adult-onset chronic disease. [15][16][17][18][19] Few investigations, however, have assessed sleep in early gestation as a contributor to established risk factors or adverse pregnancy outcomes.…”

mentioning

confidence: 99%

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

Okun

Kline

Roberts

et al. 2013

Journal of Women's Health

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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.

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Sleep Complaints in Late Pregnancy and the Recurrence of Postpartum Depression

Cited by 114 publications

References 43 publications

Minimal Effect of Daytime Napping Behavior on Nocturnal Sleep in Pregnant Women

Minimal Effect of Daytime Napping Behavior on Nocturnal Sleep in Pregnant Women

Psychometric Properties of the Pittsburgh Sleep Quality Index (PSQI) in a Cohort of Peruvian Pregnant Women

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

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