Insomnia and depressive symptoms in late pregnancy: a population-based study

A population-based questionnaire study of 2,816 women was conducted in week 32 of pregnancy to estimate the prevalence of and risk factors for insomnia and depressive symptoms. The Bergen Insomnia Scale (BIS) measured insomnia. The Edinburgh Postnatal Depression Scale (EPDS) measured depressive symptoms. The prevalence of insomnia (DSM-IV-TR criteria) was 61.9%, and mean BIS score 17.5 (SD = 10.5), significantly higher than among the general population. The prevalence of depressive symptoms (EPDS ≥ 10) was 14.6%. Depressive symptoms were strongly associated with insomnia during late pregnancy, especially with sleep durations <5 or >10 hours, sleep efficiency <75%, daytime impairment, and long sleep onset latency. Pelvic girdle pain and lower back pain was associated with insomnia, but not with depressive symptoms.

Sleep disturbances in Korean pregnant and postpartum women

This was a prospective, cohort study in Korean pregnant and postpartum women, to estimate the prevalence and patterns of sleep disturbances. The survey was composed of the following validated sleep questionnaires: the Pittsburgh Sleep Quality Index (PSQI), Epworth Sleepiness Scale (ESS), Women's Health Initiative Insomnia Rating Scale, Berlin Questionnaire for sleep disordered breathing, the international restless leg syndrome (IRLS) Study Group criteria, and the Johns Hopkins Telephone Diagnostic Interview Form (JHTDIF) for RLS. Statistical analyses were performed using SPSS version 18.0. Six hundred eighty-nine women completed sleep surveys. The overall percentage of women with very poor sleep quality (a PSQI score greater than 10), clinically significant insomnia (a total score of 9 or more), excessive daytime sleepiness (a total ESS score of 10 or more), short sleep duration (less than 7 hours per night) were 80.7%, 50.5%, 34.0% and 29.5%, respectively, and all of three parameters became increased as pregnancy progressed and after delivery ( p = 0.002, 0.001, and 0.001, respectively). The overall positive rates in Berlin and RLS questionnaires were 25.4% and 19.4%. In conclusion, sleep disturbances are prevalent among Korean pregnant and postpartum women, and increase significantly as pregnancy progresses and after delivery.

Daily sleep and fatigue characteristics in nulliparous women during the third trimester of pregnancy

OBJECTIVES

To examine the association among nighttime sleep and daytime napping behaviors, depressive symptoms, and perception of fatigue in pregnant women.

DESIGN

A prospective descriptive study with within-subject design.

SETTING

A university-affiliated hospital and participants' home environments.

PARTICIPANTS

Thirty-eight third trimester nulliparous women completed sleep and depressive symptom questionnaires, wore a wrist actigraphy monitor for 7 consecutive days, and kept a concurrent diary reporting naps and rating their level of fatigue using a 0-10 visual analogue scale each morning, midday, afternoon, and evening. A generalized estimating equation regression model was applied to evaluate the time-dependent association.

INTERVENTIONS

N/A.

MEASUREMENTS AND RESULTS

Mean duration of total nighttime sleep by actigraphy was 386.3 ± 60.7 min, with 11 (28.9%) women having an average total nighttime sleep < 6 h. Nineteen women (50%) napped > 3 days, and only 2 women did not nap over the entire week. Antecedent night sleep duration had a significant inverse association with morning (P = 0.022) and afternoon fatigue (P = 0.009) of the subsequent day. Self-reported naps were significantly associated with midday fatigue (P = 0.003). More depressive symptoms predicted more severe fatigue throughout the day.

CONCLUSIONS

Results suggest that interventions designed to increase sleep duration and decrease depressive symptoms have the potential to prevent, ameliorate, or reduce fatigue in pregnant women. Depressive symptoms during pregnancy likely share some psychological and behavioral tendencies with fatigue and/or sleep disturbance which may complicate the evaluation of intervention effect.

Factors associated with sleep quality in pregnant women: a prospective observational study

BACKGROUND

: Sleep disturbance is a significant health issue in pregnant women. Although previous studies contribute to an understanding of the multifactorial nature of pregnancy-related sleep disturbance, objective measures of sleep were not included, and so data may be subject to recall and potential participant self-report bias.

OBJECTIVE

: The aim of this study was to identify sociodemographic, lifestyle, and health-related factors associated with poor sleep quality in women during their third trimester of pregnancy.

METHODS

: This prospective study included 30 nulliparous women who wore a wrist actigraph to objectively monitor sleep for 7 consecutive days and completed the Pittsburgh Sleep Quality Index.

RESULTS

: Fifteen women (50%) had a Pittsburgh Sleep Quality Index global score of >5, indicating poor sleep quality. Mean actigraphic sleep efficiency was only 80.05% ± 6.27%. There were significant differences (p < .01) in sleep offset time and total nocturnal sleep time between weekdays and weekends. Later sleep onset time was associated with poorer sleep, including longer sleep latency, and reduced total nocturnal sleep time and sleep efficiency.

DISCUSSION

: Nulliparous women experience both objective and subjective sleep disturbances, and their sleep patterns differ between weekdays and weekends during their third trimester of pregnancy. Results suggest that maternal sleep pattern may be improved by maintaining a regular and earlier bedtime so women have more opportunity to obtain sufficient nocturnal sleep and improved sleep quality.

Sleep-wake schedules in preschool children who snore

PURPOSE

The aim of the study was to compare sleep-wake schedules between snoring and nonsnoring preschool age children.

MATERIAL AND METHODS

Daytime and nighttime sleep duration, daytime and nighttime symptoms were assessed in 34 children at preschool age who snore (5.38+/-1.21 years) and in 66 age- and sex-matched nonsnorers (5.67+/-1.12 years). The snoring group consisted of children with obstructive sleep apnea (OSA) scores <+3.5 and >-1, the nonsnoring group with OSA score <-1.

RESULTS

Children who snore differ from the nonsnorers in daytime sleep duration (51.62+/-28.9 minutes vs. 10.70+/-20.2 minutes; p<0.001), but not in nighttime sleep (10.97+/-0.52 hours vs. 9.83+/-1.34 hours; p>0.05). The percentage of children with daytime napping was higher in the snoring group than in the nonsnorers (47.1% vs. 9.1%; p<0.00004), and parents-reported behavioral problems were more frequent in children who snore (41.2% vs. 19.7%; p<0.02). Multivariate odds ratios, including variables for nighttime (sleep apnea) and daytime symptoms (daytime napping and oral breathing), showed that regular sleep during the day was the most predictive of snoring (OR=6.1; 95%CI 1.76-21.04; p<0.005).

CONCLUSION

In preschool age children, when the daytime nap begins to disappear, snoring may have an effect on daytime schedule through an increased need for daytime sleep.