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Kiyoko M, Takayuki A, Kaoru F, Junko T, Kiwamu O, Kazuya M. Objective and self-reported assessment of sleep quality during each trimester of pregnancy: A prospective observational study. Eur J Obstet Gynecol Reprod Biol 2024; 300:296-301. [PMID: 39053090 DOI: 10.1016/j.ejogrb.2024.07.041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2024] [Revised: 07/18/2024] [Accepted: 07/21/2024] [Indexed: 07/27/2024]
Abstract
OBJECTIVES Studies on actual circumstances of sleep in pregnant women are limited to surveys of self-reported symptoms, and objective assessments are missing. Sleep disturbances due to hormonal imbalances are common during pregnancy. This study aimed to assess sleep quality by objective assessment using an actigraph and by self-reported assessment using a questionnaire for sleep during each trimester of pregnancy and to elucidate how sleep quality changed from the first to the third trimester of pregnancy. STUDY DESIGN A longitudinal questionnaire survey was administered and sleep measurements using an actigraph were recorded at three time points during the first, second, and third trimesters in primiparous women who had conceived naturally. RESULTS During the first trimester, "feeling of being refreshed when waking up in the morning" was not noted, and a decline was observed in mental function. During the second trimester, a positive correlation was observed between morning sickness and sleep quality. CONCLUSIONS Sleep quality was the worst during the third trimester, with the shortest total sleep time and poor sleep efficiency, along with poor physical function scores. Back pain and leg cramps significantly correlated with sleep efficiency in the third trimester. Poor sleep during pregnancy begins in the first trimester. If minor problems, such as morning sickness, continue in the second trimester, sleep quality is greatly affected. Furthermore, during the third trimester of pregnancy, low back pain and leg cramps are more likely to occur due to an increase in the abdominal area and may interfere with sleep.
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Affiliation(s)
- Miyauchi Kiyoko
- Program for Nursing Science, Ehime University Graduate School of Medicine, Toon, Ehime 791-0295, Japan.
| | - Abe Takayuki
- Faculty of Data Science, Kyoto Women's University, Higashiyama-ku, Kyoto 605-8501, Japan
| | - Fujimoto Kaoru
- Department of Nursing, Bunkyo Gakuin University, Bunkyo-ku, Tokyo 113-8668, Japan
| | - Tabata Junko
- Department of Nursing, Faculty of Medical Technology, Teikyo University, Itabashi-ku, Tokyo 173-8605, Japan
| | - Ohtaka Kiwamu
- Department of Obstetrics and Gynecology, Ohtaka Clinic, Ichikawa, Chiba 272-0826, Japan
| | - Makita Kazuya
- Department of Obstetrics and Gynecology, Makita Clinic, Niiza, Saitama 352-0021, Japan
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Na M, Shetty SS, Niu X, Hinkle SN, Zhang C, Gao X. Sleep duration, napping behaviors and restless legs syndrome during pregnancy and the trajectories of ultrasonographic measures of fetal growth: Findings from the NICHD Fetal Growth Studies-Singletons. Sleep Health 2024; 10:462-469. [PMID: 38862351 DOI: 10.1016/j.sleh.2024.04.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Revised: 04/15/2024] [Accepted: 04/18/2024] [Indexed: 06/13/2024]
Abstract
OBJECTIVES Given the plausible mechanisms and the lacking of empirical evidence, the study aims to investigate how gestational sleep behaviors and the development of sleep disorders, such as restless legs syndrome, influence ultrasonographic measures of fetal growth. METHODS The study included 2457 pregnant women from the NICHD Fetal Growth Studies - Singletons (2009-2013), who were recruited between 8-13 gestational weeks and followed up to five times during pregnancy. Women were categorized into six groups based on their total sleep hours and napping frequency. The trajectory of estimated fetal weight from 10-40weeks was derived from three ultrasonographic measures. Linear mixed effect models were applied to model the estimated fetal weight in relation to self-reported sleep-napping behaviors and restless legs syndrome status, adjusting for age, race and ethnicity, education, parity, prepregnancy body mass index category, infant sex, and prepregnancy sleep-napping behavior. RESULTS From enrollment to near delivery, pregnant women's total sleep duration and nap frequency declined and restless legs syndrome symptoms frequency increased generally. No significant differences in estimated fetal weight were observed by sleep-napping group or by restless legs syndrome status. Results remained similar in sensitivity analyses and stratified analyses by women's prepregnancy body mass index category (normal vs. overweight/obese) or by infant sex. CONCLUSIONS Our data indicate that there is no association between sleep during pregnancy-assessed as total sleep duration and napping frequency, nor restless legs syndrome symptoms-and fetal growth from weeks 10 to 40 in healthy pregnant women.
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Affiliation(s)
- Muzi Na
- Department of Nutritional Sciences, College of Health and Human Development, The Pennsylvania State University, University Park, Pennsylvania, USA
| | - Samidha Sudhakar Shetty
- Department of Mathematical Sciences, College of Letters and Science, Montana State University, Bozeman, Montana, USA
| | - Xiaoyue Niu
- Department of Statistics, Eberly College of Science, The Pennsylvania State University, University Park, Pennsylvania, USA
| | - Stefanie N Hinkle
- Department of Biostatistics, Epidemiology and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Cuilin Zhang
- Global Center for Asian Women's Health (GloW) and Bia-Echo Asia Centre for Reproductive Longevity and Equality (ACRLE), National University of Singapore, Singapore, Singapore; Department of Obstetrics and Gynecology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore; Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA.
| | - Xiang Gao
- Department of Nutrition and Food Hygiene, School of Public Health, Institute of Nutrition, Fudan University, Shanghai, China.
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Wu F, Sun L, Chen J, Du Y, Fan Z, Cao Z, Liu H, Lei X, Zhang F. Sleep quality during pregnancy and fetal growth: A prospective cohort study. J Sleep Res 2024:e14233. [PMID: 38768974 DOI: 10.1111/jsr.14233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2024] [Revised: 04/22/2024] [Accepted: 04/24/2024] [Indexed: 05/22/2024]
Abstract
The aim of this study is to investigate the association between sleep quality during pregnancy and fetal growth. Pregnant women and their fetuses at 16-20 gestational weeks in Nantong Maternal and Child Health Hospital were recruited. Women were classified as having "good sleep quality" (Pittsburgh Sleep Quality Index score ≤ 5) and "poor sleep quality" (Pittsburgh Sleep Quality Index score > 5) according to the Pittsburgh Sleep Quality Index scores. The fetal growth was evaluated by three ultrasonographic examinations, birth weight and birth length. We used general linear model and multiple linear regression models to estimate the associations. A total of 386 pairs of mother and infant were included in the data analysis. After adjusting for gestational weight gain, anxiety and depression, fetuses in the good sleep quality group had greater abdominal circumference (p = 0.039 for 28-31+6 weeks gestation, p = 0.012 for 37-40+6 weeks gestation) and femur length (p = 0.014 for 28-31+6 weeks gestation, p = 0.041for 37-40+6 weeks gestation) at 28-31+6 weeks gestation and 37-40+6 weeks gestation, and increased femur length (p = 0.007) at 28-31+6 weeks gestation. Birth weights (p = 0.018) were positively associated with sleep quality. Poor sleep quality was associated with poor intrauterine physical development, decreased abdominal circumference and femur length, and lower birth weight after adjusting for confounding factors. Attention to the fetal growth of pregnant women with poor sleep quality has the potential to decrease the risk of adverse fetal outcomes.
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Affiliation(s)
- Fan Wu
- School of Nursing and Rehabilitation, Nantong University, Nantong, China
- Jiangsu Vocational College of Medicine, Yancheng, China
| | - Li Sun
- School of Nursing and Rehabilitation, Nantong University, Nantong, China
| | - Jinhuang Chen
- School of Nursing and Rehabilitation, Nantong University, Nantong, China
| | - Yijuan Du
- School of Nursing and Rehabilitation, Nantong University, Nantong, China
| | - Zhanhong Fan
- School of Nursing and Rehabilitation, Nantong University, Nantong, China
| | - Zhiqiu Cao
- School of Nursing and Rehabilitation, Nantong University, Nantong, China
| | - Huahua Liu
- Affiliated Maternity and Child Health Care Hospital of Nantong University, Nantong, China
| | - Xiaoling Lei
- School of Nursing and Rehabilitation, Nantong University, Nantong, China
| | - Feng Zhang
- School of Nursing and Rehabilitation, Nantong University, Nantong, China
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Wang Y, Chen P, Wang J, Lin Q, Li H, Izci-Balserak B, Yuan J, Zhao R, Zhu B. Sleep health predicted glucose metabolism among pregnant women: A prospective cohort study. Diabetes Res Clin Pract 2024; 209:111570. [PMID: 38341040 DOI: 10.1016/j.diabres.2024.111570] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Revised: 01/23/2024] [Accepted: 02/05/2024] [Indexed: 02/12/2024]
Abstract
AIMS To examine whether sleep health in the first trimester could predict glucose metabolism in the second trimester. METHODS Pregnant women (N = 127) during the first trimester were recruited (August 2022 to March 2023). Overall sleep health was assessed by the Sleep Health Index. Various dimensions of sleep health were measured using a 7-day sleep diary and questionnaires. The outcomes, including diagnosis of gestational diabetes mellitus (GDM) and HbA1c, were obtained from the medical records in the second trimester. Poisson regression analysis and multiple linear regression were used for data analysis. RESULTS The average age of the participants was 32.6 years. The incidence of GDM was 28.3 % and the mean HbA1c was 5.2 % (33 mmol/mol). Sleep duration regularity (RR = 1.808; 95 %CI 1.023, 3.196) was associated with GDM after controlling for confounders. SHI total score (β = -0.278; 95 %CI -0.022, -0.005) and sleep duration regularity (β = 0.243; 95 %CI 0.057, 0.372) were associated with HbA1c. CONCLUSIONS Worse sleep health, particularly lower sleep regularity, predicted worse glucose metabolism among pregnant women. Healthcare professional may consider adding sleep-related assessment to prenatal care. Maintaining regular sleep should be encouraged. Studies examining the impact of sleep intervention on glucose metabolism among pregnant women are warranted.
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Affiliation(s)
- Yueying Wang
- School of Nursing, Shanghai Jiao Tong University, Shanghai, China
| | - Pei Chen
- College of Nursing, University of Illinois Chicago, Chicago, IL, USA
| | - Jinle Wang
- School of Nursing, Shanghai Jiao Tong University, Shanghai, China
| | - Qin Lin
- International Peace Maternity and Child Health Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Hong Li
- International Peace Maternity and Child Health Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | | | - Jinjin Yuan
- School of Nursing, Shanghai Jiao Tong University, Shanghai, China
| | - Ruru Zhao
- Shanghai First Maternity and Infant Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Bingqian Zhu
- School of Nursing, Shanghai Jiao Tong University, Shanghai, China.
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Nissen M, Barrios Campo N, Flaucher M, Jaeger KM, Titzmann A, Blunck D, Fasching PA, Engelhardt V, Eskofier BM, Leutheuser H. Prevalence and course of pregnancy symptoms using self-reported pregnancy app symptom tracker data. NPJ Digit Med 2023; 6:189. [PMID: 37821584 PMCID: PMC10567694 DOI: 10.1038/s41746-023-00935-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Accepted: 09/29/2023] [Indexed: 10/13/2023] Open
Abstract
During pregnancy, almost all women experience pregnancy-related symptoms. The relationship between symptoms and their association with pregnancy outcomes is not well understood. Many pregnancy apps allow pregnant women to track their symptoms. To date, the resulting data are primarily used from a commercial rather than a scientific perspective. In this work, we aim to examine symptom occurrence, course, and their correlation throughout pregnancy. Self-reported app data of a pregnancy symptom tracker is used. In this context, we present methods to handle noisy real-world app data from commercial applications to understand the trajectory of user and patient-reported data. We report real-world evidence from patient-reported outcomes that exceeds previous works: 1,549,186 tracked symptoms from 183,732 users of a smartphone pregnancy app symptom tracker are analyzed. The majority of users track symptoms on a single day. These data are generalizable to those users who use the tracker for at least 5 months. Week-by-week symptom report data are presented for each symptom. There are few or conflicting reports in the literature on the course of diarrhea, fatigue, headache, heartburn, and sleep problems. A peak in fatigue in the first trimester, a peak in headache reports around gestation week 15, and a steady increase in the reports of sleeping difficulty throughout pregnancy are found. Our work highlights the potential of secondary use of industry data. It reveals and clarifies several previously unknown or disputed symptom trajectories and relationships. Collaboration between academia and industry can help generate new scientific knowledge.
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Affiliation(s)
- Michael Nissen
- Machine Learning and Data Analytics (MaD) Lab, Department Artificial Intelligence in Biomedical Engineering, Friedrich-Alexander-Universität Erlangen-Nürnberg, Carl-Thiersch-Straße 2b, 91052, Erlangen, Bavaria, Germany.
| | - Nuria Barrios Campo
- Machine Learning and Data Analytics (MaD) Lab, Department Artificial Intelligence in Biomedical Engineering, Friedrich-Alexander-Universität Erlangen-Nürnberg, Carl-Thiersch-Straße 2b, 91052, Erlangen, Bavaria, Germany
| | - Madeleine Flaucher
- Machine Learning and Data Analytics (MaD) Lab, Department Artificial Intelligence in Biomedical Engineering, Friedrich-Alexander-Universität Erlangen-Nürnberg, Carl-Thiersch-Straße 2b, 91052, Erlangen, Bavaria, Germany
| | - Katharina M Jaeger
- Machine Learning and Data Analytics (MaD) Lab, Department Artificial Intelligence in Biomedical Engineering, Friedrich-Alexander-Universität Erlangen-Nürnberg, Carl-Thiersch-Straße 2b, 91052, Erlangen, Bavaria, Germany
| | - Adriana Titzmann
- Department of Gynecology and Obstetrics, Erlangen University Hospital, Friedrich-Alexander-Universität Erlangen-Nürnberg, Universitätsstraße 21/23, 91054, Erlangen, Bavaria, Germany
| | - Dominik Blunck
- Department of Health Management, Institute of Management, Friedrich-Alexander-Universität Erlangen-Nürnberg, Lange Gasse 20, 90403, Nürnberg, Bavaria, Germany
| | - Peter A Fasching
- Department of Gynecology and Obstetrics, Erlangen University Hospital, Friedrich-Alexander-Universität Erlangen-Nürnberg, Universitätsstraße 21/23, 91054, Erlangen, Bavaria, Germany
| | - Victoria Engelhardt
- Keleya Digital-Health Solutions GmbH, Max-Beer-Straße 25, 10119, Berlin, Germany
| | - Bjoern M Eskofier
- Machine Learning and Data Analytics (MaD) Lab, Department Artificial Intelligence in Biomedical Engineering, Friedrich-Alexander-Universität Erlangen-Nürnberg, Carl-Thiersch-Straße 2b, 91052, Erlangen, Bavaria, Germany
- Translational Digital Health Group, Institute of AI for Health, Helmholtz Zentrum München - German Research Center for Environmental Health, Ingolstädter Landstraße 1, 85764, Neuherberg, Bavaria, Germany
| | - Heike Leutheuser
- Machine Learning and Data Analytics (MaD) Lab, Department Artificial Intelligence in Biomedical Engineering, Friedrich-Alexander-Universität Erlangen-Nürnberg, Carl-Thiersch-Straße 2b, 91052, Erlangen, Bavaria, Germany
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Hawkins MS, Pokutnaya DY, Bodnar LM, Levine MD, Buysse DJ, Davis EM, Wallace ML, Zee PC, Grobman WA, Reid KJ, Facco FL. The association between multidimensional sleep health and gestational weight gain. Paediatr Perinat Epidemiol 2023; 37:586-595. [PMID: 37641423 PMCID: PMC10543452 DOI: 10.1111/ppe.13004] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2023] [Revised: 08/09/2023] [Accepted: 08/13/2023] [Indexed: 08/31/2023]
Abstract
BACKGROUND Although poor sleep health is associated with weight gain and obesity in the non-pregnant population, research on the impact of sleep health on weight change among pregnant people using a multidimensional sleep health framework is needed. OBJECTIVES This secondary data analysis of the Nulliparous Pregnancy Outcome Study: Monitoring Mothers-to-be Sleep Duration and Continuity Study (n = 745) examined associations between mid-pregnancy sleep health indicators, multidimensional sleep health and gestational weight gain (GWG). METHODS Sleep domains (i.e. regularity, nap duration, timing, efficiency and duration) were assessed via actigraphy between 16 and 21 weeks of gestation. We defined 'healthy' sleep in each domain with empirical thresholds. Multidimensional sleep health was based on sleep profiles derived from latent class analysis and composite score defined as the sum of healthy sleep domains. Total GWG, the difference between self-reported pre-pregnancy weight and the last measured weight before delivery, was converted to z-scores using gestational age- and BMI-specific charts. GWG was defined as low (<-1 SD), moderate (-1 or +1 SD) and high (>+1 SD). RESULTS Nearly 50% of the participants had a healthy sleep profile (i.e. healthy sleep in most domains), whereas others had a sleep profile defined as having varying degrees of unhealthy sleep in each domain. The individual sleep domains were associated with a 20%-30% lower risk of low or high GWG. Each additional healthy sleep indicator was associated with a 10% lower risk of low (vs. moderate), but not high, GWG. Participants with late timing, long duration and low efficiency (vs. healthy) profiles had the strongest risk of low GWG (relative risk 1.5, 95% confidence interval 0.9, 2.4). Probabilistic bias analysis suggested that most associations between individual sleep health indicators, sleep health profiles and GWG were biased towards the null. CONCLUSIONS Future research should determine whether sleep health is an intervention target for healthy GWG.
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Affiliation(s)
| | | | | | | | | | - Esa M. Davis
- University of Pittsburgh, Department of Medicine
| | | | | | | | | | - Francesca L. Facco
- University of Pittsburgh, Department of Obstetrics, Gynecology & Reproductive Sciences
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Hawkins MS, Conlon RK, Donofry S, Buysse DJ, Venditti EM, Cheng Y, Levine MD. Sleep characteristics modify the associations of physical activity during pregnancy and gestational weight gain. Arch Gynecol Obstet 2023; 308:101-109. [PMID: 35870008 PMCID: PMC11186598 DOI: 10.1007/s00404-022-06677-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Accepted: 06/14/2022] [Indexed: 11/02/2022]
Abstract
OBJECTIVE Excessive gestational weight gain (eGWG) is associated with adverse long-term maternal outcomes. Most lifestyle interventions that incorporate physical activity have been ineffective at reducing eGWG. The purpose of this study was to determine if sleep modified the relationships between physical activity change from the 2nd to 3rd trimester and the odds of excessive gestational weight gain (eGWG). METHODS This was a secondary data analysis of a prospective cohort study of pregnant birthing people with overweight or obesity (n = 105). We estimated physical activity energy expenditure (PAEE) in the 2nd and 3rd trimesters of pregnancy and sleep characteristics (i.e., sleep quality, daytime dysfunction, sleep efficiency, sleep duration) in the 2nd trimester of pregnancy with validated measures. We used regression models with sleep and PAEE change (increase/stable vs. decrease) interaction terms to examine the impact of sleep on PAEE change and eGWG. RESULTS Mean GWG was 37.02 ± 16.76 lbs. and 80% of participants experienced eGWG. Eighteen percent of participants increased their PAEE from the 2nd to the 3rd trimester. Increasing (vs. decreasing) PAEE was associated with lower log-odds of eGWG only among participants that slept at least 8 h/night (p = 0.06), had at least 85% sleep efficiency (p = 0.03), or reported less daytime dysfunction (p = 0.08). Sleep quality did not moderate the association between PAEE change and eGWG. CONCLUSIONS Weight management interventions in pregnancy should consider screening for and addressing poor sleep in the second trimester.
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Affiliation(s)
- Marquis S Hawkins
- Department of Epidemiology, University of Pittsburgh, 5138 Public Health, Pittsburgh, PA, 15261, USA.
| | - Rachel K Conlon
- Department of Psychiatry, University of Pittsburgh, 5138 Public Health, Pittsburgh, PA, 15261, USA
| | - Shannon Donofry
- Department of Psychology, University of Pittsburgh, 5138 Public Health, Pittsburgh, PA, 15261, USA
| | - Daniel J Buysse
- Department of Psychiatry, University of Pittsburgh, 5138 Public Health, Pittsburgh, PA, 15261, USA
| | - Elizabeth M Venditti
- Department of Psychiatry, University of Pittsburgh, 5138 Public Health, Pittsburgh, PA, 15261, USA
| | - Yu Cheng
- Department of Statistics, University of Pittsburgh, 5138 Public Health, Pittsburgh, PA, 15261, USA
| | - Michele D Levine
- Department of Psychiatry, University of Pittsburgh, 5138 Public Health, Pittsburgh, PA, 15261, USA
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Wang Y, Yuan J, Lin Q, Wang J, Li H, Zhu B. Psychometric evaluation of the Chinese version of Sleep Health Index in pregnant women. Midwifery 2023; 122:103703. [PMID: 37119671 DOI: 10.1016/j.midw.2023.103703] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Revised: 04/18/2023] [Accepted: 04/21/2023] [Indexed: 05/01/2023]
Abstract
OBJECTIVE The aim of this study was to investigate the psychometric properties of the Chinese version of the Sleep Health Index (SHI-C) among pregnant women. DESIGN Cross-sectional design. SETTING Outpatient clinic of three hospitals in China. PARTICIPANTS Pregnant women (N = 264) aged between 18 and 45 years were recruited via convenience sampling. METHODS The Pittsburgh Sleep Quality Index (PSQI), Epworth Sleepiness Scale (ESS) and Insomnia Severity Index (ISI) were used to measure sleep quality, daytime sleepiness, and insomnia, respectively. The Fatigue Assessment Scale (FAS) and the Edinburgh Postnatal Depression Scale (EPDS) were used to measure fatigue and depression, respectively. Structural validity was assessed via confirmatory factor analysis (CFA). Concurrent and convergent validity were assessed using bivariate correlation analyses. Known-group validity was assessed by comparing the SHI-C score between different groups. Cronbach's α was calculated for reliability. FINDINGS The average sample age was 30.6 years old and their average score of SHI-C was 86.4 (SD 8.2). Based on PSQI, ISI, and ESS, 43.6%, 32.2%, and 26.9% had poor sleep quality, insomnia, and excessive daytime sleepiness, respectively. The SHI-C total and sleep quality sub-index scores had moderate to strong correlations with both PSQI (r=-0.542, p<0.01; r=-0.648, p<0.01) and ISI (r=-0.692, p<0.01; r=-0.752, p<0.01). The SHI-C total and sleep quality sub-index scores were significantly associated with ESS, FAS, and EPDS (r=-0.171 to -0.276; p<0.01). The SHI-C total score was higher in the second trimester and among those who were working, never drank coffee, or took a nap every day. The Cronbach's α of the SHI-C total and the sleep quality sub-index were 0.723 and 0.806, respectively. The Cronbach's α of sleep duration and disordered sleep sub-indices were 0.594 and 0.545, respectively. KEY CONCLUSIONS Overall, the SHI-C has good validity and acceptable reliability among the pregnant population in China. It can be a useful tool for the assessment of sleep health. More research is warranted to refine the sleep duration and disordered sleep sub-indices. IMPLICATIONS FOR PRACTICE The use of SHI-C would facilitate the assessment of sleep health among pregnant women, which could contribute to the promotion of perinatal care.
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Affiliation(s)
- Yueying Wang
- School of Nursing, Shanghai Jiao Tong University, Shanghai, China
| | - Jinjin Yuan
- School of Nursing, Shanghai Jiao Tong University, Shanghai, China
| | - Qin Lin
- International Peace Maternity and Child Health Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jinle Wang
- School of Nursing, Shanghai Jiao Tong University, Shanghai, China
| | - Hong Li
- International Peace Maternity and Child Health Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Bingqian Zhu
- School of Nursing, Shanghai Jiao Tong University, Shanghai, China.
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Hawkins MS, Pokutnaya DY, Bodnar LM, Levine MD, Buysse DJ, Davis EM, Wallace ML, Zee PC, Grobman WA, Reid KJ, Facco FL. The association between multidimensional sleep health and gestational weight gain: nuMoM2b Sleep Duration and Continuity Study. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2023:2023.02.21.23285931. [PMID: 36891291 PMCID: PMC9994039 DOI: 10.1101/2023.02.21.23285931] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/26/2023]
Abstract
Background Although poor sleep health is associated with weight gain and obesity in the non-pregnant population, research on the impact of sleep health on weight change among pregnant people using a multidimensional sleep-health framework is needed. This study examined associations among mid-pregnancy sleep health indicators, multidimensional sleep health, and gestational weight gain (GWG). Methods We conducted a secondary data analysis of the Nulliparous Pregnancy Outcome Study: Monitoring Mothers-to-be Sleep Duration and Continuity Study (n=745). Indicators of individual sleep domains (i.e., regularity, nap duration, timing, efficiency, and duration) were assessed via actigraphy between 16 and 21 weeks of gestation. We defined "healthy" sleep in each domain based on empirical thresholds. Multidimensional sleep health was based on sleep profiles derived from latent class analysis. Total GWG, the difference between self-reported pre-pregnancy weight and the last measured weight before delivery, was converted to z-scores using gestational age- and BMI-specific charts. GWG was defined as low (<-1 SD), moderate (-1 or +1 SD), and high (>+1 SD). Results Nearly 50% of the participants had a healthy sleep profile (i.e., healthy sleep in most domains), whereas others had a sleep profile defined as having varying degrees of poor health in each domain. While indicators of individual sleep domains were not associated with GWG, multidimensional sleep health was related to low and high GWG. Participants with a sleep profile characterized as having low efficiency, late timing, and long sleep duration (vs. healthy sleep profile) had a higher risk (RR 1.7; 95% CI 1.0, 3.1) of low GWG a lower risk of high GWG (RR 0.5 95% CI 0.2, 1.1) (vs. moderate GWG). Conclusions Multidimensional sleep health was more strongly associated with GWG than individual sleep domains. Future research should determine whether sleep health is a valuable intervention target for optimizing GWG. Synopsis Study question: What is the association between mid-pregnancy multidimensional sleep health and gestational weight gain?What's already known?: Sleep is associated with weight and weight gain outside of pregnancyWhat does this study add?: We identified patterns of sleep behaviors associated with an increased risk of low gestational weight gain.
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Wirth MD, Liu J, Wallace MK, McLain AC, Turner-McGrievy GM, Davis JE, Ryan N, Hébert JR. Dietary Inflammatory Index and sleep quality and duration among pregnant women with overweight or obesity. Sleep 2022; 45:zsac241. [PMID: 36173829 PMCID: PMC9742888 DOI: 10.1093/sleep/zsac241] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Revised: 08/31/2022] [Indexed: 12/15/2022] Open
Abstract
STUDY OBJECTIVES Sleep disturbances, which can worsen during pregnancy, have been linked to inflammatory processes. This study tested the hypothesis that more pro-inflammatory diets during pregnancy are associated with a decrease in sleep quality and shorter sleep duration. METHODS The Health in Pregnancy and Postpartum study promoted a healthy lifestyle in pregnant women with pre-pregnancy overweight or obesity (n = 207). Data from <16 weeks and 32 weeks gestation were used. Sleep was measured using BodyMedia's SenseWear® armband. Diet was assessed using two 24-hr dietary recalls. Energy-density Dietary Inflammatory Index (E-DIITM) scores were calculated from micro and macronutrients. Linear mixed-effects models estimated the impact of the E-DII score on sleep parameters. RESULTS Women with more pro-inflammatory diets, compared to those with more anti-inflammatory diets, were more likely to be nulliparous (51% vs. 25%, p = 0.03), frequent consumers of fast food (29% vs. 10% consuming on 4-6 days during the previous week, p = 0.01), ever-smokers (21% vs. 6%, p = 0.02), and younger (mean age 29.2 vs. 31.3 years, p = 0.02). For every one-unit increase (i.e., more pro-inflammatory) in the E-DII score, sleep latency increased by 0.69 min (p < 0.01). Among European Americans only, every one-unit higher E-DII was associated with a 2.92-min longer wake-after-sleep-onset (p = 0.02). CONCLUSION An E-DII score that is 5 points lower (i.e., more anti-inflammatory) would equate to about 105 min of additional sleep per week among European American women. Anti-inflammatory diets may help to counteract detriments in sleep during pregnancy, especially among European American women. Additional work is needed among African American women. CLINICAL TRIALS IDENTIFIER Name: Promoting Health in Pregnancy and Postpartum (HIPP); URL: https://clinicaltrials.gov/ct2/show/NCT02260518; Registration Identifier: NCT02260518.
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Affiliation(s)
- Michael D Wirth
- College of Nursing, University of South Carolina, Columbia, SC, United States
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, SC, United States
- Cancer Prevention and Control Program, University of South Carolina, Columbia, SC, United States
| | - Jihong Liu
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, SC, United States
| | - McKenzie K Wallace
- School of Nursing, University of Pittsburgh, Pittsburgh, PA, United States
| | - Alexander C McLain
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, SC, United States
| | - Gabrielle M Turner-McGrievy
- Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, SC, United States
| | - Jean E Davis
- College of Nursing, University of South Carolina, Columbia, SC, United States
| | - Nicole Ryan
- Department of Exercise Science, Arnold School of Public Health, University of South Carolina, Columbia, SC, United States
| | - James R Hébert
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, SC, United States
- Cancer Prevention and Control Program, University of South Carolina, Columbia, SC, United States
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11
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Abstract
PURPOSE OF REVIEW This article will provide a brief review of most recent findings of sleep, insomnia, obstructive sleep apnea, and restless leg syndrome during pregnancy. RECENT FINDINGS Recent meta-analyses have found that 38.2% of pregnant women experience insomnia, 15% experience obstructive sleep apnea, and 20% experience restless leg syndrome. Poor sleep during pregnancy is associated with increased odds of preterm birth, cesarean section, hypertension, gestational diabetes, and longer deliveries. OSA is also associated with poor outcomes such as maternal hypertension, gestational diabetes, preterm birth, and low infant Apgar score. Incidence of new-onset RLS increases with parity, gestational age, maternal age, and increased maternal adiposity. Typical treatments have been found to be effective for treating sleep disorders in pregnant women. Obtaining sufficient sleep quality and quantity in addition to assessing and treating sleep disorders should be a priority for pregnant women and their providers.
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Affiliation(s)
- Jessica M Meers
- Department of Medicine, Baylor College of Medicine, Houston, USA.,Center of Innovation in Quality, Effectiveness, and Safety, Michael E. DeBakey Veterans Affairs Medical Center, 2450 Holcombe Blvd., Suite 01Y, Houston, TX, 77030, USA.,South Central Mental Illness Research Education Clinical Center, Department of Veterans Affairs, Houston, USA
| | - Sara Nowakowski
- Department of Medicine, Baylor College of Medicine, Houston, USA. .,Center of Innovation in Quality, Effectiveness, and Safety, Michael E. DeBakey Veterans Affairs Medical Center, 2450 Holcombe Blvd., Suite 01Y, Houston, TX, 77030, USA. .,South Central Mental Illness Research Education Clinical Center, Department of Veterans Affairs, Houston, USA.
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12
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El-Sherbeeny N, El Tantawy A, Ibrahim O, Elsayed M, El-Okda N, Hassan H. Insomnia and sleep quality among women during the perinatal period. MIDDLE EAST CURRENT PSYCHIATRY 2022. [DOI: 10.1186/s43045-022-00209-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Insomnia is the most common sleep disorder affecting sleep quality and quality of life among women during the perinatal period. The aim of the study is to study the frequency of insomnia and sleep quality among perinatal women and their effect on quality of life: 131 participants; 64 perinatal and 67 control groups from the outpatient clinics of Suez Canal University Hospital, Ismailia, Egypt. DSM-5 criteria were used to diagnose insomnia. Sleep quality was assessed using PSQI, and SF-36 questionnaire was used for assessment of health-related quality of life.
Results
Insomnia was statistically significant higher among the perinatal group than the control; 28.1% and 10.4%, respectively (P < 0.05). The perinatal women had poor sleep quality as compared with the control group with a higher mean global PSQI score; 8.02 ± 2.97 and 4.97 ± 2.45, respectively (P < 0.05). The quality of life in the perinatal group was lower than the control group with scores of 54.96 ± 14.63 versus 62.34 ± 14.63, respectively.
Conclusions
Insomnia and poor sleep quality are found in higher frequency in perinatal women than their counterpart control. The study also showed a significant impact of these changes on maternal HRQoL.
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13
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Simanovski J, Ralph J. A Scoping Review of the Literature on Sleep Quality in Adult Lung Transplant Recipients. Prog Transplant 2022; 32:88-100. [PMID: 35301887 DOI: 10.1177/15269248221087439] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Introduction: Lung transplant recipients face challenging postoperative complications and are at risk for poor sleep quality. Sleep quality, as a complex clinical phenomenon, has multiple subjective and objective connotations. Measures and definitions of sleep quality are not standardized. Objective: A scoping review methodology was used to systematically map the relevant literature, provide an overview of available sleep quality measures, and to identify knowledge gaps. Methods: A systematic search of published and gray literature enabled knowledge synthesis of the last 10 years of evidence documenting sleep quality in lung transplant recipients. The search revealed 246 articles with only 12 sources meeting the eligibility criteria. Results: Sources varied in terms of definitions and measures of sleep quality. Subjective, objective, or a combination of both measures were used across the relevant literature with findings confirming that poor sleep quality was common in lung transplant recipients. Significant associations with poor sleep quality included younger age, female gender, exposure to tacrolimus, anxiety, and depression. Discussion: Systematic literature assessing sleep quality in lung transplant recipients is sparse and lacks conceptual and operational definitions. Future research can focus on designing prospective observational studies. Subjective and objective measures for sleep quality need to be validated in lung transplant recipients. Further rigorous research is needed to standardize measures of sleep quality and to further examine potential risk factors that affect sleep after lung transplantation.
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Affiliation(s)
- Jane Simanovski
- Transplant Institute, Henry Ford Hospital, Detroit, MI, USA.,Faculty of Nursing, 8637University of Windsor, Windsor, Ontario, Canada
| | - Jody Ralph
- Faculty of Nursing, 8637University of Windsor, Windsor, Ontario, Canada
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14
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Signal TL, Sweeney BM, Muller DP, Ladyman CI, Wu L, Paine SJ. Moe Kura: a longitudinal study of mother and child sleep and well-being in Aotearoa New Zealand. J R Soc N Z 2022. [DOI: 10.1080/03036758.2022.2051569] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Affiliation(s)
- Tracey Leigh Signal
- Sleep/Wake Research Centre, School of Health Sciences, College of Health, Massey University, Wellington, New Zealand
| | - Bronwyn Marie Sweeney
- Sleep/Wake Research Centre, School of Health Sciences, College of Health, Massey University, Wellington, New Zealand
| | - Diane Patricia Muller
- Sleep/Wake Research Centre, School of Health Sciences, College of Health, Massey University, Wellington, New Zealand
| | - Clare Iona Ladyman
- Sleep/Wake Research Centre, School of Health Sciences, College of Health, Massey University, Wellington, New Zealand
| | - Lora Wu
- Sleep/Wake Research Centre, School of Health Sciences, College of Health, Massey University, Wellington, New Zealand
- Department of Psychiatry and Human Behavior, Brown University, Providence, RI, USA
| | - Sarah-Jane Paine
- Te Kupenga Hauora Māori, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
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15
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Ladyman C, Gander P, Huthwaite M, Sweeney B, Signal TL. Sleep HAPi: A Feasibility and Descriptive Analysis of an Early and Longitudinal Sleep Education Intervention for Pregnant Women. Behav Sleep Med 2021; 19:427-444. [PMID: 32497446 DOI: 10.1080/15402002.2020.1772265] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
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.
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Affiliation(s)
- Clare Ladyman
- Sleep/Wake Research Centre, College of Health, Massey University, Wellington, New Zealand
| | - Philippa Gander
- Sleep/Wake Research Centre, College of Health, Massey University, Wellington, New Zealand
| | - Mark Huthwaite
- Department of Psychological Medicine, University of Otago, Wellington, New Zealand
| | - Bronwyn Sweeney
- Sleep/Wake Research Centre, College of Health, Massey University, Wellington, New Zealand
| | - T Leigh Signal
- Sleep/Wake Research Centre, College of Health, Massey University, Wellington, New Zealand
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16
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Vietheer A, Kiserud T, Lie RT, Haaland ØA, Kessler J. Sleep and physical activity from before conception to the end of pregnancy in healthy women: a longitudinal actigraphy study. Sleep Med 2021; 83:89-98. [PMID: 33991895 DOI: 10.1016/j.sleep.2021.04.028] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Revised: 03/22/2021] [Accepted: 04/20/2021] [Indexed: 12/12/2022]
Abstract
BACKGROUND Sleep and physical activity changes are common in pregnancy, but longitudinal data starting before conception are scarce. Our aim was to determine the changes of the daily total sleep time (TST) and physical activity duration (PAD) from before conception to end of pregnancies in respect of pregestational maternal factors. METHODS This longitudinal observational study formed part of the CONIMPREG research project and recruited healthy women planning to become pregnant. Sleep and physical activity were recorded around-the-clock for ≥4 days via actigraphy before conception and during each trimester of pregnancy. Data were adjusted according to pregestational maternal body composition, parity and age. RESULTS Among 123 women with eligible data, the unadjusted mean (95% confidence interval) TST increased from 415.3 min (405.5-425.2 min) before conception to 458.0 min (445.4-470.6 min) in the 1st trimester, remaining high through the 2nd and 3rd trimesters. Variation was substantial before conception (±2SD range: 307-523 min). The unadjusted mean PAD before conception was 363.7 min (±2SD range: 120-608 min), decreasing sharply to 262.1 min in the first trimester and more gradually thereafter. Vigorous and moderate activity decreased more than light activity. TST and PAD were significantly associated with age, parity, and pregestational body fat percentage; lean body mass was negatively correlated with TST. Results were generally unaffected by seasonal variations. CONCLUSION Marked variations were found in pregestational TST and PAD. Healthy women slept ≥30 min longer during pregnancy, while PAD decreased by ≥ 90 min in early pregnancy and continued to decrease thereafter.
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Affiliation(s)
- Alexander Vietheer
- Department of Obstetrics and Gynecology, Haukeland University Hospital, Bergen, Norway; Department of Clinical Science, University of Bergen, Bergen, Norway.
| | - Torvid Kiserud
- Department of Obstetrics and Gynecology, Haukeland University Hospital, Bergen, Norway; Department of Clinical Science, University of Bergen, Bergen, Norway
| | - Rolv Terje Lie
- Department of Obstetrics and Gynecology, Haukeland University Hospital, Bergen, Norway; Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway; Norwegian Institute of Public Health, Bergen, Norway
| | | | - Jörg Kessler
- Department of Obstetrics and Gynecology, Haukeland University Hospital, Bergen, Norway; Department of Clinical Science, University of Bergen, Bergen, Norway
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17
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Façanha C, Bruin VD, Bruin PD, Façanha A, Rocha HC, Araujo M, Forti A, Macêdo R. Hyperglycemia in pregnancy: sleep alterations, comorbidities and pharmacotherapy. ACTA ACUST UNITED AC 2021; 67:45-51. [PMID: 34161489 DOI: 10.1590/1806-9282.67.01.20200216] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Accepted: 08/19/2020] [Indexed: 11/21/2022]
Abstract
OBJECTIVE To investigate sleep alterations and associated factors in pregnant diabetic women (n=141). METHODS Sleep profile, sociodemographics and clinical information were collected. Poor sleep quality (Pittsburgh Sleep Quality Index >5) and excessive daytime sleepiness (Epworth Sleepiness Scale ≥10), sleep duration (h), sleep latency (min), frequent sleep interruption and short sleep (≤6 h) were assessed in type 1 diabetes mellitus (16.3%), type 2 diabetes mellitus (25.5%) and gestational diabetes mellitus (58.2%). RESULTS Poor sleep quality was found in 58.8% of patients and daytime sleepiness in 25.7%, regardless of hyperglycemia etiology. No correlation existed between daytime sleepiness and poor sleep quality (Pearson correlation r=0.02, p=0.84). Short sleep duration occurred in 1/3 of patients (31.2%). Sleep interruptions due to frequent urination affected 72% of all and sleep interruptions due to any cause 71.2%. Metformin was used by 65.7% of type 2 diabetes mellitus and 28.7% of gestational diabetes mellitus. In gestational diabetes mellitus, parity number was independently associated with poor sleep quality (p=0.02; OR=1.90; 95%CI 1.07-3.36) and metformin use was also independently associated with poor sleep quality (p=0.03; OR=2.36; 95%CI 1.05-5.29). CONCLUSIONS Our study originally shows that poor sleep quality and excessive daytime sleepiness are frequent in diabetic pregnancy due to different etiologies. Interestingly, only in gestational diabetes mellitus, metformin therapy and higher parity were associated with poor sleep quality.
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Affiliation(s)
- Cristina Façanha
- Universidade Federal do Ceará, Centro Universitário Christus, Centro Integrado de Diabetes e Hipertensão do Ceará - Fortaleza (CE), Brasil
| | | | | | | | | | - Mariana Araujo
- Universidade Federal do Ceará, Centro Universitário Christus - Fortaleza (CE), Brasil
| | - Adriana Forti
- Universidade Federal do Ceará, Centro Integrado de Diabetes e Hipertensão do Ceará - Fortaleza (CE), Brasil
| | - Rejane Macêdo
- Universidade Federal do Ceará, Centro Integrado de Diabetes e Hipertensão do Ceará - Fortaleza (CE), Brasil
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18
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DiPietro JA, Watson H, Raghunathan RS, Henderson JL, Sgambati FP, Pien GW. Fetal neuromaturation in late gestation is affected by maternal sleep disordered breathing and sleep disruption in pregnant women with obesity. Int J Gynaecol Obstet 2021; 157:181-187. [PMID: 33969483 DOI: 10.1002/ijgo.13738] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Revised: 04/26/2021] [Accepted: 05/07/2021] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Maternal sleep disordered breathing and sleep disruption have adverse effects on pregnancy outcomes through multiple potential pathophysiologic pathways. We hypothesize that disordered maternal sleep also adversely impacts the neuromaturation of the fetus. METHODS Participants in this prospective observational study included 102 obese pregnant women (pre-pregnancy body mass index [BMI] of 30 or higher) at 36 weeks of pregnancy. Fetal neuromaturation, defined through measures of fetal heart rate variability, motor activity, and motor-cardiac coupling, was quantified through digitized fetal actocardiography during an afternoon recording. Maternal sleep measures were collected overnight through polysomnography. Data analysis focused on multiple regression, controlling for maternal BMI, blood pressure, and diabetes. RESULTS Indicators of higher sleep disordered breathing were associated with delayed fetal neuromaturation and greater fetal motor activity. Less maternal sleep disruption (shorter rapid eye movement [REM] latency, more REM sleep, and/or fewer transitions) was associated with higher fetal heart rate variability and coupling-based neuromaturation. CONCLUSION Characteristics of disordered maternal sleep affect the developing fetal nervous system. It is unknown whether these results extend to populations that are not characterized by obesity. The influence of maternal sleep on the developing fetal nervous system has been understudied and may yield effects that persist beyond pregnancy.
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Affiliation(s)
- Janet A DiPietro
- Department of Population, Family & Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Heather Watson
- Department of Population, Family & Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Radhika S Raghunathan
- Department of Population, Family & Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Janice L Henderson
- Division of Maternal-Fetal Medicine, Department of Gynecology & Obstetrics, Johns Hopkins School of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Francis P Sgambati
- Center for Interdisciplinary Sleep Research and Education, Johns Hopkins School of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Grace W Pien
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Johns Hopkins School of Medicine, Johns Hopkins University, Baltimore, MD, USA
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19
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DiPietro JA, Raghunathan RS, Wu HT, Bai J, Watson H, Sgambati FP, Henderson JL, Pien GW. Fetal heart rate during maternal sleep. Dev Psychobiol 2021; 63:945-959. [PMID: 33764539 DOI: 10.1002/dev.22118] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Revised: 01/07/2021] [Accepted: 02/22/2021] [Indexed: 11/09/2022]
Abstract
Despite prolonged and cumulative exposure during gestation, little is known about the fetal response to maternal sleep. Eighty-four pregnant women with obesity (based on pre-pregnancy BMI) participated in laboratory-based polysomnography (PSG) with continuous fetal electrocardiogram monitoring at 36 weeks gestation. Multilevel modeling revealed both correspondence and lack of it in maternal and fetal heart rate patterns. Fetal heart rate (fHR) and variability (fHRV), and maternal heart rate (mHR) and variability (mHRV), all declined during the night, with steeper rates of decline prior to 01:00. fHR declined upon maternal sleep onset but was not otherwise associated with maternal sleep stage; fHRV differed during maternal REM and NREM. There was frequent maternal waking after sleep onset (WASO) and fHRV and mHRV were elevated during these episodes. Cross-correlation analyses revealed little temporal coupling between maternal and fetal heart rate, except during WASO, suggesting that any observed associations in maternal and fetal heart rates during sleep are the result of other physiological processes. Implications of the maternal sleep context for the developing fetus are discussed, including the potential consequences of the typical sleep fragmentation that accompanies pregnancy.
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Affiliation(s)
- Janet A DiPietro
- Department of Population, Family & Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Radhika S Raghunathan
- Department of Population, Family & Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Hau-Tieng Wu
- Department of Mathematics and Department of Statistical Science, Duke University, Durham, NC, USA
| | - Jiawei Bai
- Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Heather Watson
- Department of Population, Family & Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Francis P Sgambati
- Center for Interdisciplinary Sleep Research and Education, Johns Hopkins School of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Janice L Henderson
- Division of Maternal-Fetal Medicine, Department of Gynecology & Obstetrics, Johns Hopkins School of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Grace W Pien
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Johns Hopkins School of Medicine, Johns Hopkins University, Baltimore, MD, USA
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20
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Hill C, Lipsky LM, Betts GM, Siega-Riz AM, Nansel TR. A Prospective Study of the Relationship of Sleep Quality and Duration with Gestational Weight Gain and Fat Gain. J Womens Health (Larchmt) 2020; 30:405-411. [PMID: 32945728 DOI: 10.1089/jwh.2020.8306] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Objective/Background: Fewer than one-third of U.S. women meet the Institute of Medicine guidelines for healthy gestational weight gain (GWG). While poor sleep quality and short sleep duration have been associated with weight gain and obesity in the general population, the relationship of sleep with pregnancy weight and body composition changes is unclear. This study aimed to examine associations of sleep duration and quality with pregnancy-related changes in body weight and fat. Participants: Pregnant women obtaining obstetric care through the University of North Carolina at Chapel Hill Healthcare System (UNC) (n = 339 who reported any sleep data) participating in the Pregnancy Eating Attributes Study. Materials and Methods: Participants were recruited at ≤12 weeks gestation and followed through delivery. The Pittsburgh Sleep Quality Index measured sleep duration and quality in early and late pregnancy. Weight was measured at each pregnancy medical visit and skinfolds were measured each trimester. t-tests examined sleep changes from early to late pregnancy and regression analyses estimated associations of sleep quality and duration with GWG and gestational fat gain (GFG). Results: Sleep quality and duration declined across pregnancy. A greater proportion of women with high early pregnancy body mass index (>25) reported low sleep quality and short sleep duration. Sleep quality was not associated with GWG adequacy, whereas longer late pregnancy sleep duration was associated with greater odds of inadequate GWG. Shorter sleep duration and lower sleep quality in late, but not early, pregnancy were associated with greater GFG. Conclusions: Lower sleep quality and shorter sleep duration in late pregnancy were associated with greater GFG. Experimental studies are needed to test the direction of causality between GFG and sleep attributes. ClinicalTrials.gov ID: NCT02217462.
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Affiliation(s)
- Christine Hill
- Social and Behavioral Sciences Branch, Eunice Kennedy Shriver National Institute for Child Health and Human Development, Bethesda, Maryland, USA
| | - Leah M Lipsky
- Social and Behavioral Sciences Branch, Eunice Kennedy Shriver National Institute for Child Health and Human Development, Bethesda, Maryland, USA
| | - Grace M Betts
- Social and Behavioral Sciences Branch, Eunice Kennedy Shriver National Institute for Child Health and Human Development, Bethesda, Maryland, USA
| | - Anna Maria Siega-Riz
- Departments of Nutrition, and Biostatistics and Epidemiology, School of Public Health and Health Sciences, University of Massachusetts, Amherst, Massachusetts, USA
| | - Tonja R Nansel
- Social and Behavioral Sciences Branch, Eunice Kennedy Shriver National Institute for Child Health and Human Development, Bethesda, Maryland, USA
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21
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Zhang X, Zhang R, Cheng L, Wang Y, Ding X, Fu J, Dang J, Moore J, Li R. The effect of sleep impairment on gestational diabetes mellitus: a systematic review and meta-analysis of cohort studies. Sleep Med 2020; 74:267-277. [PMID: 32862011 DOI: 10.1016/j.sleep.2020.05.014] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2019] [Revised: 10/21/2019] [Accepted: 05/08/2020] [Indexed: 11/26/2022]
Abstract
OBJECTIVE This systematic review and meta-analysis evaluated the influence of sleep duration or impairment (poor sleep quality, snoring, and obstructive sleep apnea [OSA]) on gestational diabetes mellitus (GDM) risk. METHODS PubMed, Embase, EBSCO, and WOS databases were searched up to March 4th, 2019. Cohort studies were included and relative risk (RR) with 95% confidence interval (CI) were used as the measure of effects. Heterogeneity was assessed by the Chi-squared and I2 tests. Subgroup analyses, sensitivity analysis, and dose-response analysis were performed. The overall quality of the evidence was assessed using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. RESULTS A total of 16 studies with 2,551,017 pregnant women and 142,103 GDM cases were included in this study. Both short and long sleep duration were associated with increased risk of GDM. There was a U-shaped relationship between sleep duration and GDM risk (P-nonlinearity < 0.001), and pregnant women with 8 h of sleep presented lower GDM risk. Poor sleep quality, snoring and OSA also increased the subsequent risk of GDM. CONCLUSIONS Pregnant women should be made aware of the benefits of proper sleep, and those with poor sleep quality, snoring, and OSA should be screened for GDM.
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Affiliation(s)
- Xinge Zhang
- School of Health Sciences, Wuhan University, Wuhan, 430071, China.
| | - Rui Zhang
- College of Life Sciences, South-Central University for Nationalities, Wuhan, 430074, China.
| | - Lei Cheng
- School of Health Sciences, Wuhan University, Wuhan, 430071, China.
| | - Yueqiao Wang
- Department of Dermatology and Skin Science, University of British Columbia, Vancouver, V5Z 4E8, Canada.
| | - Xiaoting Ding
- Maternal and Child Health Hospital of Hubei Province, Wuhan, 430071, China.
| | - Jialin Fu
- School of Health Sciences, Wuhan University, Wuhan, 430071, China.
| | - Jiajia Dang
- School of Health Sciences, Wuhan University, Wuhan, 430071, China.
| | - Justin Moore
- Department of Family & Community Medicine, Wake Forest School of Medicine, Wake Forest Baptist Medical Center, Medical Center Boulevard, Winston-Salem, NC, 27157, USA; Department of Epidemiology & Prevention, Wake Forest School of Medicine, USA; Department of Implementation Science, Wake Forest School of Medicine, USA.
| | - Rui Li
- School of Health Sciences, Wuhan University, Wuhan, 430071, China.
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22
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Cronin RS, Wilson J, Gordon A, Li M, Culling VM, Raynes-Greenow CH, Heazell AEP, Stacey T, Askie LM, Mitchell EA, Thompson JMD, McCowan LME, O’Brien LM. Associations between symptoms of sleep-disordered breathing and maternal sleep patterns with late stillbirth: Findings from an individual participant data meta-analysis. PLoS One 2020; 15:e0230861. [PMID: 32214393 PMCID: PMC7098581 DOI: 10.1371/journal.pone.0230861] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2019] [Accepted: 03/10/2020] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Sleep-disordered breathing (SDB) affects up to one third of women during late pregnancy and is associated with adverse pregnancy outcomes, including hypertension, diabetes, impaired fetal growth, and preterm birth. However, it is unclear if SDB is associated with late stillbirth (≥28 weeks' gestation). The aim of this study was to investigate the relationship between self-reported symptoms of SDB and late stillbirth. METHODS Data were obtained from five case-control studies (cases 851, controls 2257) from New Zealand (2 studies), Australia, the United Kingdom, and an international study. This was a secondary analysis of an individual participant data meta-analysis that investigated maternal going-to-sleep position and late stillbirth, with a one-stage approach stratified by study and site. Inclusion criteria: singleton, non-anomalous pregnancy, ≥28 weeks' gestation. Sleep data ('any' snoring, habitual snoring ≥3 nights per week, the Berlin Questionnaire [BQ], sleep quality, sleep duration, restless sleep, daytime sleepiness, and daytime naps) were collected by self-report for the month before stillbirth. Multivariable analysis adjusted for known major risk factors for stillbirth, including maternal age, body mass index (BMI kg/m2), ethnicity, parity, education, marital status, pre-existing hypertension and diabetes, smoking, recreational drug use, baby birthweight centile, fetal movement, supine going-to-sleep position, getting up to use the toilet, measures of SDB and maternal sleep patterns significant in univariable analysis (habitual snoring, the BQ, sleep duration, restless sleep, and daytime naps). Registration number: PROSPERO, CRD42017047703. RESULTS In the last month, a positive BQ (adjusted odds ratio [aOR] 1.44, 95% confidence interval [CI] 1.02-2.04), sleep duration >9 hours (aOR 1.82, 95% CI 1.14-2.90), daily daytime naps (aOR 1.52, 95% CI 1.02-2.28) and restless sleep greater than average (aOR 0.62, 95% CI 0.44-0.88) were independently related to the odds of late stillbirth. 'Any' snoring, habitual snoring, sleep quality, daytime sleepiness, and a positive BQ excluding the BMI criterion, were not associated. CONCLUSION A positive BQ, long sleep duration >9 hours, and daily daytime naps last month were associated with increased odds of late stillbirth, while sleep that is more restless than average was associated with reduced odds. Pregnant women may be reassured that the commonly reported restless sleep of late pregnancy may be physiological and associated with a reduced risk of late stillbirth.
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Affiliation(s)
- Robin S. Cronin
- Departments of Obstetrics and Gynaecology, and Paediatrics: Child and Youth Health, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
- * E-mail: ,
| | - Jessica Wilson
- Departments of Obstetrics and Gynaecology, and Paediatrics: Child and Youth Health, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Adrienne Gordon
- Discipline of Obstetrics, Gynaecology and Neonatology, University of Sydney, Sydney, Australia
| | - Minglan Li
- Departments of Obstetrics and Gynaecology, and Paediatrics: Child and Youth Health, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Vicki M. Culling
- Departments of Obstetrics and Gynaecology, and Paediatrics: Child and Youth Health, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | | | - Alexander E. P. Heazell
- Division of Developmental Biology & Medicine, Maternal and Fetal Health Research Centre, School of Medical Sciences, University of Manchester, Manchester, England, United Kingdom
| | - Tomasina Stacey
- Department of Nursing and Midwifery, School of Human and Health Sciences, University of Huddersfield, Huddersfield, England, United Kingdom
| | - Lisa M. Askie
- National Health and Medical Research Council Clinical Trials Centre, University of Sydney, Sydney, Australia
| | - Edwin A. Mitchell
- Departments of Obstetrics and Gynaecology, and Paediatrics: Child and Youth Health, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - John M. D. Thompson
- Departments of Obstetrics and Gynaecology, and Paediatrics: Child and Youth Health, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Lesley M. E. McCowan
- Departments of Obstetrics and Gynaecology, and Paediatrics: Child and Youth Health, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Louise M. O’Brien
- Departments of Neurology Sleep Disorders Center, and Obstetrics and Gynecology, University of Michigan, Ann Arbor, Michigan, United States of America
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Maternal sleep disturbances in late pregnancy and the association with emergency caesarean section: A prospective cohort study. Sleep Health 2020; 6:65-70. [DOI: 10.1016/j.sleh.2019.11.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2019] [Revised: 11/04/2019] [Accepted: 11/17/2019] [Indexed: 11/20/2022]
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24
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Tan L, Zou J, Zhang Y, Yang Q, Shi H. A Longitudinal Study of Physical Activity to Improve Sleep Quality During Pregnancy. Nat Sci Sleep 2020; 12:431-442. [PMID: 32765140 PMCID: PMC7367923 DOI: 10.2147/nss.s253213] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2020] [Accepted: 06/17/2020] [Indexed: 01/08/2023] Open
Abstract
PURPOSE To explore the association between maternal physical activity (PA) and sleep quality during pregnancy, and the necessary PA level at different gestational stages to attain improved sleep quality. METHODS A total of 2443 participants were recruited from the Shanghai Maternal-Child Pairs Cohort (Shanghai MCPC) study, who had completed questionnaires including the Pittsburgh Sleep Quality Index (PSQI) and the International Physical Activity Questionnaire (IPAQ) at gestational weeks (GW) of 12-16 and 32-36. PSQI scores and their seven components at the two GW were compared, as were PSQI scores at 12-16 and 32-36 GW and the increment in PSQI relative to PA. Regression analysis was conducted to assess the effect of PA and its change on the total PSQI score at different GW. RESULTS The mean PSQI scores increased significantly during pregnancy, from 6.30 ± 3.01 at 12-16 GW to 7.23 ± 3.47 at 32-36 GW. Compared with women in low PA level, moderate levels of PA at both 12-16 GW and 32-36 GW were significantly reduced PSQI scores of 0.42 (95% CI:-0.68,-0.16) and 0.32 (95% CI:-0.63,-0.01), respectively. At 32-36 GW, high PA level also significantly decreased PSQI score, with a greater decline than moderate PA level. (AOR=-0.87,95% CI:-1.57,-0.18). PA increment from 12-16 to 32-36 weeks of pregnancy created a significant decline of 0.54 in PSQI scores. CONCLUSION The study revealed sleep quality was worse at the third trimester and moderate PA level had the potential for improvement of sleep quality both in the first and the third trimester. High PA level was also beneficial to improve sleep quality of pregnant women in the third trimester.
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Affiliation(s)
- Liwei Tan
- Department of Maternal, Child and Adolescent Health, School of Public Health, Fudan University, Shanghai, People's Republic of China
| | - Jiaojiao Zou
- Department of Maternal, Child and Adolescent Health, School of Public Health, Fudan University, Shanghai, People's Republic of China
| | - Yunhui Zhang
- Department of Environmental Health, School of Public Health, Fudan University, Shanghai, People's Republic of China
| | - Qing Yang
- Department of Child Care, The Maternal and Child Healthcare Institute of Songjiang District, Shanghai, People's Republic of China
| | - Huijing Shi
- Department of Maternal, Child and Adolescent Health, School of Public Health, Fudan University, Shanghai, People's Republic of China
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Bennett CJ, Cain SW, Blumfield ML. Monounsaturated fat intake is associated with improved sleep quality in pregnancy. Midwifery 2019; 78:64-70. [DOI: 10.1016/j.midw.2019.07.019] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2019] [Revised: 05/19/2019] [Accepted: 07/24/2019] [Indexed: 11/29/2022]
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26
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Bin YS, Ford JB, Cistulli PA. Sleep in multiple pregnancy: Obstructive sleep apnoea and beyond. Aust N Z J Obstet Gynaecol 2019; 59:E15-E16. [PMID: 31625148 DOI: 10.1111/ajo.12985] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Affiliation(s)
- Yu Sun Bin
- Charles Perkins Centre, University of Sydney, Sydney, New South Wales, Australia.,Northern Clinical School, Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia
| | - Jane B Ford
- Northern Clinical School, Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia.,Clinical and Population Perinatal Health Research, Kolling Institute, Northern Sydney Local Health District, Sydney, New South Wales, Australia
| | - Peter A Cistulli
- Charles Perkins Centre, University of Sydney, Sydney, New South Wales, Australia.,Northern Clinical School, Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia.,Department of Respiratory and Sleep Medicine, Royal North Shore Hospital, Sydney, New South Wales, Australia
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