Construct validity and factor structure of the Pittsburgh Sleep Quality Index among pregnant women in a Pacific-Northwest cohort

Sleep Quality in High-Risk Pregnancies: Mixed Methods Results from a Randomized Controlled Trial of a Mindfulness Training Intervention

Objectives: Sleep difficulties in pregnancy are common and increase the risk for obstetric complications. Past research shows that mindfulness training (MT) is helpful for improving sleep in non-pregnant adults and may improve sleep during pregnancy. However, it is unknown if MT improves sleep among pregnant people at risk for obstetric complications. We examined the effects of MT on sleep quality in individuals at risk of developing hypertensive disorders of pregnancy. Methods: Twenty-nine participants (mean age, 32 ± 4 years; mean gestational age, 16 ± 3weeks) at risk for hypertensive disorders in pregnancy (HDP) were randomized to an 8-week phone-delivered MT intervention (n = 15) or treatment as usual (TAU; n = 14), designed to test MT feasibility and acceptability. As part of the study, participants completed the Pittsburgh Sleep Quality Index and participated in a semi-structured individual qualitative interview which queried for sleep changes over pregnancy. Results: Participants randomized to MT reported less daytime sleep dysfunction compared to TAU (F = 5.79, p = 0.03, ηp2 = 0.28). Qualitative data illustrated the common experiences of sleep disturbance across both study groups; however, MT participants reported an improved ability to initiate sleep and return to sleep using mindfulness skills. About half of the participants in the MT condition reported an improvement in overall sleep quality due to less interference related to anxiety and restlessness, while other MT participants reported no change in sleep quality. Conclusions: Results from this study confirm that pregnant individuals frequently encounter sleep challenges. Findings also suggest that MT may be a helpful tool in improving sleep quality among pregnant people at risk for obstetric complications.

Factors Associated with Poor Sleep Quality in Postpartum Women: A Crossectional Study

Objective  This study aimed to analyze the factors associated with poor sleep quality in women in the postpartum period who were assisted in a municipality in central Brazil. Material and Methods  This is a cross-sectional study ( n  = 400) conducted virtually from 2020 to 2021. Sociodemographic and clinical characteristics, self-perceived sleep, and the Pittsburgh Sleep Quality Index (PSQI) were assessed. Results  It was identified that 82% of postpartum women were between 18 and 35-years-old and had an average monthly household income of R$2,339.27 ± 1,812.95. It was also found that 33.50% (95% CI: 28.7-38.0) had sleep disorders (PSQI >10); 70.25% (95%CI 65.8-74.8) had poor sleep quality (PSQI >5); 57.4% (95% CI: 52.0-63.1) had inadequate sleep on weekdays/workdays; and 64.1% (95% CI 59.3-69.2) had unsuitable sleep on weekends/days off. It was found that the factors associated with sleep disturbance were: age between <18 years and >35 years ( p  = 0.048); difficulty to think clearly ( p  = 0.043); frequent sadness ( p  = 0.046); poor sleep quality; low income ( p  = 0.030); difficulty to think clearly ( p  = 0.013); and loss of interest in things ( p  = 0.030). As for sleep on weekdays, the associated factors were: marital status without a partner ( p  = 0.008); and being a victim of physical violence ( p  = 0.003). Finally, for sleep on weekends/off: nonwhite skin-color ( p  = 0.039); and having postpartum depression ( p  = 0.029). Conclusion  The findings of the present study call attention to the impacts of changes in women's bodies, behavior, and interpersonal relationships caused by the arrival of a newborn. We also highlight the need for a multidisciplinary and comprehensive medical approach in this period.

Improvements in Maternal Cardiovascular Health Over the Perinatal Period Longitudinally Predict Lower Postpartum Psychological Distress Among Individuals Who Began Their Pregnancies With Overweight or Obesity

BACKGROUND

Adverse cardiovascular events during pregnancy (eg, preeclampsia) occur at higher rates among individuals with overweight or obesity (body mass index ≥25 kg/m2) and have been associated with postpartum depression. The present study examined whether changes in cardiovascular health (CVH) during the perinatal period, as defined by the American Heart Association's Life's Essential 8 framework, predicted postpartum psychological functioning among individuals with prepregnancy body mass index ≥25 kg/m2.

METHODS AND RESULTS

Pregnant individuals (N = 226; mean ± SD age = 28.43 ± 5.4 years; mean body mass index = 34.17 ± 7.15 kg/m2) were recruited at 12 to 20 weeks of gestation (mean, 15.64 ± 2.45 weeks) for a longitudinal study of health and well-being. Participants completed ratings of depression and perceived stress and reported on CVH behaviors (dietary intake, physical activity, nicotine exposure, and sleep) at baseline and at 6 months postpartum. Body mass index and CVH behaviors were used to calculate a composite CVH score at both time points. Linear regression analyses were performed to examine whether change in CVH related to postpartum symptom scores. Because sleep was measured in only a subset of participants (n = 114), analyses were conducted with and without sleep. Improved CVH was associated with lower postpartum depression (β = -0.18, P<0.01) and perceived stress (β = -0.13, P=0.02) scores. However, when including sleep, these relationships were no longer significant (all P>0.4).

CONCLUSIONS

Improvements in CVH from early pregnancy to 6 months postpartum were associated with lower postpartum depressive symptoms and perceived stress but not when including sleep in the CVH metric, potentially due to the large reduction in sample size. These data suggest that intervening during pregnancy to promote CVH may improve postpartum psychological functioning among high-risk individuals.

Association between sleep duration and quality with food intake, chrononutrition patterns, and weight gain during pregnancy

To analyse the association between sleep duration and quality with food intake, chrononutrition patterns, and weight gain during pregnancy. A prospective cohort study was conducted with 100 pregnant women. Data collection occurred once during each gestational trimester. The assessment of sleep quality and duration was performed using the Pittsburgh Sleep Quality Index. Food intake was assessed using three 24-h recalls in each trimester. Body weight was measured during the three trimesters, and height was measured only once to calculate the BMI. Linear regression analyses were performed to associate sleep duration and quality with food consumption and weight gain variables. Longer sleep duration was associated with a later dinner in the first trimester (β = 0·228, P = 0·025) and earlier in the third trimester (β = -0·223, P = 0·026), in addition to a later morning snack in the second trimester (β = 0·315, P = 0·026). Worse sleep quality was associated with higher total energy intake (β = 0·243, P = 0·044), total fat (β = 0·291, P = 0·015) and the chrononutrition variables such as a higher number of meals (β = 0·252, P = 0·037), higher energetic midpoint (β = 0·243, P = 0·044) and shorter fasting time (β = -0·255, P = 0·034) in the third trimester. Sleep quality was also associated with a higher BMI in the first trimester of pregnancy (β = 0·420, P = < 0·001). Most of the associations found in the present study show that poor sleep is associated with higher energy and fat intake and higher BMI. Longer sleep duration was associated with a later dinner in early pregnancy and an earlier dinner in late pregnancy, as well as with a later morning snack in the second trimester of pregnancy.

Examining the structure validity of the Pittsburgh Sleep Quality Index among female workers during New Zealand's initial COVID-19 lockdown

Sleep is important for good physical and mental health. The COVID-19 pandemic lockdown created a unique context that impacted psychological and social drivers for sleeping well. The Pittsburgh Sleep Quality Index (PSQI) is a widely used measurement tool assessing subjective sleep quality. The traditional model of the PSQI (a one-factor model), whilst validated and used across different populations, has also been questioned with regards to data fit and representativeness of its global score in different social and work-related circumstances. Examination of the structure validity of the PSQI in the unique context of the pandemic has been scarce. This study determined the PSQI structure validity amongst employed women considered to experience increased stressors during the pandemic lockdown. The subjectively reported PSQI data from 498 female workers (mean age 44.6 years) collected during New Zealand's first national COVID-19 lockdown (April, 2020) was used. Confirmatory factor analyses compared the original one-factor model of the PSQI with the two- and three-factor models used by Jia et al. (2019) within this pandemic context. Results showed that the two-factor model provided a superior fit of the PSQI data compared to the original one-factor or a three-factor model. These findings suggest that a sub-score of the PSQI with two factors appears to be better at describing the sleep quality of healthy working women during the constrained situation of the pandemic lockdown compared to a single global sleep quality score. This indicates the importance of considering the validity of subjective sleep measures when used within unique social contexts and stressors.

Assessment of Sleep Quality in Spanish Twin Pregnancy: An Observational Single-Center Study

Women with twin pregnancies experience greater sleep disturbance compared to women with singleton pregnancies. The aims of this study were to explore the sleep quality in women with twin pregnancies and to compare their sleep dimensions with coetaneous single pregnancies. This was an observational study in which women were enrolled at the end of pregnancy in the Obstetric Service of Hospital La Paz (Spain). The women were classified as single (n = 143) or twin pregnancy (n = 62). Pregnant women responded to the Pittsburgh Sleep Quality Index to evaluate sleep quality, latency, duration, efficiency, perturbance, use of medication, and daytime dysfunction. The higher the index, the greater the alteration of sleep quality. Without statistical differences, a poor sleep quality was higher in women with single (66.7%) than women with twin pregnancies (22.8%). The good sleeper slept 6.8 h/day in single pregnancy and 7.3 h/day in twin pregnancy. The sleep perturbation and dysfunctionality were higher in women with twin than single pregnancies. The use of medication to sleep was significantly lower in women with twin than single pregnancies. In women with twin pregnancy, the body weight gain during first trimester had a positive correlation with worse sleep quality and sleep perturbations. Twin pregnancy needed more than 7 h/day to have a high sleep quality, showing greater sleep perturbations and daytime dysfunction than single pregnancies. The control of gestational body weight can improve the sleep quality, disturbances, and duration in twin gestations. Sleep screening during pregnancy would be necessary to handle sleep issues and increase benefits in twin gestational outcomes.

Sleep Quality and Associated Factors among Pregnant Women Attending Antenatal Care Unit at the Referral Hospitals in Oromia National Regional State, Ethiopia, 2021: A Multicenter Cross-Sectional Study

INTRODUCTION

Poor sleep quality during pregnancy leads to adverse neonatal outcomes such as low birth weight, intrauterine growth retardation, preterm birth, and operative birth. Though it has many consequences, a limited study was conducted on the prevalence and associated factors of poor sleep quality among pregnant women in Ethiopia.

OBJECTIVE

This study is aimed to determine poor sleep quality and associated factors among pregnant women attending antenatal care units at the selected referral hospitals.

METHODS

Institution-based cross-sectional study was used from April 20 to June 10, 2021. A The data were collected through systematic random sampling. The Pittsburgh Sleep Quality Index (PSQI) was used to assess the outcome variable based on interview.

RESULTS

Out of 423, almost 414 participated in the study with a response rate of 97.9%. The prevalence of poor sleep quality was 54.6% (95% CI: 49.7%, 59%). Based on the trimester; about 44.8%, 36.8%, and 64.2% were observed poor sleep quality in the first, second, and third trimesters, respectively. Third trimester [AOR (Adjusted Odd Ratio) = 4.33; 95% CI (Confidence Interval) (1.43, 13.7)], primigravida [AOR = 4.03; 95% CI (2.59, 7.97)], para ≥2 [AOR = 1.95: 95% CI (1.09, 3.48)], depression [AOR = 4.59: 95% CI (2.31, 9.15)], and perceived stress [AOR = 1.15: 95% CI (1.1, 1.22)] were factors significantly associated.

CONCLUSION

One in every two pregnant women has poor sleep quality. Depression, perceived stress, gestational age, gravida, and parity were identified as associated factors with poor sleep quality. Therefore, healthcare providers should work on screening and counseling for sleep problems during prenatal checkups.

The Effect of Sleep Quality on Coronary Lesion Severity and Prognosis in the Young Acute Coronary Syndrome Population

This study aimed to explore the effect of long-term (≥1 year) sleep quality on coronary lesion complexity and cardiovascular prognosis in young acute coronary syndrome (ACS) patients. We consecutively recruited young patients aged from 18 to 44 years old with first-episode ACS and significant epicardial stenosis on coronary angiography from January 2016 to January 2017. Coronary lesion complexity was evaluated based on SYNTAX scores. Long-term sleep quality was assessed using the Pittsburgh Sleep Quality Index (PSQI) (PSQI ≤ 5 and PSQI > 5 groups). The primary endpoints were major adverse cardiovascular events (MACEs). A total of 466 young ACS patients (93.13% male; median age, 41 years) were included. Poor sleepers (PSQI > 5) had higher SYNTAX scores. After adjusting for confounders, PSQI scores (continuous variables, OR: 1.264; 95%CI: 1.166-1.371; p < 0.001) and PSQI grade (binary variable, OR: 3.864; 95%CI: 2.313-6.394; p = 0.001) were significantly associated with an increased risk of complex coronary lesions. During a median follow-up of 74 months, long-term poor sleep quality (PSQI > 5) was significantly associated with an increased risk of MACEs (HR: 4.266; 95%CI: 2.274-8.001; p < 0.001). Long-term poor sleep quality was a risk factor for complex coronary lesions and has adverse effects on cardiovascular prognosis in the young ACS population.

Sleep Disturbances in Early Gestation and the Risks of Hypertensive Disorders of Pregnancy: A Prospective Cohort Study

Maternal poor sleep quality may increase blood pressure during pregnancy, but sound evidence is still limited and inconsistent. To evaluate whether sleep disturbances in early gestation are risk factors for the development of hypertensive disorders of pregnancy, we conducted the Early Life Plan Project from June 2016 to December 2019. Maternal sleep patterns were assessed at 12-16 weeks of gestation by using the Pittsburgh Sleep Quality Index questionnaire. For gestational hypertension and preeclampsia, we estimated adjusted odds ratios (ORs) and 95% confidence intervals (CIs) using multinomial logistic regression models adjusting for potential confounders. Among 5,532 eligible women, we observed that maternal blood pressure in early gestation was significantly higher in women with low sleep efficiency (≤85%), long sleep duration (≥9 hours/night), and snoring. Compared with nonsnorers, snoring in early gestation was independently associated with preeclampsia (OR = 1.72 (95% CI: 1.09, 2.73) for snoring once or twice per week; OR = 2.06 (95% CI: 1.01, 4.31) for snoring 3 or more times per week), particularly for term preeclampsia (OR = 1.79 (95% CI: 1.08, 2.95) and 2.26 (95% CI: 1.03, 4.95), respectively). Results suggest that snoring in early gestation may be a significant risk factor for preeclampsia, with a dose-response pattern.

The Association between Sleep and Depression during Late Pregnancy and the Early Postpartum Period

Objective  To assess and correlate sleep quality and depressed mood symptoms in the late pregnancy and early postpartum periods. Study Design  In a prospective pilot observational study, participants completed the Pittsburgh Sleep Quality Index (PSQI) and the Edinburgh Postnatal Depression Scale (EPDS) questionnaires at delivery, 1, and 2 months postpartum. Pearson's correlation coefficients and PROC MIXED function estimated overall correlation for repeated measures. Results  Twenty-six women were enrolled with a mean gestational age at delivery of 38.4 (± 2.4) weeks. Sleep quality and mood data were available at the three time points for 24, 16, and 11 participants, respectively. Poor sleep scores were noted by 75.0, 87.5, and 72.7% of women at the three time points. An elevated EPDS score of 10 or higher was claimed by 20.8, 12.5, and 18.2% of women, respectively. Higher PSQI scores were positively associated with higher EPDS scores overall ( r  = 0.71, p  < 0.001) and at each of the individual time points ( r  = 0.79, p  < 0.0001; r  = 0.52, p  = 0.04; and r  = 0.70, p  = 0.016, respectively). None of the women reporting good sleep quality had elevated EPDS scores. Conclusion  Poor sleep is commonly reported around delivery, and at 1 and 2 months postpartum, and there is an association between poor sleep and depression symptoms.

Improvements in cardiovascular health over the perinatal period predicts lower postpartum psychological distress

Background

Adverse cardiovascular events during pregnancy (e.g., pre-eclampsia) occur at higher rates among individuals with pre-pregnancy overweight or obesity (body mass index [BMI]≥25kg/m2) and have been associated with postpartum depression. However, it is unclear whether cardiovascular health (CVH), defined more holistically than the absence of cardiovascular conditions in pregnancy, relates to postpartum psychological functioning. The present study examined whether changes in CVH during the perinatal period predicted postpartum psychological functioning among individuals with pre-pregnancy BMI≥25kg/m2.

Methods

Individuals (N=226; Mage=28.43±5.4 years; MBMI=34.17±7.15kg/m2) were recruited when their pregnancies were 12-20 weeks gestation (M=15.64±2.45 weeks) for a longitudinal study of health and well-being. Participants completed the Center for Epidemiological Studies Depression Scale (CES-D) and Perceived Stress Scale (PSS) and reported on CVH behaviors (dietary intake, physical activity, nicotine exposure, and sleep) at baseline and at 6-months postpartum. BMI and CVH behaviors were coded according to the American Heart Association's Life's Essential 8 to create a CVH score at both timepoints. Linear regression analyses were performed to examine whether change in CVH related to postpartum CES-D and PSS scores. Because sleep was only measured in a subset of participants (n=114), analyses were conducted with and without sleep included. Baseline CVH, CES-D and PSS scores, and demographic factors were included as covariates in all models.

Results

Improved CVH was associated with lower postpartum CES-D (β=-0.18, p<0.01) and PSS (β=-0.13, p=0.02) scores when excluding sleep. Compared to those whose CVH improved by >1SD from pregnancy to 6-months postpartum, individuals whose CVH worsened by >1SD scored 6.42 points higher on the CESD (MCESD=15.25±10.92 vs. 8.52±6.90) and 6.12 points higher on the PSS (MPSS=24.45±8.29 vs. 17.83±8.70). However, when including sleep, these relationships were no longer significant (ps>0.4).

Conclusions

Improvements in CVH from early pregnancy to 6-months postpartum were associated with lower postpartum depressive symptoms and perceived stress. However, these relationships were no longer significant when including sleep in the CVH metric, potentially due to the large reduction in sample size. These data suggest that intervening during pregnancy to promote CVH may improve postpartum psychological functioning among high-risk individuals.

Predictors of maternal satisfaction with labor induction: A prospective observational cohort study

OBJECTIVE

To identify independent predictors of maternal satisfaction with labor induction.

METHOD

In this prospective observational cohort study, 769 women prior to their labor induction had sleep and psychological well-being assessed using Pittsburgh Sleep Quality Index and Depression, Anxiety and Stress Scales. Women were asked about the adequacy of labor induction information provided and their involvement and time pressure felt in the decision-making for their labor induction. Maternal characteristics, induction and intrapartum care measures, and labor and neonatal outcomes were also assessed. Prior to discharge, women rated their satisfaction with their birth experience.

RESULTS

A total of 34 variables were considered for bivariate analysis, with 15 found to have P < 0.05. Following adjusted analysis, 10 independent predictors of maternal satisfaction were identified: maternal education, previous cesarean delivery, maternal involvement, information provided, and decision-making time pressure regarding labor induction, amniotomy, induction to delivery interval, mode of delivery, postpartum hemorrhage, and neonatal admission. Maternal satisfaction was not associated with sleep, depression, anxiety, or stress.

CONCLUSION

The identification of independent predictors of maternal satisfaction allows for patient selection, targeting of specific preinduction and intrapartum care, and focus on induction methods that can reduce induction to delivery interval, cesarean birth, and delivery blood loss to maximize women's satisfaction with labor induction.

How do infant feeding method, sleeping location, and postpartum depression interact with maternal sleep quality?

New mothers generally experience poor and/or disrupted sleep. A range of infant care and mental health factors may impact new mothers' sleep quality. A cross-sectional online survey was completed by a sample of 101 Australian new mothers with children under 12 months (M = 5.52 months, SD = 3.29 months) to examine the relationship between infant feeding method, infant sleeping location, and postpartum depression with maternal sleep quality. Subjective maternal sleep quality was measured using the Pittsburgh Sleep Quality Index (PSQI), and postpartum depression was measured using the Edinburgh Postpartum Depression Scale (EPDS). Overall, new mothers experienced poor subjective sleep quality, with high average PSQI scores, above the cut-off of 5 (M = 9.63, SD = 4.07). The majority of new mothers did not experience postpartum depression, with an average EPDS score below the cut-off of 11 (8.66, SD = 5.20). Mothers who breastfed their infants experienced significantly better subjective sleep quality than mothers who bottle-fed, with a medium effect size (ηp2 = 0.458). Subjective maternal sleep quality did not differ based on infant sleeping location. Poor subjective maternal sleep quality was a significant predictor of postpartum depression. While poor sleep was common in this sample of Australian new mothers, this study demonstrated that new mothers who breastfeed may experience slightly better subjective sleep quality than other feeding methods. Further research into, and better services for the education and advocation of, new mothers' sleep quality will be beneficial to both new mothers and clinicians.

A Feasibility Study to Assess Sleep and Subsequent Breast Milk Volume Among Mothers With Hospitalized Preterm Infants

BACKGROUND

Sleep is essential for optimal health, and disturbed postpartum sleep is associated with compromised infant attachment. The postpartum experience of mothers with preterm infants is unlike the biological norm, as they are separated from their infants and often express breast milk.

PURPOSE

The purpose of this study was to examine the feasibility of conducting a clinical research study among women with hospitalized preterm infants. We also explored for associations between maternal sleep patterns and sleep-related psychological states and subsequent breast milk volume.

METHODS

Participants were recruited from Magee-Womens Hospital, located in Pittsburgh, Pennsylvania New mothers completed daily sleep and pumping logs and scales to measure stress, trauma, depression, fatigue, and sleep quality.

RESULTS

A total of 78 women were screened, 18 women consented, and a total of 8 participants completed the study. Screening from the postpartum unit increased recruitment. The participants experience worsening sleep quality over time, moderate stress, and fatigue. Stress, postnatal depression, and fatigue are negatively associated with milk volume.

IMPLICATIONS FOR PRACTICE AND RESEARCH

Postpartum recruitment with frequent follow-ups improved recruitment and retention. We present a preliminary association between maternal stress, fatigue, and depression, and subsequent breast milk volume. Sleep-related psychological states may negatively influence milk volume.

Postpartum Insomnia and Poor Sleep Quality Are Longitudinally Predictive of Postpartum Mood Symptoms

OBJECTIVE

Insomnia and poor sleep quality are frequently reported by perinatal women. Both are noted to increase the risk of postpartum depression, with less known about their association with postpartum anxiety. This study sought to assess whether perinatal sleep disturbances predicted depression and anxiety symptoms across each month of the first 6 months postpartum in women with a history of depression.

METHODS

Pregnant women without active depression at enrollment ( N = 159), 18 to 45 years of age, were recruited. In late pregnancy and for up to 6 months postpartum, women completed monthly online questionnaires including the Insomnia Symptom Questionnaire, Pittsburgh Sleep Quality Index, Edinburgh Postnatal Depression Scale, and Generalized Anxiety Disorder-7. Repeated-measures multilevel models were used to predict depression and anxiety across the postpartum.

RESULTS

The prevalence of insomnia was 20.4%, and the prevalence of poor sleep quality was 67.8% across the first 6 months postpartum. Postpartum insomnia and poor sleep quality at the between-subject and within-subject levels tended to uniquely predict greater depressive and anxiety symptoms, even after controlling for demographic characteristics, prenatal insomnia, and prenatal poor sleep quality.

CONCLUSIONS

Most of the women in our sample had sleep disturbances across the perinatal period. Consistent with the extant literature, postpartum insomnia and poor sleep quality, but not prenatal measures of sleep, longitudinally predicted greater postpartum depression and anxiety symptoms. The chronic sleep deprivation of insomnia and the subjective experience of poor sleep quality are uniquely relevant risks of postpartum mood disorders. Evaluation and mitigation of perinatal sleep disturbance are ideal opportunities to reduce postpartum mood disorders and subsequent health outcomes.

Exposure to ambient air pollution and metabolic kidney diseases: evidence from the Northeast China Biobank

BACKGROUND

At present, there is no epidemiological evidence of the association between metabolic kidney diseases (MKD) and exposure to air pollution.

METHODS

We investigated the association between exposure to long-term air pollution and the risk of developing MKD using samples from the Northeast China Biobank.

RESULTS

Data from 29 191 participants were analyzed. MKD prevalence was 3.23%. Every standard deviation increment in PM2.5 increased the risk of MKD [odds ratio (OR) = 1.37, 95% confidence interval (CI) 1.19-1.58), diabetic kidney disease (DKD) (OR = 2.03, 95% CI 1.52-2.73), hypertensive kidney disease (BKD) (OR = 1.31, 95% CI 1.11-1.56), hyperlipidemic kidney disease (PKD) (OR = 1.39, 95% CI 1.19-1.63) and obese kidney disease (OKD) (OR = 1.34, 95% CI 1.00-1.81). PM10 increased the risk of MKD (OR = 1.42, 95% CI 1.20-1.67), DKD (OR = 1.38, 95% CI 1.03-1.85), BKD (OR = 1.30, 95% CI 1.07-1.58) and PKD (OR = 1.50, 95% CI 1.26-1.80). Sulfur dioxide increased the risk of MKD (OR = 1.57, 95% CI 1.34-1.85), DKD (OR = 1.81, 95% CI 1.36-2.40), BKD (OR = 1.44, 95% CI 1.19-1.74) and PKD (OR = 1.72, 95% CI 1.44-2.04). Ozone decreased the risk of PKD (OR = 0.83, 95% CI 0.70-0.99). Age, ethnicity and air pollution interacted to affect the risk of MKD, BKD and PKD. Associations between air pollution and CKD or metabolic disease were weaker than those with MKD. The association between air pollution and MKD became stronger when compared with participants with non-metabolic disease.

CONCLUSIONS

Air pollution may cause MKD or facilitate the progression from metabolic disease to renal failure.

Positive affect improves a transdiagnostic model of perinatal depression symptoms

INTRODUCTION

Accurate measurement of perinatal depression is vital. We aimed to 1) test whether a factor that measured positive affect (PA) bettered a transdiagnostic model of depression symptoms and 2) replicate the model in a second sample.

METHODS

We conducted secondary analyses from two samples (n's = 657 and 142) of women in treatment at perinatal psychiatric clinics. Data were derived from items from seven commonly used measures. We compared fit indices from our original factor model-one general and six specific factors derived from the Research Domain Criteria (Loss, Potential Threat, Frustrative Nonreward, and Sleep-Wakefulness) and depression literatures (Somatic and Coping)-to our novel factor model with a PA factor. The PA factor was created by recategorizing items that measured affective states with a positive valence into a new factor. Sample 1 data were split into six perinatal periods.

RESULTS

In both samples, the addition of a PA factor improved model fit. At least partial metric invariance was found between perinatal periods, with the exception of trimester 3 - postpartum period 1.

LIMITATIONS

Our measures did not operationalize PA in the same way as in the positive valence system in RDoC and we were unable to perform longitudinal analyses on our cross-validation sample.

CONCLUSIONS

Clinicians and researchers are encouraged to consider these findings as a template for understanding symptoms of depression in perinatal patients, which can be used to guide treatment planning and the development of more effective screening, prevention, and intervention tools to prevent deleterious outcomes.

Sleep quality in women with diabetes in pregnancy: a single-center retrospective study

PURPOSE

Sleep quality is an important indicator of individual quality of life, which not only affects people's mental health but is also closely related to the occurrence of many diseases. Sleep disorders associated with diabetes in pregnancy can greatly endanger the health of both mothers and babies, and their hazards are strongly associated with blood glucose levels. This study explored the quality of sleep and sleep disorders in pregnant women with diabetes.

METHODS

From June 2020 to July 2021, a total of 693 patients diagnosed with diabetes during pregnancy in Gansu Provincial Maternal and Child Health Hospital were used as the experiment group, including 626 patients with gestational diabetes mellitus (GDM) and 67 patients with pregestational diabetes mellitus (PGDM). At the same time, 709 women not having diabetes were randomly selected as the control group. To obtain the general situation of the participants, the participants were surveyed using the Pittsburgh Sleep Quality Index (PSQI) and the STOP-BANG (S, Snoring; T, Tiredness; O, Observed apnea; P, high blood Pressure; B, Body mass index > 35 kg/ m2; A, Age > 50 years; N, Neck circumference > 40 cm; G, male Gender) questionnaire. The differences in sleep quality and obstructive sleep apnea-hypopnea syndrome (OSAHS) were analyzed between the experiment group and the control group by using chi-square and t-test, and the clinical features and related factors of sleep disorder were analyzed.

RESULTS

Compared with the control group, the age, pre-pregnancy weight, body mass index (BMI), and neck circumference were larger in the experimental group (P < 0.05). The experimental group had higher PSQI scores for sleep quality, time to fall asleep score, sleep duration, sleep efficiency, sleep disorder, and daytime dysfunction than the control group (all P < 0.001). Specific analysis of the clinical features of sleep disorders indicated that the experimental group scored higher than the control group (P < 0.05). The analysis of the types of daytime dysfunction showed that the experiment group scored higher in terms of frequently feeling sleepy and lack of energy to do things than the control group (P < 0.05). Analysis of STOP-BANG scores indicated that the proportion of patients with GDM or PGDM having fatigue, hypertension, BMI > 35 kg/m2, and neck circumference > 40 cm was higher than that in the control group (P < 0.05). According to regression analysis, sleep quality of patients with GDM was significantly impacted by the increases in age (OR: 1.243, CI:1.197-1.290), neck circumference (OR: 1.350, CI: 1.234-1.476), PSQI score (OR: 2.124, CI:1.656-2.724), and sleep efficiency score (OR: 3.083, CI:1.534-6.195), whereas that of patients with PGDM was impacted by age (OR: 1.191, CI:1.086-1.305), neck circumference (OR: 1.981, CI: 1.469-2.673), and PSQI score (OR: 7.835, CI: 2.383-25.761).

CONCLUSIONS

Pregnant women with diabetes had poorer sleep quality and a higher risk of developing OSAHS than those without diabetes. There may be some link between sleep quality and the onset of diabetic.

Effects of Two Physical Activity Interventions on Sleep and Sedentary Time in Pregnant Women

Pregnancy is often associated with poor sleep and high sedentary time (SED). We investigated the effect of physical activity (PA) interventions on sleep and SED in pregnant women. A secondary analysis of a randomized controlled trial (n = 219) explored the effect of structured supervised exercise training (EXE) or motivational counseling on PA (MOT) compared to standard prenatal care (CON) on sleep and SED during pregnancy. Three times during pregnancy, sleep was determined by the Pittsburgh Sleep Quality Index (PSQI) and SED by the Pregnancy Physical Activity Questionnaire (PPAQ). Also, a wrist-worn consumer activity tracker measured sleep and SED continuously. Data from the activity tracker confirmed that sleep time decreases, and SED increases by approx. 30 and 24 min/day, respectively, from baseline (maximum gestational age (GA) week 15) to delivery. Compared to CON, the global PSQI score was better for EXE in GA week 28 (-0.8 [-1.5; -0.1], p = 0.031) and for both EXE and MOT in GA week 34 (-1 [-2; -0.5], p = 0.002; -1 [-2; -0.1], p = 0.026). In GA week 28, SED (h/day) from PPAQ was lower in EXE compared to both CON and MOT (-0.69 [-1; -0.0], p = 0.049; -0.6 [-1.0; -0.02], p = 0.042). In conclusion, PA interventions during pregnancy improved sleep quality and reduced SED.

Factorial Structure and Psychometric Properties of the Spanish Version of the Pittsburgh Sleep Quality Index in Non-Professional Caregivers

Although sleep issues are among the symptoms commonly experienced by the non-professional caregiver population, and the Pittsburgh Sleep Quality Index (PSQI) is the most widely used instrument for the assessment of sleep quality, this has not been validated specifically for this population. The objective of this study was to analyze the factorial structure and psychometric properties of the Spanish version of the PSQI in a sample of Spanish non-professional caregivers. Trained clinical psychologists assessed sleep quality using the PSQI, as well as caregiver burden and psychological distress in 201 non-professional caregivers (87.1% female, Mage = 56.2 years). The internal consistency of the PSQI was 0.75. The two-factor model (Sleep quality and Disturbances) had an acceptable fit to the data, was found to be superior to the one-factor model, and more parsimonious than the three-factor model. There was a significant correlation between the PSQI and caregiver burden, as well as between the PSQI and psychological distress (p < 0.001 in all cases). A total score ≥ 9 allowed the identification of caregivers with possible anxiety and depression disorders (sensitivity 70.5%, specificity 71.9%). The results show that the PSQI is a reliable and valid instrument for the assessment of sleep quality in caregivers.

Modifiable Maternal Factors and Their Relationship to Postpartum Depression

The purpose of the study was to examine how modifiable maternal factors (body mass index (BMI), household income, fatigue, sleep, breastfeeding status, diet, and physical activity) relate to postpartum depression (PPD) at 6 and 12 months postpartum. Participants (n = 26) participated in two study visits (6 and 12 months postpartum) where vitals, weight, body composition (skinfold anthropometrics), and physical activity levels (Actigraph GTX9 accelerometer) were assessed. Validated instruments (BRUMS-32, Subjective Exercise Experience Scale, Pittsburg Sleep Quality index, NIH breastfeeding survey, NIH Dietary History Questionnaire, and Edinburg Postnatal Depression Scale) assessed lifestyle and demographic factors of interest. PPD at six months was correlated to PPD at 12 months (r = 0.926, p < 0.001). At six months postpartum, PPD was positively correlated to BMI (r = 0.473, p = 0.020) and fatigue (r = 0.701, p < 0.001), and negatively correlated to household income (r = -0.442, p = 0.035). Mothers who were breastfeeding had lower PPD scores (breastfeeding 3.9 ± 3.5 vs. not breastfeeding 7.6 ± 4.8, p = 0.048). At 12 months, PPD was positively correlated to sleep scores (where a higher score indicates poorer sleep quality) (r = 0.752, p < 0.001) and fatigue (r = 0.680, p = 0.004). When analyzed collectively via regression analyses, household income and fatigue appeared to be the strongest predictors of PPD at six months postpartum.

Racial/ethnic disparities in subjective sleep duration, sleep quality, and sleep disturbances during pregnancy: an ECHO study

In the United States, racial/ethnic minoritized groups experience worse sleep than non-Hispanic Whites (nHW), but less is known about pregnant people. This is a key consideration since poor sleep during pregnancy is common and associated with increased risk of adverse perinatal outcomes. This study reports the prevalence of subjective sleep measures in a multi-racial/ethnic pregnant population from the Environmental influences on Child Health Outcomes (ECHO) program. Participants' self-reported race and ethnicity were grouped into: nHW, non-Hispanic Black/African American (nHB/AA), Hispanic, non-Hispanic Asian (nHA). Analyses examined trimester-specific (first (T1), second (T2), third (T3)) nocturnal sleep duration, quality, and disturbances (Pittsburgh Sleep Quality Index and ECHO maternal sleep health questionnaire). Linear or multinomial regressions estimated the associations between race/ethnicity and each sleep domain by trimester, controlling for body mass index and age, with nHW as reference group. We repeated analyses within maternal education strata. nHB/AA participants reported shorter sleep duration (T2: β = -0.55 [-0.80,-0.31]; T3: β = -0.65 [-0.99,-0.31]) and more sleep disturbances (T2: β = 1.92 [1.09,2.75]; T3: β = 1.41 [0.09,2.74]). Hispanic participants reported longer sleep duration (T1: β = 0.22 [0.00004,0.44]; T2: β = 0.61 [0.47,0.76]; T3: β = 0.46 [0.22,0.70]), better sleep quality (Reference group: Very good. Fairly good T1: OR = 0.48 [0.32,0.73], T2: OR = 0.36 [0.26,0.48], T3: OR = 0.31 [0.18,0.52]. Fairly bad T1: OR = 0.27 [0.16,0.44], T2: OR = 0.46 [0.31, 0.67], T3: OR = 0.31 [0.17,0.55]), and fewer sleep disturbances (T2: β = -0.5 [-1.0,-0.12]; T3: β = -1.21 [-2.07,-0.35]). Differences persisted within the high-SES subsample. Given the stark racial/ethnic disparities in perinatal outcomes and their associations with sleep health, further research is warranted to investigate the determinants of these disparities.

Comparison of factor structures of the Pittsburgh sleep quality index between mid- and late pregnancy among Korean women: a cross-sectional study

Background

Sleep disturbance in pregnant women needs to be accurately assessed in a timely manner during pregnancy, to receive assessment-driven accurate intervention. This study aims to compare the factor structure of the Pittsburgh Sleep Quality Index (PSQI) among women in mid- and late pregnancy and evaluate the psychometric features of the Korean version of the PSQI.

Methods

The survey questionnaire with the PSQI, Center for Epidemiological Studies Depression scale, and pregnancy stress, was completed by 281 women in mid- or late pregnancy. Exploratory factor analysis determined the best factor structure of the PSQI, and the Pearson correlation coefficient examined a convergent validity with depressive symptoms and pregnancy stress. Internal consistency was examined using Cronbach’s alpha.

Results

In both mid- and late-pregnancy women, a two-factor structure model was identified. However, each factor’s different components were named differently. For women in mid-pregnancy, it was named “quantitative sleep quality” and “subjective sleep quality,” and for those in later stages of pregnancy, they were named “perceived sleep quality” and “daily disturbance.” The PQSI score showed a significantly positive correlation between depressive symptoms and pregnancy stress in mid- (r = 0.57 and r = 0.39, respectively), and late pregnancy (r = 0.48 and 0.28, respectively). The overall Cronbach’s alpha for the PSQI was 0.63.

Conclusions

The Korean version of the PSQI demonstrated excellent construct and convergent validity, making it suitable to assess the sleep quality of women in middle to late stages of their pregnancy. The PSQI was found to have a two-factor structure in the mid-and late pregnancy, but the components were different. As sleep quality changes with each gestational stage, factors affecting it during mid- and late pregnancy need to be separately examined. It will make it easier for medical professionals to provide pregnant women sleeping irregularly, with the right kind of intervention.

Glycemic response to acute high-intensity interval versus moderate-intensity continuous exercise during pregnancy

The present study investigated the glycemic response to an acute high-intensity interval training (HIIT) session (10 one-minute intervals ≥90% HRmax interspersed with one-minute of active recovery) versus a moderate-intensity continuous training (MICT) session (30 min at 64%-76% HRmax ) during pregnancy. Twenty-four normoglycemic females with a singleton pregnancy (27.8 ± 4.7 weeks of gestation, 31.5 ± 4.1 years of age, body mass index: 25.2 ± 11.3) participated in a randomized crossover design study. A flash glucose monitor and accelerometer were worn continuously for 7 days recording glycemic response, physical activity, and sleep. Nutritional intake and enjoyment of the exercise were self-reported. Average heart rate during exercise was higher for HIIT (82 ± 4% HRmax ) compared with MICT (74 ± 4% HRmax ; p < 0.001) and participants achieved a peak heart rate of 92 ± 3% during HIIT (range 85%-97% HRmax ) compared with 81 ± 4% during MICT (p < 0.001). The change in glucose values from pre-to-postexercise were not different between conditions (HIIT: -0.62 ± 1.00 mmol/L; MICT: -0.81 ± 1.05 mmol/L; p = 0.300) with the exception that fewer individuals experienced postexercise hypoglycemia immediately following HIIT compared with MICT (8% versus 33% respectively; p = 0.041). Other glucose variables was not different between exercise protocols. Physical activity (p = 0.07) and caloric intake did not differ (p = 0.10). The majority of participants preferred HIIT (87.5%) and had greater perceived enjoyment compared to MICT (HIIT: 7.8 ± 1.5; MICT: 6.6 ± 2.0; p = 0.015). Sleep duration was 52 ± 73 min longer after participating in HIIT compared with the night prior (main effect for time p = 0.017); no significant changes for MICT. Overall, an acute session of HIIT appears to be well tolerated and demonstrates no adverse effects on maternal glycemic response.

Associations between childhood maltreatment, poor sleep, and prenatal distress in pregnant adolescents

Childhood maltreatment (CM) is a known risk factor for adolescent pregnancy. Sleep disturbances and psychological distress, both common negative sequelae of CM, often co-occur during pregnancy, although directionality remains unclear. Furthermore, little is known about how CM affects sleep-distress associations during pregnancy. In pregnant adolescents, we examined: (a) whether there are significant predictive associations from CM to sleep quality and distress and (b) bidirectional influences of distress and sleep quality. Healthy pregnant adolescents (n = 204) were recruited before or during the 2nd trimester. CM was assessed at enrollment; sleep quality and distress were assessed in the 2nd and 3rd trimesters. Hypotheses were tested using path analysis. Findings revealed that CM was associated with worse 2nd trimester sleep quality and distress (β = .19, p < .05 for sleep; β = .30, p < .001 for distress). Higher levels of 2nd trimester distress were associated with lower 3rd trimester sleep quality (β = .19, p < .05). Findings provide novel information about (a) associations from CM to prenatal mood and sleep in pregnant adolescents, and (b) sleep-distress directionality over the course of pregnancy. These results have implications for better understanding the ways in which CM potentially exerts influences later in life, and for targeting interventions to address physical and mental health during pregnancy.

Ultra-Processed Food Consumption during Pregnancy and Its Association with Maternal Oxidative Stress Markers

Ultra-processed food (UPF) consumption during gestation may lead to increased oxidative stress (OS) and could affect pregnancy outcomes. This study aims to evaluate the association of UPF consumption during pregnancy with circulating levels of OS markers. Diet was assessed (average of three assessments) in 119 pregnant women enrolled in the OBESO perinatal cohort (Mexico), obtaining quantitative data and the percentage of energy that UPFs (NOVA) contributed to the total diet. Sociodemographic, clinical (pregestational body-mass index and gestational weight gain) and lifestyle data were collected. Maternal circulating levels of OS markers (malondialdehyde (MDA), protein carbonylation (PC), and total antioxidant capacity (TAC)) were determined at the third trimester of pregnancy. Adjusted linear regression models were performed to analyze the association between UPFs and OS markers. UPFs represented 27.99% of the total energy intake. Women with a lower UPF consumption (<75 percentile°) presented a higher intake of fiber, ω-3, ω-6, and a lower ω-6/3 ratio. Linear regression models showed that UPFs were inversely associated with TAC and MDA. Fiber intake was associated with PC. UPF intake during pregnancy may result in an increase in oxidative stress. When providing nutrition care, limiting or avoiding UPFs may be an intervention strategy that could promote a better antioxidant capacity in the body.

Evaluation of the Effect of Supervised Group Exercise on Self-Reported Sleep Quality in Pregnant Women with or at High Risk of Depression: A Secondary Analysis of a Randomized Controlled Trial

Poor sleep quality is common during pregnancy. Our objective was to evaluate the effect of supervised group physical exercise on self-reported sleep quality in pregnant women with or at high risk of depression, and secondly, to describe the association between sleep quality and psychological well-being during pregnancy and postpartum. This was a secondary analysis of a randomized controlled trial (n = 282) (NCT02833519) at Rigshospitalet, Denmark. Sleep quality was evaluated using the Pittsburgh Sleep Quality Index (PSQI), psychological well-being by the five-item WHO Well-Being Index (WHO-5). The intention-to-treat analysis showed no difference in mean global PSQI score neither at 29−34 weeks, 6.56 (95% CI: 6.05−7.07) in the intervention group and 7.00 (95% CI: 6.47−7.53) in the control group, p = 0.2, nor at eight weeks postpartum. Women with WHO-5 ≤ 50 reported higher mean global PSQI scores at baseline, 7.82 (95% CI: 7.26−8.38), than women with WHO-5 score > 50, mean 5.42 (95% CI: 5.02−5.82), p < 0.0001. A significant difference was also present post-intervention and eight weeks postpartum. No significant effect of group exercise regarding self-reported sleep quality was seen at 29−34 weeks of gestation or postpartum. Low psychological well-being was associated with poor sleep quality during pregnancy and postpartum.

Association between depressive symptoms and poor sleep quality among pregnant women in Northern Rural Bangladesh: a community-based cross-sectional study

BACKGROUND

Adequate good quality of sleep is essential for physical fitness during pregnancy as well as being a depressive symptoms-free mind. However, there is little evidence of the relationship between depressive symptoms and poor sleep quality among pregnant women in Bangladesh. This study aimed to find the association between depressive symptoms and poor sleep quality among pregnant women in northern rural Bangladesh.

METHODS

A community-based cross-sectional study was carried out from May 2021 to June 2021 among 481 pregnant women tested positive in the pregnancy test of Jaldhaka and Dimla Upazila of Nilphamari district, Rangpur Division. Data were collected with a structured questionnaire including socio-demographic conditions, sleep quality, and depressive symptoms, comprising the Pittsburgh Sleep Quality Index (PSQI) and the Patient Health Questionnaire- 9 (PHQ-9).

RESULTS

8.94% of the women had depressive symptoms, whereas 38.88% of the participants were bad sleepers. However, women who had depressive symptoms [Adjusted odds ratio (AOR) = 2.55; 95% CI 1.33-4.9] and educational qualifications above 10 years [AOR = 0.60; 95% CI: 0.39-0.92] were associated with poor sleep quality.

CONCLUSIONS

A higher percentage of pregnant women had poor sleep quality, whereas depressive symptoms and academic background of the participants were significantly associated with poor sleep quality. Ensuring adequate sleep time and better quality could be helpful to prevent depressive symptoms.

The Protective Role of Physical Fitness on Cardiometabolic Risk During Pregnancy: The GESTAtion and FITness Project

Physical fitness (PF) is a cornerstone of metabolic health. However, its role in maternal-fetal metabolism during pregnancy is poorly understood. The present work investigates: (i) the association of PF with maternal and fetal cardiometabolic markers, and with clustered cardiometabolic risk during pregnancy, and (ii) whether being fit counteracts cardiometabolic abnormalities associated with overweight/obesity. Several PF components (flexibility, lower and upper body strength, and cardiorespiratory fitness [CRF]) were objectively assessed in 151 pregnant women at gestational weeks 16 and 33, and an overall PF cluster score calculated. At the same times, maternal glycemic and lipid markers, cortisol, and C-reactive protein were assessed with standard biochemical methods, along with blood pressure and a proxy for insulin resistance, and a cardiometabolic risk cluster score determined. These analytes were also measured in maternal and umbilical cord arterial and venous blood collected at delivery. PF was found to be associated with several maternal and a small number of fetal cardiometabolic markers (p < .05). Lower and upper body muscle strength, CRF, overall PF (week 16), and CRF changes (weeks 16-33) were inversely associated with clustered cardiometabolic risk (p < .05). Normal weight fit women had lower values for insulin level, insulin resistance, triglycerides, low-density lipoprotein cholesterol, C-reactive protein, and diastolic blood pressure than did overweight/obese unfit women at week 16 (p < .05). In conclusion, greater PF, especially muscle strength and CRF in early-middle pregnancy, appears to be associated with a better metabolic phenotype, and may protect against maternal cardiometabolic risk. "Keep yourself fit and normal weight before and during early pregnancy" should be a key public health message.

The prevalence and correlates of peripartum depression in different stages of pregnancy during COVID-19 pandemic in China

BACKGROUND

Peripartum depression in and after pregnancy are common, reported by 11.9% of women worldwide, and the proportion was even higher during the outbreak of coronavirus disease 2019 (COVID-19). We aimed to investigate the prevalence and risk factors of peripartum depression under the influence of COVID-19 in China.

METHODS

Using a cross-sectional design, 2026 pregnant and postpartum women residing in Beijing, Wuhan, and Lanzhou of China were recruited from February 28 to April 9, 2020. The Patient Health Questionnaire-9 was used to assess their depressive symptoms. The women were divided into four subgroups based on pregnancy stage, and a binary logistic regression analysis was conducted on each subgroup.

RESULTS

Under the influence of COVID-19, the prevalence rate of peripartum depression among Chinese women was 9.7%. It was 13.6, 10.8, 7.9 and 7.3% in the first, second, third trimester and puerperium, respectively. Regression analysis showed that the influence of current pregnancy status on movement (Mild vs. No, aORs were 3.89, P < 0.001, 2.92, P = 0.003, 1.58, P = 0.150 in the three trimesters, respectively; Severe vs. No, aORs were 13.00, 20.45, 5.38 in the three trimesters, respectively, all P < 0.05), and worries and fears about childbirth (aORs were 2.46, 2.96, 2.50 in the three trimesters, respectively, all P < 0.05) were associated with depression throughout pregnancy.

CONCLUSIONS

The prevalence rate of peripartum depression during the COVID-19 outbreak in China was not higher than usual. The influence of current pregnancy status on movement, as well as worries and fears about childbirth were independent risk factors for peripartum depression throughout pregnancy during COVID-19. The stage of pregnancy should be considered when implementing interventions.

Association of Poor Sleep With Depressive and Anxiety Symptoms by HIV Disease Status: Women's Interagency HIV Study

BACKGROUND

Sleep disturbances are prevalent in women living with HIV (WLWH) and can affect mental health and overall quality of life. We examined the prevalence and predictors of poor sleep quality in a US cohort of WLWH and HIV-uninfected controls and the relationship between sleep quality and mental health symptom burden stratified by HIV disease status (viremic WLWH, aviremic WLWH, and HIV-uninfected women).

METHODS

Sleep quality was assessed using the Pittsburgh Sleep Quality Index in 1583 (400 viremic WLWH, 723 aviremic WLWH, and 460 HIV-uninfected women) Women's Interagency HIV Study participants. Depressive and anxiety symptoms were concurrently assessed using the Center for Epidemiological Studies-Depression (CES-D) scale and General Anxiety Disorder (GAD-7) scale. Associations between poor sleep quality (global Pittsburgh Sleep Quality Index >5) and both high depressive (CES-D ≥16) and anxiety (GAD-7 ≥10) symptoms were each assessed by HIV disease status using multivariable logistic regression models.

RESULTS

Prevalence of poor sleep quality in the overall sample was 52%, differed by HIV disease status (P = 0.045), and was significantly associated with high depressive and anxiety symptoms in (1) viremic WLWH, (2) aviremic WLWH, and (3) HIV-uninfected women [CES-D: (1) adjusted odds ratio (aOR) = 7.50, 95% confidence interval (CI): 4.10 to 13.7; (2) aOR = 4.54, 95% CI: 3.07 to 6.73; and (3) aOR = 6.03, 95% CI: 3.50 to 10.4; GAD-7: (1) aOR = 5.20; 95% CI: 2.60 to 10.4, (2) aOR = 6.03; 95% CI: 3.67 to 9.91, and (3) aOR = 6.24; 95% CI: 3.11 to 12.6].

CONCLUSIONS

Poor sleep quality is highly prevalent, as is mental health symptom burden, among WLWH and HIV-uninfected controls. Future longitudinal studies are necessary to clarify the directionality of the relationship.

Sleep quality and health among pregnant smokers

STUDY OBJECTIVES

We aimed to examine 1) sleep quality trends of pregnant smokers and 2) their associations with health outcomes.

METHODS

A secondary analysis of 88 participants from the University at Buffalo Pregnancy and Smoking Cessation Study (non-randomized clinical study) was performed. Sleep quality was measured with the Pittsburgh Sleep Quality Index (PSQI) (higher scores, worse quality) and sleep duration was self-reported repeatedly during pregnancy at pre-intervention, post-intervention, and end-of-pregnancy visits. Participants were divided into 3 groups (until pre-intervention, until post-intervention, until end-of-pregnancy). Maternal outcomes included gestational weight gain (GWG) and smoking cessation. Infant outcomes included birth weight, gestational age, and APGAR score.

RESULTS

There was a significant increase (P= 0.046) in PSQI score from post-intervention (mean, 5.5 [SD, 2.6]) to end-of-pregnancy (6.6 [SD, 2.8]). Mean GWG was significantly lower for participants with poor sleep quality than those with good sleep quality (19.0 kg [SD, 21.3] vs. 36.1 kg [SD, 22.8]; P=0.008). Newborns with poor maternal sleep quality had a significantly lower mean 5-minute APGAR score (8.1 [SD, 1.3] vs. 9.0 [SD, 0.0]; P=0.021) than newborns with good maternal sleep quality. Pre-intervention sleep quality was not associated with smoking cessation, birth weight, or gestational age. Smoking cessation was almost half as prevalent in participants with insufficient sleep (<7 hours/night) vs. sufficient sleep duration (47.4% vs. 92.3%, P=0.011).

CONCLUSIONS

Sleep quality worsened towards the end-of-pregnancy among smokers. Poor sleep might negatively influence GWG and APGAR score. Insufficient pre-intervention sleep might negatively influence smoking cessation.

The Ava bracelet for collection of fertility and pregnancy data in free-living conditions: An exploratory validity and acceptability study

Objective

To evaluate the validity and acceptability of the Ava bracelet for collecting heart rate, sleep, mood, and physical activity data among reproductive-aged women (pregnant and nonpregnant) under free-living conditions.

Methods

Thirty-three participants wore the Ava bracelet on their non-dominant wrist and reported mood and physical activity in the Ava mobile application for seven nights. Criterion validity was determined by comparing the Ava bracelet heart rate and sleep duration measures to criterion measures from the Polar chest strap and ActiGraph GTX3 + accelerometer. Construct validity was determined by comparing self-report measures and the heart rate variability ratio collected in the Ava mobile application to previously validated measures. Acceptability was evaluated using the modified Acceptability of Health Apps among Adolescents Scale.

Results

Mean absolute percentage error was 11.4% for heart rate and 8.5% for sleep duration. There was no meaningful difference between the Ava bracelet, ActiGraph, and construct a measure of sleep quality. Compared to construct measures, Ava bracelet heart rate variability had a significant low negative correlation (r:−0.28), mood had a significant low positive correlation (r : 0.39), and physical activity level had a significant low (r_{level of physical activity}: 0.56) to moderate positive correlation (r_{MET−minutes/week}: 0.71). The acceptability of the Ava bracelet was high for fertility and low for pregnancy tracking.

Conclusion

Preliminary evidence suggests the Ava bracelet and mobile application estimates of sleep and heart rate are not equivalent to criterion measures in free-living conditions. Further research is needed to establish its utility for collecting prospective, subjective data throughout periods of preconception and pregnancy.

Circadian misalignment measured by social jetlag from early to late pregnancy and its association with nutritional status: a longitudinal study

A mismatch between circadian and social clocks leads to a circadian misalignment, which has been widely measured by social jetlag (SJL). There are several studies measuring SJL, but it has not been studied in pregnant women. Therefore, this study aimed to identify the occurrence of SJL throughout pregnancy and to verify whether there is an effect of pre-pregnancy body mass index (BMI) on SJL throughout pregnancy. The baseline of the present study was conducted with 205 1st trimester pregnant women of whom 100 were followed in their 2nd and 3rd trimester. SJL was calculated based on the absolute difference between mid-sleep time on workdays versus work-free days. The pre-pregnancy BMI and current BMI (kg/m²) were calculated. Linear regression and Generalised Estimating Equation (GEE) adjusted for confounders were used to determine the association between SJL and the gestational trimesters (time), and anthropometric variables. Most of the pregnant women (54.5%) presented SJL > 1 h in the first gestational trimester. We also found an isolated effect of the gestation trimester on the SJL mean. In this sense, pregnant women had a decrease in SJL from the second to the third trimester (1.33 ± 0.08 versus 1.12 ± 0.07, respectively; p = 0.012). GEE analyzes showed that pregnant women of a normal weight showed a decrease in SJL from the second to the third trimester (1.29 ± 0.11 and 0.93 ± 0.08, respectively, p = 0.032), but this was not found in the other groups of nutritional status (underweight, overweight and obesity). In addition, a positive association between SJL and pre-gestational BMI in the third trimester (β = 0.200, p = 0.046) was found. SJL is quite prevalent during the gestational period and excessive BMI both before and during pregnancy is associated with an increased risk of having SJL > 1 h in the third and second trimesters, respectively. In addition, pregnant women of normal weight—but not underweight or overweight—had decreased SJL from the second to the third trimester.

Reliability and Validity of the Czech Version of the Pittsburgh Sleep Quality Index in Patients with Sleep Disorders and Healthy Controls

Objectives

Psychometric properties of the Czech version of the Pittsburgh Sleep Quality Index (PSQI-CZ) have been evaluated only in patients with chronic insomnia, and thus, it is unclear whether PSQI-CZ is suitable for use in other clinical and nonclinical populations. This study was aimed at examining the validity and reliability of the PSQI-CZ and at assessing whether the unidimensional or multidimensional scoring of the instrument would be recommended.

Methods

A total of 524 adult subjects from the Czech population participated in the study. The internal consistency of PSQI was evaluated using Cronbach's alpha. The known-group validity was tested using the Kruskal-Wallis H test to verify the difference between patients with sleep disorders and healthy control sample. For testing the structural validity, a cross-validation approach was used with both exploratory factor analysis (EFA) and confirmatory factor analysis (CFA). For EFA, the maximum likelihood method with direct oblimin rotation and parallel analysis was used.

Results

The internal consistency of PSQI-CZ items was moderate (α = 0.75). Receiver operating characteristic (ROC) curve analysis showed high specificity (0.79) and moderate sensitivity (0.64) using an optimal cut-off score of 10. The EFA revealed a 3-factor structure with factors labelled as “sleep duration and efficiency,” “sleep disturbances and quality,” and “sleep latency.” The CFA showed that the emerged 3-factor model had a partly acceptable fit, which was better than other previously supported models.

Conclusions

A high cut-off score of 10 is recommended to define poor sleep quality. Given the inconsistency of structural analyses, alternative scoring was not recommended. However, the individual components in addition to a total score should be interpreted when assessing sleep quality. We recommend editing and verifying the PSQI-CZ translation.

Sleeping for two: study protocol for a randomized controlled trial of cognitive behavioral therapy for insomnia in pregnant women

BACKGROUND

Insomnia and sleep disturbances are common in pregnancy and have potentially significant consequences for both maternal and infant health. There is limited research examining the effectiveness of cognitive behavioral therapy for insomnia (CBT-I) during pregnancy. With increased distress and limited access to services during the COVID-19 pandemic, there is also an unprecedented need for telehealth delivery of treatment programs for pregnant women. The aims of this trial are to evaluate the impact of the Sleeping for Two adaptation of CBT-I in pregnancy (in-person or telehealth) versus treatment as usual (TAU) in reducing symptoms of insomnia (primary outcome), as well as increasing gestational length and reducing symptoms of depression (secondary outcomes).

METHODS

A two-arm, single-blinded, parallel group randomized controlled trial (RCT) design with repeated measures will be used to evaluate the impact of CBT-I compared to TAU among a sample of 62 pregnant women, enrolled between 12 and 28 weeks of gestation, who self-identify as experiencing insomnia. Five weekly individual sessions of CBT-I will be delivered in person or via telehealth depending on physical distancing guidelines. Assessment of insomnia diagnosis by structured interview, self-reported insomnia symptom severity and sleep problems, and sleep quantity and quality as measured by a daily diary and actigraphy will occur at 12-28 weeks of pregnancy (T1), 1 week post-treatment (T2), and 6 months postpartum (T3).

DISCUSSION

CBT-I delivered in pregnancy has the potential to reduce symptoms of insomnia and depression and could lead to reduced risk of preterm birth, all of which can minimize risk of negative maternal and child health and developmental consequences in the short (e.g., infant death) and long terms (e.g., developmental delays). This RCT builds on a successful open pilot trial conducted by our team and will provide further evaluation of a novel evidence-based treatment for pregnancy-related insomnia, which can be widely disseminated and used to treat individuals that are most in need of intervention. Findings will enhance understanding of pregnancy-related sleep problems, as well as means by which to improve the health and sleep of mothers and their children.

TRIAL REGISTRATION

ClinicalTrials.gov NCT03918057. Registered on 17 April 2019.

Sleep HAPi: A Feasibility and Descriptive Analysis of an Early and Longitudinal Sleep Education Intervention for Pregnant Women

Background: Poor sleep and prior depression are key predictors of perinatal depression, with research suggesting depressive symptoms may emerge in early pregnancy. Sleep is a potentially modifiable risk factor for depression. This pilot study examined the feasibility and acceptability of a six-month sleep education intervention designed to optimize sleep and minimize depressive symptoms throughout pregnancy. Sleep measures and depressive symptoms are described from 12 weeks gestation to 12 weeks postpartum.Participants: A community sample of nulliparous pregnant women with a history of depression were recruited prior to 14 weeks gestation.Methods: An individualized sleep education program was developed and participants engaged in three trimester specific sleep education sessions. Feasibility and acceptability were determined via recruitment and retention rates and participant feedback. Depressive symptoms and sleep were measured at five time points throughout the study.Results: 22 women enrolled in the study and 15 completed the intervention. Participants reported the intervention as highly acceptable. There was minimal change in all dimensions of sleep across pregnancy, but sleep measures were significantly worse at six weeks postpartum and improved by 12 weeks postpartum. Depressive symptoms were significantly lower at the conclusion of the intervention and 12 weeks postpartum compared to trimester 1.Conclusions: This sleep education program appears feasible, acceptable and may be effective in minimizing depressive symptoms in pregnant women with a history of depression. Trials with larger and more diverse samples are warranted and further studies to ascertain efficacy should be undertaken with a control group.

Postpartum Metabolism: How Does It Change from Pregnancy and What are the Potential Implications?

BACKGROUND

Metabolic dysfunction after pregnancy may have serious consequences for a new mother. The purpose of the study was to characterize basic changes that occur in metabolic profiles from late pregnancy through 4-6 months postpartum. A secondary purpose was to determine metabolic factors that may be contributing to postpartum weight retention.

METHODS

Participants (n=25) came in for 2 visits: late pregnancy (~34 weeks gestation) and postpartum (4-6 months). Resting metabolic rate (RMR), respiratory quotient (RQ), and substrate oxidation values were assessed for 15 minutes during fasted conditions. Blood was drawn and skinfold anthropometry was performed to assess additional outcomes (inflammation, insulin resistance, lipid profiles, body composition). The participants completed a number of surveys that examined other lifestyle and demographic data of interest. At the postpartum visit, additional assessments regarding sleep and breastfeeding habits were administered.

RESULTS

RMR was lower during postpartum (1517.2±225.1 kcal/day) compared to pregnancy (1867.9±302.6 kcal/day) (p<0.001), and remained lower when expressing RMR per kg body weight (postpartum: 22.3±2.7 vs pregnant: 23.7±3.4 kcal/kg, (p=0.034). Relative RMR (RMR per kg body weight) was negatively correlated to insulin resistance (HOMA-IR) during postpartum (r=-.463, p=0.034). Maternal HOMA-IR, inflammation (CRP), triglycerides (TAG), and carbohydrate oxidation were all positively correlated to postpartum weight retention (HOMA-IR: r=0.617, p=0.004; CRP: r=0.477, p=0.039, TAG: r=0.463, p=0.040; Carbohydrate Oxidation: (r=0.469, p=0.018).

CONCLUSION

Metabolic rate is lower during postpartum compared to pregnancy, and may be connected to insulin resistance. Maternal insulin resistance, inflammation, blood lipids, and substrate metabolism are all related to postpartum weight retention.

Exploring the mediating role of serum retinol-binding protein 4 in the relationship between sleep quality and insulin resistance in pregnant women

AIMS

We aimed to explore the mediating role of plasma retinol-binding protein 4 (RBP4) in the relationship between sleep quality and insulin resistance (IR) among pregnant women.

METHODS

We conducted a cross-sectional study including 263 pregnant women in the first trimester. Sleep quality was evaluated by Pittsburgh Sleep Quality Index (PSQI). The ELISA and homeostasis model assessment (HOMA) was used to analyze plasma RBP4 and estimate IR. The mediating model was used to analyze the mediating role of RBP4 in the relationship between PSQI score and IR.

RESULTS

In the multivariable linear regression model, the three terms were positively related with each other, PSQI score was positively associated with IR levels (β = 0.55, p < 0.05). In the mediating model, RBP4 levels mediated completely the relationship between PSQI scores and IR levels (β = 0.29, p < 0.0001). The indirect effect of RBP4 in the relation between sleep quality and IR explained 89.10% of total effect.

CONCLUSIONS

RPB4 may play a complete mediating role in the relation between sleep quality and insulin resistance in early pregnancy. Improvements in sleep quality in the first trimester may provide a pathway to reduce plasma RBP4, which is beneficial for less IR and GDM prevention.

Maternal Depressive Symptoms, Sleep, and Odds of Spontaneous Early Birth: Implications for Racial Inequities in Birth Outcomes

STUDY OBJECTIVES

Delivery prior to full term affects 37% of US births, including ~400,000 preterm births (<37 weeks) and >1,000,000 early term births (37-38 weeks). Approximately 70% of cases of shortened gestation are spontaneous - without medically-indicated cause. Elucidation of modifiable behavioral factors would have considerable clinical impact.

METHODS

This study examined the role of depressive symptoms and sleep quality in predicting the odds of spontaneous shortened gestation among 317 women (135 Black, 182 White) who completed psychosocial assessment in mid-pregnancy.

RESULTS

Adjusting for key covariates, Black women had 1.89 times higher odds of spontaneous shortened gestation compared to White women (OR (95% CI) = 1.89 (1.01, 3.53), p=0.046). Women who reported only poor subjective sleep quality (PSQI > 6) or only elevated depressive symptoms (CES-D ≥ 16) exhibited no statistically significant differences in odds of spontaneous shortened gestation compared to those with neither risk factor. However, women with comorbid poor sleep and depressive symptoms exhibited markedly higher odds of spontaneous shortened gestation than those with neither risk factor [39.2% versus 15.7%, [OR (95% CI) = 2.69 (1.27, 5.70), p = 0.01]. A higher proportion of Black women met criteria for both risk factors (23% of Black women versus 11% of White women; p=0.004), with a lower proportion experiencing neither risk factor (40.7% of Black versus 64.3% of White women; p < 0.001).

CONCLUSIONS

Additive effects of poor subjective sleep quality and depressive symptoms were observed with markedly higher odds of spontaneous shortened gestation among women with both risk factors. Racial inequities in rates of comorbid exposure corresponded with inequities in shortened gestation. Future empirical studies and intervention efforts should consider the interactive effects of these commonly co-morbid exposures.

Sleep quality according to the Pittsburgh Sleep Quality Index in over 7000 pregnant women in Poland

The aim was to assess sleep quality in pregnant women, characterize sleep patterns in each trimester and to establish independent risk factors of poor sleep quality during gestation. A cross-sectional survey was conducted. The questionnaire included questions regarding sociodemographic data, information on the current pregnancy, sleep patterns and Pittsburgh Sleep Quality Index. 7202 respondents fulfilled the survey completely and only those were included. A total of 95.1% of the respondents in the first trimester, 93% in the second trimester and 94.8% in the third trimester had poor sleep quality. Significantly more women with poor sleep quality assessed their socioeconomic status as bad or sufficient (15.7 vs 8.8%; p < 0.001), stress level as higher (mean 4.7 points vs 3.9 points; p < 0.001), had lower relationship rating (mean 8.8 points vs 9.3 points; p < 0.001) or suffered from depression and anxiety disorders. Logistic regression revealed pregnancy ailments to be the strongest independent risk factors of poor sleep quality during gestation. Sleep disorders are common among pregnant women in Poland and increase significantly as the pregnancy progresses. Developing and introducing a simple and easily available screening tool to assess sleep quality in common practice might improve the quality of the health care of pregnant women.

Objective sleep efficiency but not subjective sleep quality is associated with longitudinal risk of depression in pregnant women: A prospective observational cohort study

BACKGROUND

Sleep disturbances are one of the most frequent chief complaints brought to the healthcare professionals during routine prenatal care visits. Sleep and mood disturbances are often intertwined, and depression in particular is a leading cause of disability and disease burden worldwide with women more likely to be affected than men. However, limited studies have prospectively investigated the association between sleep disturbances and longitudinal risk of depression in pregnant women, with no studies using actigraphy to objectively estimate daytime and nighttime sleep duration and the extent of sleep disruption.

OBJECTIVES

To examine the predictive and longitudinal association of objective actigraphic and subjective sleep disturbances with depressive symptoms in pregnant women.

DESIGN

A prospective observational cohort study.

METHODS

204 1st trimester pregnant women recruited from a university-affiliated hospital provided socio-demographic and health information, wore a wrist actigraph for 7 days, and completed Pittsburgh Sleep Quality Index, Center for Epidemiologic Studies - Depression Scale, and Epworth Sleepiness Scale. Identical data collection procedures were implemented again in the 2nd and 3rd trimester, with each data collection scheduled at least 8 weeks apart. We estimated unadjusted and multivariable adjusted odds ratios and 95% confidence intervals to evaluate various types of sleep disturbances at 1st trimester and risk of depression at follow-ups.

RESULTS

121 (59.3%) 1st trimester women had a sleep efficiency of < 85% by actigraphy, and 92 (45.1%) had Pittsburgh Sleep Quality Index global scores > 5 indicative of poor sleep quality. In multivariable adjusted models, 1st trimester objectively measured sleep efficiency < 85% was associated with 2.71-, 3.87-, and 5.27-fold increased odds having risk of depression at 2nd trimester, 3rd trimester, and both 2nd and 3rd trimesters, respectively.

CONCLUSIONS

Healthy pregnant women experience both objective and subjective sleep disturbances during the early trimester, with a substantial proportion of them also having high depressive symptoms throughout the pregnancy. Objectively assessed poor sleep quality in the 1st trimester, but not self-reported characteristics of disturbed sleep, may play a role in the development of both elevated and persistent high depressive symptoms in pregnancy. Future studies using objective sleep measurements and clinical diagnostic interviews are warranted to examine whether an early intervention aiming at improving sleep may help reduce high depressive symptom risk and lower depression rate in women during pregnancy. Tweetable abstract: Objectively assessed poor sleep efficiency in the 1st trimester predicts both elevated and persistent high depressive symptoms in pregnancy.

Obstructive sleep apnea is associated with depressive symptoms in pregnancy

STUDY OBJECTIVES

In pregnancy, the prevalence of both obstructive sleep apnea (OSA) and depression increases. Research reveals an association in the general population with up to 45% of patients diagnosed with OSA having depressive symptoms. Therefore, this study aimed to investigate the relationship between OSA and depression in pregnant women.

METHODS

One hundred and eighty-nine women ≥26 weeks pregnant were recruited from a tertiary perinatal hospital. This cross-sectional study measured OSA (Apnea Hypopnea Index, AHI, using an ApneaLink device) and symptoms of depression (Edinburgh Postnatal Depression Scale, EPDS). Data were collected from medical records including participant age, ethnicity, parity, BMI, smoking status, history of depression, and use of antidepressants.

RESULTS

Of the consenting women, data from 124 were suitable for analysis. Twenty women (16.1%) had OSA (AHI ≥ 5 events/h) and 11 (8.8%) had depressive symptoms (EPDS > 12). Women with OSA were more likely to have depressive symptoms after adjusting for covariates, odds ratio = 8.36, 95% CI [1.57, 44.46]. OSA was also related to higher EPDS scores and these were greater in women with a history of depression.

CONCLUSIONS

During late pregnancy women with OSA had eight times the odds of having depressive symptoms. Furthermore, an interaction was found between OSA and history of depression. Specifically, in women with no history of depression, OSA increases depressive symptoms. In women with a history of depression, OSA has an even stronger effect on depressive symptomology. This suggests screening for OSA in pregnancy may identify women prone to future depressive episodes and allow for targeted interventions.

Demographic, Pregnancy-Related, and Health-Related Factors in Association with Changes in Sleep Among Pregnant Women with Overweight or Obesity

BACKGROUND

Women with prepregnancy overweight/obesity are at high risk for obstetric complications and cardiometabolic disease. Poorer sleep quality is associated with obesity in non-pregnant individuals and, during pregnancy, poor sleep predicts negative obstetric and health outcomes. This study examined sleep patterns among women with overweight/obesity and factors associated with different sleep trajectories during pregnancy.

METHODS

Women (N = 146, 17-40 years old) with a prepregnancy body mass index ≥ 25 kg/m2 were recruited during early pregnancy. Participants reported demographic information and completed the Pittsburgh Sleep Quality Index (PSQI) at up to six monthly assessments, with the first assessment occurring between 12 and 20 weeks gestation and the final assessment between 35 weeks gestation and delivery. PSQI scores > 5 indicate "poor sleep."

RESULTS

On average, women's PSQI scores were 6.66 ± 3.58 in the first half of pregnancy and were significantly higher (worse) at the end of pregnancy (t(644) = 4.55, p < 0.001), with the greatest change occurring in the third trimester (t(636.3) = 3.72, p < 0.001). Women who currently smoked had poorer sleep than women who did not currently smoke (t(1) = 2.29, p = 0.02). Prepregnancy weight status, age, parity, race, education, and income were not significantly associated with sleep changes (t(1) < 1.76, ps > 0.08). The percentage of women with PSQI scores > 5 (the threshold for poor sleep quality) was 37-63% across assessments, with the greatest increase occurring during the third trimester (t(633) = 2.92, p = 0.004).

CONCLUSIONS

Sleep quality worsens during the third trimester and is associated with current smoking. Future studies of sleep during pregnancy should examine health outcomes among women with overweight/obesity and early intervention to mitigate sleep disturbances as pregnancy progresses.

Structured supervised exercise training or motivational counselling during pregnancy on physical activity level and health of mother and offspring: FitMum study protocol

INTRODUCTION

A physically active lifestyle during pregnancy improves maternal and offspring health but can be difficult to follow. In Denmark, less than 40% of pregnant women meet physical activity (PA) recommendations. The FitMum study aims to explore strategies to increase PA during pregnancy among women with low PA and assess the health effects of PA. This paper presents the FitMum protocol, which evaluates the effects of structured supervised exercise training or motivational counselling supported by health technology during pregnancy on PA level and health of mother and offspring.

METHODS AND ANALYSIS

A single-site three-arm randomised controlled trial that aims to recruit 220 healthy, pregnant women with gestational age (GA) no later than week 15 and whose PA level does not exceed one hour/week. Participants are randomised to one of three groups: structured supervised exercise training consisting of three weekly exercise sessions, motivational counselling supported by health technology or a control group receiving standard care. The interventions take place from randomisation until delivery. The primary outcome is min/week of moderate-to-vigorous intensity PA (MVPA) as determined by a commercial activity tracker, collected from randomisation until GA of 28 weeks and 0-6 days, and the secondary outcome is gestational weight gain (GWG). Additional outcomes are complementary measures of PA; clinical and psychological health parameters in participant, partner and offspring; analyses of blood, placenta and breastmilk samples; process evaluation of interventions; and personal understandings of PA.

ETHICS AND DISSEMINATION

The study is approved by the Danish National Committee on Health Research Ethics (# H-18011067) and the Danish Data Protection Agency (# P-2019-512). Findings will be disseminated via peer-reviewed publications, at conferences, and to health professionals via science theatre performances.

TRIAL REGISTRATION NUMBER

NCT03679130.

PROTOCOL VERSION

This paper was written per the study protocol version 8 dated 28 August 2019.

Associations of Sleep With Sedentary Behavior and Physical Activity Patterns Across Pregnancy Trimesters

INTRODUCTION

Sleep, sedentary behavior, and moderate-to-vigorous physical activity (MVPA) are altered in pregnancy and may affect pregnancy health; however, how these behaviors are associated with each other is unclear.

METHODS

Pregnant women (N = 120) completed the Pittsburgh Sleep Quality Index and wore an activPAL3 micro and ActiGraph GT3X for 7 days in each trimester to assess sleep, sedentary behavior, and MVPA, respectively. Latent trajectories described patterns of sleep duration, efficiency, and quality as well as sedentary behavior and MVPA. Multinomial logistic regression examined associations of sleep patterns with sedentary behavior and MVPA patterns and, in exploratory analyses, with adverse pregnancy outcomes.

RESULTS

Trajectories were identified for sleep duration (consistently short, 20.7% of sample; consistently adequate, 79.3%), efficiency (consistently low, 17.5%; consistently high, 82.5%), and quality (consistently poor, 15.1%; worsening, 23.5%; and consistently good, 61.5%). Compared with those in more optimal sleep groups, women in the short duration, low efficiency, and worsening quality groups had lower odds of being in the moderate and/or high sedentary behavior group (odds ratio range, 0.21-0.31; 95% confidence interval range, 0.09-0.65). Women in the worsening quality group had greater odds of being in the low MVPA group (odds ratio, 2.51; 95% confidence interval, 1.18-5.38). Trends were observed with women in less optimal sleep groups having greater odds of adverse pregnancy outcomes and lower odds of excessive gestational weight gain.

CONCLUSIONS

Less optimal sleep patterns in pregnancy are associated with less sedentary behavior and MVPA; additional research is needed to confirm associations between sleep and pregnancy outcomes.

Measuring Subjective Sleep Quality: A Review

Sleep quality is an important clinical construct since it is increasingly common for people to complain about poor sleep quality and its impact on daytime functioning. Moreover, poor sleep quality can be an important symptom of many sleep and medical disorders. However, objective measures of sleep quality, such as polysomnography, are not readily available to most clinicians in their daily routine, and are expensive, time-consuming, and impractical for epidemiological and research studies., Several self-report questionnaires have, however, been developed. The present review aims to address their psychometric properties, construct validity, and factorial structure while presenting, comparing, and discussing the measurement properties of these sleep quality questionnaires. A systematic literature search, from 2008 to 2020, was performed using the electronic databases PubMed and Scopus, with predefined search terms. In total, 49 articles were analyzed from the 5734 articles found. The psychometric properties and factor structure of the following are reported: Pittsburgh Sleep Quality Index (PSQI), Athens Insomnia Scale (AIS), Insomnia Severity Index (ISI), Mini-Sleep Questionnaire (MSQ), Jenkins Sleep Scale (JSS), Leeds Sleep Evaluation Questionnaire (LSEQ), SLEEP-50 Questionnaire, and Epworth Sleepiness Scale (ESS). As the most frequently used subjective measurement of sleep quality, the PSQI reported good internal reliability and validity; however, different factorial structures were found in a variety of samples, casting doubt on the usefulness of total score in detecting poor and good sleepers. The sleep disorder scales (AIS, ISI, MSQ, JSS, LSEQ and SLEEP-50) reported good psychometric properties; nevertheless, AIS and ISI reported a variety of factorial models whereas LSEQ and SLEEP-50 appeared to be less useful for epidemiological and research settings due to the length of the questionnaires and their scoring. The MSQ and JSS seemed to be inexpensive and easy to administer, complete, and score, but further validation studies are needed. Finally, the ESS had good internal consistency and construct validity, while the main challenges were in its factorial structure, known-group difference and estimation of reliable cut-offs. Overall, the self-report questionnaires assessing sleep quality from different perspectives have good psychometric properties, with high internal consistency and test-retest reliability, as well as convergent/divergent validity with sleep, psychological, and socio-demographic variables. However, a clear definition of the factor model underlying the tools is recommended and reliable cut-off values should be indicated in order for clinicians to discriminate poor and good sleepers.