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Lamichhane DK, Ha E, Hong YC, Lee DW, Park MS, Song S, Kim S, Kim WJ, Bae J, Kim HC. Ambient particulate matter and surrounding greenness in relation to sleep quality among pregnant women: A nationwide cohort study. Heliyon 2024; 10:e26742. [PMID: 38434397 PMCID: PMC10904245 DOI: 10.1016/j.heliyon.2024.e26742] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Revised: 02/08/2024] [Accepted: 02/19/2024] [Indexed: 03/05/2024] Open
Abstract
Background Particulate air pollution and residential greenness are associated with sleep quality in the general population; however, their influence on maternal sleep quality during pregnancy has not been assessed. Objective This cross-sectional study investigated the individual and interactive effects of exposure to particulate matter (PM) air pollution and residential greenness on sleep quality in pregnant women. Methods Pregnant women (n = 4933) enrolled in the Korean Children's Environmental Health Study with sleep quality information and residential address were included. Sleep quality was assessed using the Pittsburgh Sleep Quality Index (PSQI). The average concentrations of PM (PM2.5 and PM10) during pregnancy were estimated through land use regression, and residential greenness in a 1000 m buffer area around participants' residences was estimated using the Normalized Difference Vegetation Index (NDVI1000-m). Modified Poisson regression models were used to estimate the associations between PM and NDVI and poor sleep quality (PSQI >5) after controlling for a range of covariates. A four-way mediation analysis was conducted to examine the mediating effects of PM. Results After adjusting for confounders, each 10 μg/m3 increase in PM2.5 and PM10 exposure was associated with a higher risk of poor sleep quality (relative risk [RR]: 1.06; 95% confidence interval [CI]: 1.01, 1.11; and RR: 1.09; 95% CI: 1.06, 1.13, respectively), and each 0.1-unit increase in NDVI1000-m was associated with a lower risk of poor sleep quality (RR: 0.97; 95% CI: 0.95, 0.99). Mediation analysis showed that PM mediated approximately 37%-56% of the association between residential greenness and poor sleep quality. Conclusions This study identified a positive association between residential greenness and sleep quality. Furthermore, these associations are mediated by a reduction in exposure to particulate air pollution and highlight the link between green areas, air pollution control, and human health.
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Affiliation(s)
- Dirga Kumar Lamichhane
- Department of Occupational and Environmental Medicine, Inha University School of Medicine, Incheon, Republic of Korea
- Department of Psychiatry, Huntsman Mental Health Institute, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Eunhee Ha
- Department of Occupational and Environmental Medicine, Ewha Womans University School of Medicine, Seoul, Republic of Korea
| | - Yun-Chul Hong
- Institute of Environmental Medicine, Seoul National University Medical Research Center, Seoul, Republic of Korea
| | - Dong-Wook Lee
- Department of Occupational and Environmental Medicine, Inha University School of Medicine, Incheon, Republic of Korea
| | - Myung-Sook Park
- Institute of Environmental Medicine, Seoul National University Medical Research Center, Seoul, Republic of Korea
| | - Sanghwan Song
- Environmental Health Research Division, Department of Environmental Health Research, National Institute of Environmental Research, Ministry of Environment, Incheon, Republic of Korea
| | - Suejin Kim
- Environmental Health Research Division, Department of Environmental Health Research, National Institute of Environmental Research, Ministry of Environment, Incheon, Republic of Korea
| | - Woo Jin Kim
- Department of Internal Medicine and Environmental Health Center, Kangwon National University, Chuncheon, Republic of Korea
| | - Jisuk Bae
- Department of Preventive Medicine, Daegu Catholic University School of Medicine, Daegu, Republic of Korea
| | - Hwan-Cheol Kim
- Department of Occupational and Environmental Medicine, Inha University School of Medicine, Incheon, Republic of Korea
| | - Ko-CHENS Study Group
- Department of Occupational and Environmental Medicine, Inha University School of Medicine, Incheon, Republic of Korea
- Department of Psychiatry, Huntsman Mental Health Institute, University of Utah School of Medicine, Salt Lake City, UT, USA
- Department of Occupational and Environmental Medicine, Ewha Womans University School of Medicine, Seoul, Republic of Korea
- Institute of Environmental Medicine, Seoul National University Medical Research Center, Seoul, Republic of Korea
- Environmental Health Research Division, Department of Environmental Health Research, National Institute of Environmental Research, Ministry of Environment, Incheon, Republic of Korea
- Department of Internal Medicine and Environmental Health Center, Kangwon National University, Chuncheon, Republic of Korea
- Department of Preventive Medicine, Daegu Catholic University School of Medicine, Daegu, Republic of Korea
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Sobol M, Błachnio A, Meisner M, Wdowiak A, Wdowiak N, Gorbaniuk O, Jankowski KS. Circadian rhythm and sleep disruptions in relation to prenatal stress and depression symptoms. Chronobiol Int 2024; 41:294-303. [PMID: 38297459 DOI: 10.1080/07420528.2024.2303985] [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: 03/27/2023] [Accepted: 01/05/2024] [Indexed: 02/02/2024]
Abstract
Circadian rhythm and sleep are related to health, but there is little data on the relationship between the sleep/wake rhythm and mood at different stages of pregnancy. The aim of this prospective, longitudinal study was to investigate the associations of circadian rhythm and sleep disruptions with stress and depression among women in early and late pregnancy. The participants were 26 pregnant women. Objective and subjective estimations of circadian rhythm and sleep were administered, namely actigraphy and the Biological Rhythms Interview of Assessment in Neuropsychiatry in the form of a questionnaire. The Perceived Stress Scale and the Edinburgh Postnatal Depression Scale were also used. Subjectively perceived circadian rhythm disruptions were positively related to stress. Tendency to maintain a regular rhythm of sleep and activity in early pregnancy and subjectively perceived disruptions of circadian rhythms in late pregnancy were positively associated with prenatal depression in late pregnancy. Sleep fragmentation and long time spent in bed at night in early pregnancy were positively associated with stress and depression in late pregnancy. The results suggest the importance of flexibility and the ability to adapt one's circadian activities to the demands of the situation of pregnancy-related changes in lifestyle. They also indicate the significance of good-quality uninterrupted night sleep in early pregnancy.
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Affiliation(s)
| | - Agata Błachnio
- Department of Psychology, John Paul II Catholic University of Lublin, Lublin, Poland
| | - Michał Meisner
- Department of Psychology, University of Warsaw, Warsaw, Poland
| | - Artur Wdowiak
- Faculty of Medicine and Dentistry, Medical University of Lublin, Lublin, Poland
| | - Natalia Wdowiak
- Faculty of Medicine and Dentistry, Medical University of Lublin, Lublin, Poland
| | - Oleg Gorbaniuk
- Institute of Psychology, Maria Curie-Skłodowska University, Lublin, Poland
- Department of Psychology, Casimir Pulaski Radom University, Radom, Poland
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3
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Delgado A, Louis JM. Sleep Deficiency in Pregnancy. Sleep Med Clin 2023; 18:559-571. [PMID: 38501527 DOI: 10.1016/j.jsmc.2023.06.011] [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] [Indexed: 03/20/2024]
Abstract
Sleep is a critical aspect of one's daily life for overall health, with a recommended 7 to 9 hours in adulthood (ages 26-64). Up to a third of women do not sleep sufficiently, and pregnant women are at an increased risk for sleep deficiency. Throughout pregnancy, sleep is affected in differing ways. For example, in the first trimester, hormones affect sleep cycles, but by the third trimester, physical complaints such as increasing frequent urination and fetal movement create frequent awakenings. Associations between sleep deficiency and gestational diabetes, hypertensive disorders, depression, and some evidence regarding preterm birth exist. A woman's labor course and perception of delivery are also negatively affected by short sleep duration.
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Affiliation(s)
- Arlin Delgado
- Department of Obstetrics and Gynecology, Morsani College of Medicine, University of South Florida Morsani College of Medicine, 2 Tampa General Circle, Tampa, FL 33606, USA
| | - Judette M Louis
- Department of Obstetrics and Gynecology, Morsani College of Medicine, University of South Florida Morsani College of Medicine, 2 Tampa General Circle, Tampa, FL 33606, USA.
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Shinohara E, Hada A, Minatani M, Wakamatsu M, Kitamura T. The Insomnia Severity Index: Factor Structure and Measurement and Structural Invariance across Perinatal Time Points. Healthcare (Basel) 2023; 11:healthcare11081194. [PMID: 37108028 PMCID: PMC10138570 DOI: 10.3390/healthcare11081194] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Revised: 04/03/2023] [Accepted: 04/17/2023] [Indexed: 04/29/2023] Open
Abstract
Insomnia is associated with adverse outcomes in women in the perinatal period; thus, the assessment of insomnia is important for pregnant women. The Insomnia Severity Index (ISI) is an instrument used globally to assess the severity of insomnia. However, its factor structure and structural invariance for pregnant women have not been studied. Therefore, we aimed to conduct factor analyses to search for the best model to fit its structural invariance. A cross-sectional study with the ISI was conducted at one hospital and five clinics in Japan from January 2017 to May 2019. A set of questionnaires was administered on two occasions with a one-week interval. The study included 382 pregnant women ranging in gestational age from 10 to 13 weeks. One week later, 129 participants answered the retest. After exploratory and confirmatory factor analyses, the measurement and structural invariance between parity and two time points was tested. The two-factor structure model showed an acceptable fit for the ISI in pregnant women (χ2 (12) = 28.516, CFI = 0.971, RMSEA = 0.089). The model also showed satisfactory measurement and structure invariance between parity and time points. The findings indicate that the ISI's use would be appropriate for pregnant women as a two-factor subscale of "severity" and "impact", regardless of the parity or time point. The ISI's factor structure may vary by subject; hence, it is necessary to confirm the measurement and structural invariance of the subject for whom the ISI will be used. Furthermore, interventions that focus not only on total scores and cutoff points but also on the phenomenon of subscales should be considered.
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Affiliation(s)
- Eriko Shinohara
- Department of Nursing, School of Medicine, Yokohama City University, Yokohama 236-0004, Japan
| | - Ayako Hada
- Kitamura Institute of Mental Health Tokyo, Tokyo 151-0063, Japan
- Kitamura KOKORO Clinic Mental Health, Tokyo 151-3306, Japan
- Department of Community Mental Health & Law, National Institute of Mental Health, National Center of Neurology and Psychiatry, Tokyo 187-8553, Japan
| | - Mariko Minatani
- Life Value Creation Unit, NTT DATA Institute of Management Consulting, Inc., Tokyo 102-0093, Japan
| | - Mikiyo Wakamatsu
- Department of Reproductive Health Care Nursing, Kagoshima University Faculty of Medicine School of Health Sciences, Kagoshima 890-8544, Japan
| | - Toshinori Kitamura
- Kitamura Institute of Mental Health Tokyo, Tokyo 151-0063, Japan
- Kitamura KOKORO Clinic Mental Health, Tokyo 151-3306, Japan
- T. and F. Kitamura Foundation for Studies and Skill Advancement in Mental Health, Tokyo 151-0063, Japan
- Department of Psychiatry, Graduate School of Medicine, Nagoya University, Nagoya 466-8550, Japan
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Nevarez-Brewster M, Demers CH, Mejia A, Haase MH, Bagonis MM, Kim SH, Gilmore JH, Hoffman MC, Styner MA, Hankin BL, Davis EP. Longitudinal and prospective assessment of prenatal maternal sleep quality and associations with newborn hippocampal and amygdala volume. Dev Cogn Neurosci 2022; 58:101174. [PMID: 36375383 PMCID: PMC9661438 DOI: 10.1016/j.dcn.2022.101174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Revised: 10/12/2022] [Accepted: 11/08/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The rapid maturation of the fetal brain renders the fetus susceptible to prenatal environmental signals. Prenatal maternal sleep quality is known to have important health implications for newborns including risk for preterm birth, however, the effect on the fetal brain is poorly understood. METHOD Participants included 94 pregnant participants and their newborns (53% female). Pregnant participants (Mage = 30; SDage= 5.29) reported on sleep quality three times throughout pregnancy. Newborn hippocampal and amygdala volumes were assessed using structural magnetic resonance imaging. Multilevel modeling was used to test the associations between trajectories of prenatal maternal sleep quality and newborn hippocampal and amygdala volume. RESULTS The overall trajectory of prenatal maternal sleep quality was associated with hippocampal volume (left: b = 0.00003, p = 0.013; right: b = 0.00003, p = .008). Follow up analyses assessing timing of exposure indicate that poor sleep quality early in pregnancy was associated with larger hippocampal volume bilaterally (e.g., late gestation left: b = 0.002, p = 0.24; right: b = 0.004, p = .11). Prenatal sleep quality was not associated with amygdala volume. CONCLUSION These findings highlight the implications of poor prenatal maternal sleep quality and its role in contributing to newborn hippocampal development.
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Affiliation(s)
| | - Catherine H Demers
- University of Denver, Department of Psychology, United States; University of Colorado Anschutz Medical Campus, Department of Psychiatry, United States
| | - Alexandra Mejia
- University of Denver, Department of Psychology, United States
| | | | - Maria M Bagonis
- University of North Carolina - Chapel Hill, Department of Psychiatry, United States
| | - Sun Hyung Kim
- University of North Carolina - Chapel Hill, Department of Psychiatry, United States
| | - John H Gilmore
- University of North Carolina - Chapel Hill, Department of Psychiatry, United States
| | - M Camille Hoffman
- University of Colorado Anschutz Medical Campus, Department of Psychiatry, United States; University of Colorado Denver School of Medicine, Department of Obstetrics and Gynecology, Division of Maternal and Fetal Medicine, United States
| | - Martin A Styner
- University of North Carolina - Chapel Hill, Department of Psychiatry, United States; University of North Carolina - Chapel Hill, Department of Computer Science, United States
| | - Benjamin L Hankin
- University of Illinois at Urbana-Champaign, Department of Psychology, United States
| | - Elysia Poggi Davis
- University of Denver, Department of Psychology, United States; University of California, Irvine, Department of Pediatrics, United States
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Comparison of factor structures of the Pittsburgh sleep quality index between mid- and late pregnancy among Korean women: a cross-sectional study. BMC Pregnancy Childbirth 2022; 22:694. [PMID: 36076155 PMCID: PMC9454123 DOI: 10.1186/s12884-022-05024-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Accepted: 09/02/2022] [Indexed: 11/29/2022] Open
Abstract
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.
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Al-Musharaf S. Changes in Sleep Patterns during Pregnancy and Predictive Factors: A Longitudinal Study in Saudi Women. Nutrients 2022; 14:nu14132633. [PMID: 35807814 PMCID: PMC9268456 DOI: 10.3390/nu14132633] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Revised: 06/21/2022] [Accepted: 06/22/2022] [Indexed: 11/16/2022] Open
Abstract
This study aimed to assess sleep patterns during the three trimesters of pregnancy and whether vitamin D concentrations, along with other risk factors, are associated with these alterations. In a longitudinal study, 140 pregnant women (age 18 to 39 years) were followed throughout their first, second, and third trimesters. Sleep was measured using the Pittsburgh Sleep Quality Index (PSQI) at each trimester, along with an assessment of biochemical parameters, including serum vitamin D levels. The information that was collected included anthropometric data, socio-economic status, dietary intake, and physical activity. The PSQI was higher in mid and late pregnancy than in early pregnancy (both p = 0.001), and the sleep duration was also higher in late versus early pregnancy. Linear regression analyses revealed independent predictors of deteriorating sleep quality from early to late pregnancy, including low income (B ± SE −0.60 ± 0.26, p = 0.03) and low serum vitamin D levels in the second trimester (B ± SE −0.20 ± 0.01, p = 0.04). Energy intake and sitting in the second half of pregnancy were positively associated with changes in the PSQI score from the second to third trimesters (B ± SE 0.15 ± 0.07, p = 0.048) and (B ± SE 0.01 ± 0.00, p = 0.044), respectively. Low socio-economic status, low serum vitamin D levels, greater energy intake, and sitting time were associated with worsening patterns of sleep quality from early to late pregnancy.
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Affiliation(s)
- Sara Al-Musharaf
- Department of Community Health Sciences, College of Applied Medical Sciences, King Saud University, Riyadh 11451, Saudi Arabia
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8
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Abstract
Sleep is a critical aspect of one's daily life for overall health, with a recommended 7 to 9 hours in adulthood (ages 26-64). Up to a third of women do not sleep sufficiently, and pregnant women are at an increased risk for sleep deficiency. Throughout pregnancy, sleep is affected in differing ways. For example, in the first trimester, hormones affect sleep cycles, but by the third trimester, physical complaints such as increasing frequent urination and fetal movement create frequent awakenings. Associations between sleep deficiency and gestational diabetes, hypertensive disorders, depression, and some evidence regarding preterm birth exist. A woman's labor course and perception of delivery are also negatively affected by short sleep duration.
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Affiliation(s)
- Arlin Delgado
- Department of Obstetrics and Gynecology, Morsani College of Medicine, University of South Florida Morsani College of Medicine, 2 Tampa General Circle, Tampa, FL 33606, USA
| | - Judette M Louis
- Department of Obstetrics and Gynecology, Morsani College of Medicine, University of South Florida Morsani College of Medicine, 2 Tampa General Circle, Tampa, FL 33606, USA.
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Shaun MMA, Nizum MWR, Shuvo MA, Fayeza F, Faruk MO, Alam MF, Ahmed MS, Zaman S, Mali SK, Hawlader MDH. Association between depressive symptoms and poor sleep quality among pregnant women in Northern Rural Bangladesh: a community-based cross-sectional study. BMC Psychiatry 2022; 22:201. [PMID: 35303810 PMCID: PMC8933943 DOI: 10.1186/s12888-022-03839-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Accepted: 03/08/2022] [Indexed: 11/25/2022] Open
Abstract
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.
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Affiliation(s)
- Md Mahbubul Alam Shaun
- Department of Biochemistry and Food Analysis, Faculty of Nutrition and Food Science, Patuakhali Science and Technology University, Dumki 8602, Patuakhali, Bangladesh
| | - Md Wahidur Rahman Nizum
- Department of Public Health, School of Health and Life Sciences, North South University, Dhaka, 1229 Bangladesh
| | - Md Asaduzzaman Shuvo
- Department of Public Health, School of Health and Life Sciences, North South University, Dhaka, 1229 Bangladesh
| | - Fahmida Fayeza
- Department of Biochemistry and Food Analysis, Faculty of Nutrition and Food Science, Patuakhali Science and Technology University, Dumki 8602, Patuakhali, Bangladesh
| | - Md Omar Faruk
- Department of Biochemistry and Food Analysis, Faculty of Nutrition and Food Science, Patuakhali Science and Technology University, Dumki 8602, Patuakhali, Bangladesh
| | - Md Fakrul Alam
- Department of Biochemistry and Food Analysis, Faculty of Nutrition and Food Science, Patuakhali Science and Technology University, Dumki 8602, Patuakhali, Bangladesh
| | - Md Sabbir Ahmed
- Department of Community Health and Hygiene, Faculty of Nutrition and Food Science, Patuakhali Science and Technology University, Dumki 8602, Patuakhali, Bangladesh
| | - Sanjana Zaman
- Department of Public Health, Daffodil International University (DIU), Dhaka, 1207 Bangladesh
| | - Sujan Kanti Mali
- Department of Biochemistry and Food Analysis, Faculty of Nutrition and Food Science, Patuakhali Science and Technology University, Dumki 8602, Patuakhali, Bangladesh
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Chan C, Poon SH, Chua TE, Razali NS, Tan KH, Chen H. A Prospective Study of the Relationship Between Sleep Quality and Depression in Pregnancy. PROCEEDINGS OF SINGAPORE HEALTHCARE 2022. [DOI: 10.1177/20101058211068591] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Objective Poor sleep and depression are common problems during pregnancy, but there has been little investigation into the association between them. This prospective study aims to examine the relationship between sleep quality and depression during pregnancy. Methods Pregnant women under 14 weeks’ gestation attending routine outpatient antenatal care in Singapore’s largest maternity hospital were recruited between 2012 and 2014. Women with multiple pregnancies and deemed at high risk of miscarriage were excluded. Six hundred and forty participants completed the Pittsburgh Sleep Quality Index (PSQI) and Edinburgh Postnatal Depression Scale (EPDS) at the three trimesters during pregnancy. Results Mean PSQI score was highest in the third visit, suggesting poorer quality sleep in the late third trimester compared to other trimesters. 15.6% of participants at each time point fulfilled the criteria for antenatal depression according to the EPDS cut-off score > 14. PSQI scores were significantly correlated with EPDS scores, and also prospectively predicted EPDS scores in all three trimesters. Conclusion Sleep quality in Singaporean pregnant women was poorest in the third trimester, and was associated with the development of depressive symptoms. With more than 1 in 10 women having antenatal depression, interventions targeting sleep quality might be particularly beneficial.
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Affiliation(s)
| | - Shi Hui Poon
- Duke-National University of Singapore, Singapore
| | - Tze-Ern Chua
- Duke-National University of Singapore, Singapore
- Department of Psychological Medicine, KK Women’s and Children’s Hospital, Singapore
| | - Nurul Syaza Razali
- Division of Obstetrics & Gynaecology, KK Women’s and Children’s Hospital, Singapore
| | - Kok Hian Tan
- Duke-National University of Singapore, Singapore
- Division of Obstetrics & Gynaecology, KK Women’s and Children’s Hospital, Singapore
| | - Helen Chen
- Duke-National University of Singapore, Singapore
- Department of Psychological Medicine, KK Women’s and Children’s Hospital, Singapore
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Balieiro LCT, Gontijo CA, Marot LP, Teixeira GP, Fahmy WM, Moreno CRDC, Maia YCDP, Crispim CA. Circadian misalignment measured by social jetlag from early to late pregnancy and its association with nutritional status: a longitudinal study. Sci Rep 2021; 11:18678. [PMID: 34548528 PMCID: PMC8455574 DOI: 10.1038/s41598-021-97946-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Accepted: 09/01/2021] [Indexed: 11/25/2022] Open
Abstract
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.
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Affiliation(s)
| | | | | | | | | | - Claudia Roberta de Castro Moreno
- Department of Health, Life Cycles and Society, School of Public Health, University of São Paulo, São Paulo, São Paulo, Brazil.,Stress Research Institute, Department of Psychology, Stockholm University, Stockholm, Sweden
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12
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Reliability and Validity of the Czech Version of the Pittsburgh Sleep Quality Index in Patients with Sleep Disorders and Healthy Controls. BIOMED RESEARCH INTERNATIONAL 2021; 2021:5576348. [PMID: 34423035 PMCID: PMC8373506 DOI: 10.1155/2021/5576348] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Revised: 07/05/2021] [Accepted: 07/23/2021] [Indexed: 11/17/2022]
Abstract
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.
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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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14
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Gordon LK, Mason KA, Mepham E, Sharkey KM. A mixed methods study of perinatal sleep and breastfeeding outcomes in women at risk for postpartum depression. Sleep Health 2021; 7:353-361. [PMID: 33640360 PMCID: PMC9665349 DOI: 10.1016/j.sleh.2021.01.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Revised: 01/05/2021] [Accepted: 01/12/2021] [Indexed: 12/17/2022]
Abstract
INTRODUCTION Pregnant and postpartum women experience significant sleep disruption, but the role of perinatal sleep disturbances in breastfeeding is understudied. METHODS In this observational cohort study, we used mixed methods to examine associations between perinatal sleep and breastfeeding. Forty-eight women (mean age 28.2 ± 4.9 years) who were euthymic at enrollment but had a history of major depression (n = 43) or bipolar disorder (n = 5) had sleep recorded with wrist actigraphy. We determined feeding status through daily diaries and used semi-structured interviews to identify themes regarding participants' experiences, breastfeeding decisions, and behaviors. To examine whether sleep disturbance during pregnancy predicted breastfeeding (BF) rates, we defined "lower sleep efficiency" (LSE) and "higher sleep efficiency" (HSE) groups based on the median split of actigraphic SE at 33 weeks' gestation (cutoff SE = 84.9%) and classified mothers as No-BF, Mixed-BF (BF + formula), and Exclusive-BF at 2 weeks postpartum. RESULTS Percentages of women who did any breastfeeding were: Week 2 = 72.3%, Week 6 = 62.5%, Week 16 = 50%. LSE mothers were less likely than HSE mothers to initiate breastfeeding (percent No-BF: LSE = 45.8%, HSE = 16.7%, P < .05). Average actigraphic sleep onset, sleep offset, time in bed, sleep duration, and SE did not differ based on breastfeeding status at any time point. Qualitative themes included insufficient preparation for the demands of breastfeeding, interrupted and nonrestorative sleep, and unrelenting daytime tiredness. CONCLUSIONS In our sample, preserved actigraphic SE during pregnancy was associated with initiation and continuation of breastfeeding. Future work should examine whether improving sleep in pregnancy improves mothers' feeding experiences.
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Affiliation(s)
- Lily K Gordon
- The Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA; Sleep for Science Research Laboratory, Providence, Rhode Island, USA
| | - Katherine A Mason
- Department of Anthropology, Brown University, Providence, Rhode Island, USA
| | - Emily Mepham
- Sleep for Science Research Laboratory, Providence, Rhode Island, USA
| | - Katherine M Sharkey
- The Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA; Sleep for Science Research Laboratory, Providence, Rhode Island, USA; Rhode Island Hospital, Divison of Pulmonary, Critical Care, and Sleep Medicine, Providence, Rhode Island, USA.
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15
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Çolak S, Gürlek B, Önal Ö, Yılmaz B, Hocaoglu C. The level of depression, anxiety, and sleep quality in pregnancy during coronavirus disease 2019 pandemic. J Obstet Gynaecol Res 2021; 47:2666-2676. [PMID: 34062619 PMCID: PMC8242418 DOI: 10.1111/jog.14872] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2020] [Revised: 04/20/2021] [Accepted: 05/16/2021] [Indexed: 11/29/2022]
Abstract
Aim We aimed to evaluate the mental health and sleep quality of pregnant women in different trimesters during coronavirus disease 2019 (COVID‐19) pandemic and investigate the effect of quarantine and new lifestyle changes that come into our lives with pandemic with on this subject. Methods It was conducted on pregnant women (n = 149) who attended routine pregnancy prenatal visit during their pregnancy weeks. The data were collected using sociodemographic and clinical data form, Pittsburgh Sleep Quality Index (PSQI) to evaluate sleep quality, Beck Depression Inventory (BDI), and Beck Anxiety Inventory (BAI) to evaluate maternal depression and anxiety. Results A significant correlation was observed between the week of gestation and depression, anxiety, and defective sleep scores (p < 0.001). A moderate positive correlation was found between the week of gestation and depression (r: 0.628). A high level of positive correlation was found between the week of gestation and defective sleep quality and anxiety scores (r: 0.858, r: 0.754). A statistically significant increase in depression, anxiety, and defective sleep quality was found in the group staying in home quarantine (p = 0.002). Conclusion This study showed that the COVID‐19 pandemic can cause depression, anxiety, and serious sleep disorders in pregnant women. The depression and anxiety scores of pregnant women in home quarantine were also found to be higher than the group not in quarantine. As the week of gestation progresses, mental health symptoms worsen and sleep quality deteriorates.
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Affiliation(s)
- Sabri Çolak
- Department of Obstetrics and Gynecology, Faculty of Medicine, Recep Tayyip Erdogan University, Rize, Turkey
| | - Beril Gürlek
- Department of Obstetrics and Gynecology, Faculty of Medicine, Recep Tayyip Erdogan University, Rize, Turkey
| | - Özgür Önal
- Department of Public Health, Faculty of Medicine, Suleyman Demirel University, Isparta, Turkey
| | - Bülent Yılmaz
- Department of Obstetrics and Gynecology, Faculty of Medicine, Recep Tayyip Erdogan University, Rize, Turkey
| | - Cicek Hocaoglu
- Department of Psychiatry, Faculty of Medicine, Recep Tayyip Erdogan University, Rize, Turkey
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16
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Osnes RS, Eberhard-Gran M, Follestad T, Kallestad H, Morken G, Roaldset JO. Mid-Pregnancy Insomnia and its Association with Perinatal Depressive Symptoms: A Prospective Cohort Study. Behav Sleep Med 2021; 19:285-302. [PMID: 32228307 DOI: 10.1080/15402002.2020.1743705] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Objective/Background: Insomnia and depression are disorders that affect many perinatal women and that often are interrelated. The present study aimed to examine concurrent and prospective associations between mid-pregnancy insomnia and depression during mid-pregnancy and 8 weeks postpartum. Furthermore, differences in depression and in the sleep-related characteristics insomnia, chronotype, and sleep efficiency were explored between the two time points (mid-pregnancy versus 8 weeks postpartum), and between primiparous and multiparous participants.Participants/Methods: The study was part of the Norwegian population-based Depression and Anxiety in the Perinatal Period (DAPP) prospective cohort study. Among 539 women that were recruited for participation when receiving a routine ultrasound examination, we analyzed data from hospital birth records and questionnaire responses from pregnancy week 17 and postpartum week 8. We used the Edinburgh Postnatal Depression Scale to measure depression. The Bergen Insomnia Scale, the reduced Horne-Östberg Morningness-Eveningness Questionnaire, and three questions from the Pittsburgh Sleep Quality Index were used to measure the sleep-related characteristics.Results: Mid-pregnancy insomnia was significantly associated with concurrent depression (p < .001), but not with postpartum depression (p = .288), in a linear mixed model with adjustment for several reproductive and psychosocial variables. Sleep efficiency was reduced from mid-pregnancy to postpartum (from 88% to 77%), and primiparous women reported less efficient sleep than multiparous women after childbirth.Conclusions: The results indicate that mid-pregnancy insomnia may be a marker for concurrent depression but not a predictor of postpartum depression. Future research should examine the extent to which treatment of insomnia from mid-pregnancy on reduces both perinatal insomnia and depression.
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Affiliation(s)
- Rannveig S Osnes
- Department of Psychiatry, Ålesund Hospital, Møre & Romsdal Hospital Trust, Ålesund, Norway.,Department of Mental Health, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway
| | - Malin Eberhard-Gran
- Institute of Clinical Medicine, Campus Ahus, University of Oslo, Lørenskog, Norway.,Department of Infant Mental Health, Regional Center for Child and Adolescent Mental Health, Eastern and Southern Norway, Oslo, Norway
| | - Turid Follestad
- Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway
| | - Håvard Kallestad
- Department of Mental Health, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway.,Østmarka Department of Psychiatry, St Olavs Hospital HF, Trondheim University Hospital, Trondheim, Norway
| | - Gunnar Morken
- Department of Mental Health, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway.,Østmarka Department of Psychiatry, St Olavs Hospital HF, Trondheim University Hospital, Trondheim, Norway
| | - John Olav Roaldset
- Department of Mental Health, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway.,Centre for Research and Education in Forensic Psychiatry, Oslo University Hospital, Oslo, Norway
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17
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Obstructive Sleep Apnea Is Associated with Newly Diagnosed Gestational Diabetes Mellitus. Ann Am Thorac Soc 2021; 17:754-761. [PMID: 32040334 DOI: 10.1513/annalsats.201906-473oc] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Rationale: Sleep-disordered breathing (SDB) is associated with increased risk of adverse pregnancy outcomes, including gestational diabetes mellitus (GDM). GDM is a significant cause of maternal and infant morbidities. Assessing these risk factors concurrently may facilitate both the identification of women at GDM risk and the initiation of GDM prevention strategies.Objectives: To investigate whether SDB events, including SDB in rapid eye movement (REM) sleep and other sleep parameters, are associated with increased risk of GDM and to evaluate the performance of the models investigating associations between breathing and sleep parameters and GDM risk.Methods: In this case-control study, 46 women with newly diagnosed GDM and 46 healthy control subjects, who were individually matched for age, gestational age, body mass index, race, and parity, completed overnight polysomnographic studies and sleep questionnaires after being screened for GDM during the late-second to mid-third trimesters. Conditional logistic regression analysis was used to identify models investigating associations between risk factors and GDM risk. The Bayesian information criterion (BIC) was employed to compare models; the model with the lowest BIC is preferred.Results: Obstructive sleep apnea (OSA; defined as an apnea-hypopnea index [AHI] >5 events/h) was present in 22% of subjects with GDM and 9% of control subjects (P < 0.001). Women with OSA had a higher GDM risk (odds ratio [OR], 4.71; 95% confidence interval [CI], 1.05-21.04). In individual models, GDM risk was also significantly higher among women with higher overall AHI (events/h OR, 1.81; 95% CI, 1.01-3.27), higher AHI in REM (events/h OR, 2.09; 95% CI, 1.02-4.31), higher oxygen desaturation index greater than or equal to 4% (ODI4; events/h OR, 2.21; 95% CI, 1.03-4.73), and higher Sleep Apnea Symptom Score (OR, 2.72; 95% CI, 1.11-6.69). The percentage of non-REM sleep was significantly associated with decreased risk of GDM (percentage of non-REM sleep OR, 0.88; 95% CI, 0.78-0.99). The BIC supports the conclusion that there is a strong association between AHI in REM and GDM risk compared with the other significant models.Conclusions: SDB events, including REM-related OSA, are linked to increased GDM risk. GDM risk is also influenced by intercorrelated sleep variables.
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18
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Xie M, Wang X, Zhang J, Wang Y. Alteration in the psychologic status and family environment of pregnant women before and during the COVID-19 pandemic. Int J Gynaecol Obstet 2021; 153:71-75. [PMID: 33403679 PMCID: PMC9087655 DOI: 10.1002/ijgo.13575] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Revised: 11/10/2020] [Accepted: 11/30/2020] [Indexed: 01/11/2023]
Abstract
Objective To compare mental distress and COVID‐19‐related family environment changes among pregnant women before and during the pandemic. Methods In a survey‐based study in Lishui City, Zhejiang, China, pregnant women were recruited before (March–December, 2019; n = 2657) and during (January–August, 2020; n = 689) the COVID‐19 pandemic. They completed the Symptom Check List‐90 Revised (SCL90‐R) questionnaire and Pittsburgh Sleep Quality Index (PSQI), and were asked about their families via the Family Environment Scale (FES). Results Higher SCL90‐R scores of somatization (P = 0.003), depression (P = 0.043), anxiety (P = 0.041), hostility (P = 0.009), and others (P = 0.025) were reported by women during the COVID‐19 pandemic. Sleep disorder also occurred more frequently among pregnant women during the pandemic (P = 0.002). Social environmental characteristics of families showed impaired family cohesion, and increased levels of conflict and independence during the pandemic (all P < 0.05). The FES score for family cohesion was negatively related with obsessive–compulsive, depression, anxiety, and hostility symptoms, whereas that for conflict was positively related with these symptoms (all P < 0.001). Conclusion The mental health, sleep, and family environment of pregnant women was impaired during the COVID‐19 pandemic. Potential protective factors including increased social support might help to mitigate long‐lasting negative consequences. The mental health and sleep of pregnant women was impaired during the COVID‐19 pandemic, and they experienced more stressful family events over the crisis.
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Affiliation(s)
- Miaomiao Xie
- Department of Obstetrics and Gynecology, Lishui Maternal and Child Health Care Hospital, Zhejiang, China
| | - Xiaoyun Wang
- Department of Obstetrics and Gynecology, School of Medicine, Shanghai General Hospital, Shanghai Jiao Tong University, Shanghai, China
| | | | - Yi Wang
- Department of Obstetrics and Gynecology, Lishui Maternal and Child Health Care Hospital, Zhejiang, China
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19
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Measuring Subjective Sleep Quality: A Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18031082. [PMID: 33530453 PMCID: PMC7908437 DOI: 10.3390/ijerph18031082] [Citation(s) in RCA: 178] [Impact Index Per Article: 59.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/29/2020] [Revised: 01/07/2021] [Accepted: 01/16/2021] [Indexed: 01/31/2023]
Abstract
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.
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20
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Pietikäinen JT, Härkänen T, Polo-Kantola P, Karlsson H, Paunio T, Karlsson L, Paavonen EJ. Estimating the cumulative risk of postnatal depressive symptoms: the role of insomnia symptoms across pregnancy. Soc Psychiatry Psychiatr Epidemiol 2021; 56:2251-2261. [PMID: 33961078 PMCID: PMC8558280 DOI: 10.1007/s00127-021-02101-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Accepted: 04/23/2021] [Indexed: 11/29/2022]
Abstract
PURPOSE Insomnia symptoms during late pregnancy are a known risk for postnatal depressive symptoms (PDS). However, the cumulative effect of various risk factors throughout pregnancy has not been explored. Our aim was to test how various insomnia symptoms (sleep latency, duration, quality, frequent night awakenings, early morning awakenings) and other risk factors (e.g., history of depression, symptoms of depression and anxiety, as well as sociodemographic factors) in early, mid-, and late pregnancy predict PDS. METHODS Using data from the FinnBrain Birth Cohort Study and logistic regression analyses, we investigated the associations of distinct insomnia symptoms at gw 14, 24, and 34 with depressive symptoms (Edinburgh Postnatal Depression Scale score ≥ 11) 3 months postnatally. We also calculated separate and combined predictive models of PDS for each pregnancy time point and reported the odds ratios for each risk group. RESULTS Of the 2224 women included in the study, 7.1% scored EPDS ≥ 11 3 months postnatally. Our predictive models indicated that sleep latency of ≥ 20 min, anxiety in early pregnancy, and insufficient sleep during late pregnancy predicted the risk of PDS. Furthermore, we found highly elevated odds ratios in early, mid-, and late pregnancy for women with multiple PDS risk factors. CONCLUSION Screening of long sleep latency and anxiety during early pregnancy, in addition to depression screening, could be advisable. Odds ratios of risk factor combinations demonstrate the magnitude of cumulating risk of PDS when multiple risk factors are present.
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Affiliation(s)
- Johanna T. Pietikäinen
- Department of Psychiatry, Helsinki University Hospital and University of Helsinki, Helsinki, Finland ,Department of Public Health and Welfare, Finnish Institute for Health and Welfare, Mannerheimintie 166, P. O. Box 30, 00271 Helsinki, Finland
| | - Tommi Härkänen
- Department of Public Health and Welfare, Finnish Institute for Health and Welfare, Mannerheimintie 166, P. O. Box 30, 00271 Helsinki, Finland
| | - Päivi Polo-Kantola
- Department of Obstetrics and Gynaecology, Turku University Hospital, Turku University, Turku, Finland ,Department of Pulmonary Diseases and Allergology, Sleep Research Centre, University of Turku, Turku, Finland
| | - Hasse Karlsson
- Department of Clinical Medicine, The FinnBrain Birth Cohort Study, Turku Brain and Mind Center, University of Turku, Turku, Finland ,Department of Psychiatry, Turku University Hospital and University of Turku, Turku, Finland ,Centre for Population Health Research, Turku University Hospital and University of Turku, Turku, Finland
| | - Tiina Paunio
- Department of Public Health and Welfare, Finnish Institute for Health and Welfare, Mannerheimintie 166, P. O. Box 30, 00271 Helsinki, Finland ,Department of Psychiatry and SleepWell Research Program, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Linnea Karlsson
- Department of Clinical Medicine, The FinnBrain Birth Cohort Study, Turku Brain and Mind Center, University of Turku, Turku, Finland
| | - E. Juulia Paavonen
- Department of Public Health and Welfare, Finnish Institute for Health and Welfare, Mannerheimintie 166, P. O. Box 30, 00271 Helsinki, Finland ,Department of Child Psychiatry, Pediatric Research Center, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
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21
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Wilson DL, Barnes M, Ellett L, Permezel M, Jackson M, Crowe SF. Reduced Verbal Memory Retention is Unrelated to Sleep Disturbance During Pregnancy. AUSTRALIAN PSYCHOLOGIST 2020. [DOI: 10.1111/j.1742-9544.2012.00076.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Danielle L Wilson
- School of Psychological Science, La Trobe University
- Institute for Breathing and Sleep, Austin Health
| | - Maree Barnes
- Institute for Breathing and Sleep, Austin Health
- Department of Medicine, University of Melbourne
| | - Lenore Ellett
- Department of Obstetrics and Gynaecology, Mercy Hospital for Women
| | - Michael Permezel
- Department of Obstetrics and Gynaecology, Mercy Hospital for Women
- Department of Obstetrics and Gynaecology, University of Melbourne
| | | | - Simon F Crowe
- School of Psychological Science, La Trobe University
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22
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Esen E. The My Children’s Future Scale: Construct validity, measurement invariance, and reliability in a Turkish sample. AUSTRALIAN JOURNAL OF CAREER DEVELOPMENT 2020. [DOI: 10.1177/1038416220941853] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The My Children’s Future Scale (MCFS) measures the support provided by parents for their children’s careers. The aim of this study was to adapt the MCFS to Turkish and examine its psychometric characteristics in a study conducted in the Turkish context. Participants consisted of 280 parents (190 mothers and 90 fathers). The factor structure of the MCFS and measurement invariance across parent gender were examined. The unidimensional factor structure was confirmed and the scale was invariant across parent gender. In addition, the reliability of the MCFS was assessed for internal consistency and test-retest reliability. Cronbach’s alpha and McDonald’s omega coefficients were calculated as .87, and test-retest reliability coefficient as .83. Our findings suggested that the Turkish form of the MCFS can be considered a valid and reliable data collection tool for use in Turkey to measure the support provided by parents for their children’s careers.
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Affiliation(s)
- Erol Esen
- Department of Counseling and Guidance, Manisa Celal Bayar University, Manisa, Turkey
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23
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Bradley HA, Campbell SA, Mulder RT, Henderson JMT, Dixon L, Boden JM, Rucklidge JJ. Can broad-spectrum multinutrients treat symptoms of antenatal depression and anxiety and improve infant development? Study protocol of a double blind, randomized, controlled trial (the 'NUTRIMUM' trial). BMC Pregnancy Childbirth 2020; 20:488. [PMID: 32842983 PMCID: PMC7448485 DOI: 10.1186/s12884-020-03143-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2019] [Accepted: 07/28/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Untreated antenatal depression and anxiety can be associated with short and long term health impacts on the pregnant woman, her infant and the rest of the family. Alternative interventions to those currently available are needed. This clinical trial aims to investigate the efficacy and safety of a broad-spectrum multinutrient formula as a treatment for symptoms of depression and anxiety in pregnant women and to determine the impact supplementation has on the general health and development of the infant. METHODS This randomised, controlled trial will be conducted in Canterbury, New Zealand between April 2017 and June 2022. One hundred and twenty women aged over 16 years, between 12 and 24 weeks gestation and who score ≥ 13 on the Edinburgh Postnatal Depression Scale (EPDS) will be randomly assigned to take the intervention (n = 60) or an active control formula containing iodine and riboflavin (n = 60) for 12 weeks. After 12 weeks, participants can enter an open-label phase until the birth of their infant and naturalistically followed for the first 12 months postpartum. Infants will be followed until 12 months of age. Randomisation will be computer-generated, with allocation concealment by opaque sequentially numbered envelopes. Participants and the research team including data analysts will be blinded to group assignment. The EPDS and the Clinical Global Impressions Scale of Improvement (CGI-I) will be the maternal primary outcome measures of this study and will assess the incidence of depression and anxiety and the improvement of symptomatology respectively. Generalized linear mixed effects regression models will analyse statistical differences between the multinutrient and active control group on an intent-to-treat basis. A minimum of a three-point difference in EPDS scores between the groups will identify clinical significance. Pregnancy outcomes, adverse events and side effects will also be monitored and reported. DISCUSSION Should the multinutrient formula be shown to be beneficial for both the mother and the infant, then an alternative treatment option that may also improve the biopsychosocial development of their infants can be provided for pregnant women experiencing symptoms of depression and anxiety. TRIAL REGISTRATION Trial ID: ACTRN12617000354381 ; prospectively registered at Australian New Zealand Clinical Trials Registry on 08/03/2017.
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Affiliation(s)
- Hayley A. Bradley
- School of Psychology, Speech and Hearing, University of Canterbury, Private Bag 4800, Christchurch, 8041 New Zealand
| | - Siobhan A. Campbell
- School of Psychology, Speech and Hearing, University of Canterbury, Private Bag 4800, Christchurch, 8041 New Zealand
| | - Roger T. Mulder
- Department of Psychological Medicine, University of Otago, Christchurch, New Zealand
| | - Jaqueline M. T. Henderson
- School of Psychology, Speech and Hearing, University of Canterbury, Private Bag 4800, Christchurch, 8041 New Zealand
| | - Lesley Dixon
- New Zealand College of Midwives, Christchurch, New Zealand
| | - Joseph M. Boden
- Department of Psychological Medicine, University of Otago, Christchurch, New Zealand
| | - Julia J. Rucklidge
- School of Psychology, Speech and Hearing, University of Canterbury, Private Bag 4800, Christchurch, 8041 New Zealand
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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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Tan JJL, Tay HY, Lim CKS, Shen BJ. Measurement Structure of the Pittsburgh Sleep Quality Index and Its Association with Health Functioning in Patients with Coronary Heart Disease. J Clin Psychol Med Settings 2019; 27:677-685. [PMID: 31478169 DOI: 10.1007/s10880-019-09652-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Research on the underlying structure of sleep measures in patients with coronary heart disease (CHD) is lacking. Existing research on sleep and health outcomes primarily focused on only one dimension of sleep (e.g., sleep duration), leaving other aspects unexamined. To address this gap, this study examined the measurement structure of Pittsburgh Sleep Quality Index (PSQI) and its associations with health-related quality of life among CHD patients. Participants were 167 CHD patients from a cardiac wellness program. Confirmatory factor analysis revealed that the two-factor structure with sleep efficiency and perceived sleep quality best fitted the data. Concurrent validity analyses with structural equation modeling showed that, when considered simultaneously, perceived sleep quality, but not sleep efficiency, was significantly associated with emotional, physical, and social quality of life. Findings demonstrated that the PSQI consists of two moderately correlated factors that are differentially associated with separate health domains in cardiac patients.
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Affiliation(s)
- Jonathan Jun Liang Tan
- Psychology Program, School of Social Sciences, Nanyang Technological University, HSS-04-02, 48 Nanyang Avenue, Singapore, 639818, Singapore
| | - Hung Yong Tay
- Heart Wellness Centre, Singapore Heart Foundation, 9 Bishan Place, #07-01 Junction 8, Office Tower, Singapore, 579837, Singapore
| | - Cindy Khim Siang Lim
- Heart Wellness Centre, Singapore Heart Foundation, 9 Bishan Place, #07-01 Junction 8, Office Tower, Singapore, 579837, Singapore
| | - Biing-Jiun Shen
- Psychology Program, School of Social Sciences, Nanyang Technological University, HSS-04-02, 48 Nanyang Avenue, Singapore, 639818, Singapore.
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26
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Eichler J, Schmidt R, Hiemisch A, Kiess W, Hilbert A. Gestational weight gain, physical activity, sleep problems, substance use, and food intake as proximal risk factors of stress and depressive symptoms during pregnancy. BMC Pregnancy Childbirth 2019; 19:175. [PMID: 31101019 PMCID: PMC6525385 DOI: 10.1186/s12884-019-2328-1] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2018] [Accepted: 05/03/2019] [Indexed: 12/23/2022] Open
Abstract
Background Because maternal depressive symptoms and stress during pregnancy are strongly associated with poor health of the mother and the developing child, understanding the predictors of women’s mental health problems is important to prevent complications in the perinatal period. Therefore, this study sought to examine the association between six risk factors – gestational weight gain (GWG), low physical activity, sleep problems, alcohol use, cigarette smoking and snack food intake – and mental health problems during pregnancy. We hypothesized that risk factors would predict mental health problems while adjusting for socio-demographic characteristics and pregnancy intention, both cross-sectionally and longitudinally. Methods Hierarchical linear regression analyses were conducted in a population-based sample of N = 463 pregnant women during their 2nd trimester (gestational age: 23 to 28 weeks) of whom n = 349 were reassessed during their 3rd trimester (gestational age: 33 to 38 weeks). Women had a mean age of 29.8 ± 4.2 years and a mean pregravid body mass index of 23.5 ± 4.3 kg/m2. Data were collected by the ‘Leipzig Research Center for Civilization Diseases’ via the Patient Health Questionnaire, Pittsburgh Sleep Quality Index, Food Frequency Questionnaire, self-report items on physical activity and substance use, and objectively measured anthropometrics. Results Cross-sectionally, while a higher snack food intake and sleep problems predicted depressive symptoms and stress during the 2nd trimester, gestational weight gain predicted stress only. Longitudinally, sleep problems positively predicted depressive symptoms during the 3rd trimester. All results remained significant after controlling for age, pregravid body mass index, and pregnancy intention. GWG and significant longitudinal effects became insignificant when controlling for gestational age or baseline depressive symptoms and stress, respectively. Conclusions The results showed that sleep problems were associated with maternal mental health problems during pregnancy. Longitudinal studies using standardized measures, particularly diagnostic interviews and physiological or biochemical markers, are warranted to confirm patterns of risk factors, their association with depressive symptoms and stress during the course of pregnancy, and their effects on mother’s and child’s health. Electronic supplementary material The online version of this article (10.1186/s12884-019-2328-1) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Janina Eichler
- Integrated Research and Treatment Center AdiposityDiseases, Medical Psychology and Medical Sociology, Psychosomatic Medicine and Psychotherapy, Leipzig University Medical Center, Philipp-Rosenthal-Strasse 27, 04103, Leipzig, Germany.
| | - Ricarda Schmidt
- Integrated Research and Treatment Center AdiposityDiseases, Medical Psychology and Medical Sociology, Psychosomatic Medicine and Psychotherapy, Leipzig University Medical Center, Philipp-Rosenthal-Strasse 27, 04103, Leipzig, Germany
| | - Andreas Hiemisch
- LIFE Child Leipzig Research Center for Civilization Diseases, University of Leipzig, Philipp-Rosenthal-Strasse 27, 04103, Leipzig, Germany.,Department of Women and Child Health, Hospital for Children and Adolescents and Centre for Paediatric Research (CPL), University of Leipzig, Liebigstrasse 20a, 04103, Leipzig, Germany
| | - Wieland Kiess
- LIFE Child Leipzig Research Center for Civilization Diseases, University of Leipzig, Philipp-Rosenthal-Strasse 27, 04103, Leipzig, Germany.,Department of Women and Child Health, Hospital for Children and Adolescents and Centre for Paediatric Research (CPL), University of Leipzig, Liebigstrasse 20a, 04103, Leipzig, Germany
| | - Anja Hilbert
- Integrated Research and Treatment Center AdiposityDiseases, Medical Psychology and Medical Sociology, Psychosomatic Medicine and Psychotherapy, Leipzig University Medical Center, Philipp-Rosenthal-Strasse 27, 04103, Leipzig, Germany
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27
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Yıldırım E, Demir E. The relationship of hyperemesis gravidarum with sleep disorders, anxiety and depression. J OBSTET GYNAECOL 2019; 39:793-798. [PMID: 30983449 DOI: 10.1080/01443615.2019.1572725] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
The purpose of this study was to compare patients who were diagnosed with hyperemesis gravidarum (HG) with the control group by identifying anxiety, depression, sleep disorder levels and the relationship between them. This study involved 98 first-trimester pregnant women (46 HG patients and 52 control group patients) who applied to the Hitit University Medicine Faculty Obstetrics and Gynecology clinic. Statistically significant differences were found between HG patients and the control group according to the Beck Anxiety Inventory (BAI) and Beck Depression Inventory (BDI) scores (p < .001 and p < .001, respectively). In addition, a significant relationship was found between the classification performed according to the Pittsburgh Sleep Quality Index (PSQI) scores and HG (p < .001). According to PSQI scores, while 60.9% of HG patients had severe sleep disorders, 7.7% of the patients in the control group had severe sleep disorders. These findings clearly show that the PSQI scores increased as a result of nausea and vomiting. Impact statement What is already known on this subject? The aetiology of hyperemesis gravidarum has not yet been clarified. There are some studies that relate pregnancy to anxiety and depression. What the results of this study add? In our study, we aimed to evaluate first-trimester vomiting with psychological disorders. What the implications are of these findings for clinical practice and/or further research? There was a statistically significant relationship between PSQI scores and BAI and BDI scores in the HG group. However, this relationship was not detected in the control group. Also, PSQI scores increased as a result of nausea and vomiting in HG cases.
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Affiliation(s)
- Engin Yıldırım
- a Department of Obstetrics and Gynecology, Faculty of Medicine , Hitit University , Çorum , Turkey
| | - Emre Demir
- b Department of Biostatistics, Faculty of Medicine , Hitit University , Çorum , Turkey
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28
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Wilkerson AK, Uhde TW. Perinatal Sleep Problems: Causes, Complications, and Management. Obstet Gynecol Clin North Am 2019; 45:483-494. [PMID: 30092923 DOI: 10.1016/j.ogc.2018.04.003] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Changes in sleep are ubiquitous in the perinatal period and it is important to be able to determine when these changes are significant enough to indicate sleep deficiency associated with increased risk for poor maternal and infant outcomes. Guidelines for identifying sleep deficiency include insomnia symptoms, excessively shortened sleep duration, and perception of insufficient or nonrestful sleep. Causes and complicating factors related to such sleep problems have been well-documented and are used to tailor behavioral and pharmacologic treatments for women who are pregnant or in the early postpartum period.
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Affiliation(s)
- Allison K Wilkerson
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, 67 President Street, MSC 861, Charleston, SC 29425, USA.
| | - Thomas W Uhde
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, 67 President Street, MSC 861, Charleston, SC 29425, USA
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29
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Dimensionality of the Pittsburgh Sleep Quality Index: a systematic review. Health Qual Life Outcomes 2018; 16:89. [PMID: 29743066 PMCID: PMC5944037 DOI: 10.1186/s12955-018-0915-x] [Citation(s) in RCA: 100] [Impact Index Per Article: 16.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2017] [Accepted: 04/29/2018] [Indexed: 11/16/2022] Open
Abstract
Background The Pittsburgh Sleep Quality Index (PSQI) dimensionality is much debated, with the greatest number of reported factor structures. Therefore, this review appraised the methodologies of studies investigating the factor structure of the PSQI. Material and methods MEDLINE, PsycInfo, AJOL, BASE, Cochrane Library, Directory of Open Access Journals (Lund University), CINAHL, and Embase were searched systematically to include articles published till 23rd March, 2018. The articles with the objective of factor analysis of the PSQI (20 articles) or with a major section on the same subject (25 articles) were included. There was no limitation about participant characteristics. Descriptive analysis of articles for measures of the suitability of the data for factor analysis, details of the exploratory factor analysis (EFA) and details of the confirmatory factor analysis (CFA) was performed. Results The analysis used by the majority did not employ the simplest scheme for interpreting the observed data: the parsimony principle. Other shortcomings included under- or non-reporting of sample adequacy measures (11 out of 45 articles), non-use of EFA (20 out of 45 articles), use of EFA without relevant details, non-use of CFA (11 out of 45 articles), and use of CFA without relevant details. Overall, 31 out of 45 articles did not use either EFA or CFA. Conclusion We conclude that the various PSQI factor structures for standard sleep assessment in research and clinical settings may need further validation. Trial registration Not applicable because this was a review of existing literature.
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30
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Collings R, Hill B, Skouteris H. The influence of psychological factors on postpartum weight retention 12 months post-birth. J Reprod Infant Psychol 2018. [PMID: 29517343 DOI: 10.1080/02646838.2018.1424323] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Background During the first postpartum year 20% of women retain excessive weight from pregnancy (postpartum weight retention; PPWR), which predicts long-term overweight/obesity. Objective The aim of this study was to explore the associations between psychological factors (depression, anxiety and stress symptoms and body attitudes) in late gestation and at 12-months postpartum with PPWR one-year post-birth. Methods Pregnant women (N = 176) completed questionnaires in early-mid pregnancy (Time 1; mean (SD) = 16.97 (1.35) weeks), late pregnancy (Time 2; mean (SD) = 33.33 (2.05) weeks), and one year postpartum (Time 3; mean (SD) = 53.12 (3.34) weeks). Women provided demographic characteristics, height and pre-pregnancy weight at Time 1. At Times 2 and 3, weight, depressive, anxiety and stress symptoms and body attitudes (salience of weight and shape, attractiveness, feeling fat, and strength and fitness) were assessed in addition to physiological, socio-contextual and lifestyle factors. Gestational weight gain and PPWR were calculated. Hierarchical linear regression models were conducted to explore variance in 12-month PPWR. Results Overall, models explained 26-39% variance in PPWR. Gestational weight gain in late pregnancy and low attractiveness at 12 months postpartum were the only variables associated significantly with 12-month PPWR. Conclusion While psychological factors did not appear to be important direct contributors to PPWR at 12 months, the overall contribution of all variables suggests that such factors may be implicated in a small and incremental way. Exploration of the interactions between variables will help unpack potential mechanisms of the development of PPWR at 12 months post-birth.
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Affiliation(s)
- Rhian Collings
- a School of Psychology , Deakin University , Geelong , Australia
| | - Briony Hill
- a School of Psychology , Deakin University , Geelong , Australia
| | - Helen Skouteris
- a School of Psychology , Deakin University , Geelong , Australia
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31
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Bublitz MH, Bourjeily G, D’Angelo C, Stroud LR. Maternal Sleep Quality and Diurnal Cortisol Regulation Over Pregnancy. Behav Sleep Med 2018; 16:282-293. [PMID: 27485239 PMCID: PMC6126356 DOI: 10.1080/15402002.2016.1210147] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Poor sleep in pregnancy is related to adverse neonatal health. Elevated maternal cortisol has been proposed as a pathway, yet the association in pregnancy is not well understood. The goals of the current study were to examine associations between (a) sleep and cortisol, (b) sleep, cortisol, and neonatal outcomes, and (c) variables that could explain these associations. Two hundred pregnant women completed the Pittsburgh Sleep Quality Index (PSQI; Buysse, Reynolds, Monk, Berman, & Kupfer, 1989) and provided diurnal salivary cortisol samples at two times over pregnancy. Poor sleep quality was associated with greater evening cortisol concentrations at 36 weeks' gestation. This association was mediated by anxiety symptoms. Higher evening cortisol at 36 weeks' gestation was associated with shorter gestation.
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Affiliation(s)
- Margaret H. Bublitz
- Centers for Behavioral and Preventive Medicine, The Miriam Hospital, Providence, RI USA,Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University Providence, RI USA
| | - Ghada Bourjeily
- Department of Medicine, The Miriam Hospital, Alpert Medical School of Brown University Providence, RI USA
| | - Christina D’Angelo
- Centers for Behavioral and Preventive Medicine, The Miriam Hospital, Providence, RI USA
| | - Laura R. Stroud
- Centers for Behavioral and Preventive Medicine, The Miriam Hospital, Providence, RI USA,Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University Providence, RI USA
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32
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Baker JH, Rothenberger SD, Kline CE, Okun ML. Exercise during early pregnancy is associated with greater sleep continuity. Behav Sleep Med 2018; 16:482-493. [PMID: 27739877 PMCID: PMC6124311 DOI: 10.1080/15402002.2016.1228649] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
OBJECTIVES/BACKGROUND Pregnant women report disturbed sleep beginning in early pregnancy. Among nonpregnant populations, exercise has been associated with improved sleep; however, research in pregnant samples has been equivocal. We examined whether varying degrees of exercise were associated with better nocturnal sleep among pregnant women during early gestation. PARTICIPANTS 172 pregnant women. METHODS Self-reported sleep and exercise and objective sleep were collected during early gestation: T1 (10-12 weeks), T2 (14-16 weeks), and T3 (18-20 weeks) from 172 pregnant women. Exercise was categorized into three time-varying groups: 0 metabolic equivalent minutes per week (MET-min/week), 1 to < 500 MET-min/week, or ≥ 500 MET-min/week. Linear mixed-effects models were employed to test hypotheses. RESULTS A significant main effect for Time (F[2,254] = 9.77, p < 0.0001) and Time*Exercise group interaction were observed for actigraphic sleep efficiency (aSE) (F[4,569] = 2.73, p = 0.0285). At T2, women who reported ≥ 500 MET-min/week had higher aSE than those who reported 0 MET-min/week. Significant main effects for Exercise Group and Time were observed for actigraphic wake after sleep onset (aWASO; F[2,694] = 3.04, p = 0.0483 and F[2,260] = 3.21, p = 0.0419). aWASO was lowest for those reporting 1 to < 500 MET-min/week (t[701] = 2.35, adjusted p = .0489) and aWASO decreased from T1 to T3 (t[258] = 2.53, adjusted p value = 0.036). Lastly, there was a main effect for Time for the PSQI (F[2,689] = 52.11, p < 0.0001), indicating that sleep quality improved over time. CONCLUSIONS Some level of exercise among pregnant women appears to be more advantageous than no exercise at all. Moderate exercise, while still unclearly defined, may be a worthwhile adjunct treatment to combat sleep disturbances during pregnancy.
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Affiliation(s)
| | | | | | - Michele L Okun
- University of Pittsburgh, Department of Psychology,University of Colorado at Colorado Springs, Biofrontiers Institute
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33
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Yu Y, Li M, Pu L, Wang S, Wu J, Ruan L, Jiang S, Wang Z, Jiang W. Sleep was associated with depression and anxiety status during pregnancy: a prospective longitudinal study. Arch Womens Ment Health 2017; 20:695-701. [PMID: 28685391 DOI: 10.1007/s00737-017-0754-5] [Citation(s) in RCA: 58] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2016] [Accepted: 06/21/2017] [Indexed: 12/13/2022]
Abstract
The purpose of this study was to reveal the cross-sectional and longitudinal association of sleep with depression and anxiety among Chinese pregnant women. Pregnant women were recruited in Zhoushan Pregnant Women Cohort at Zhoushan Maternal and Child Care Hospital from 2011 to 2015. Self-rating depression scales (SDS) and self-rating anxiety scales (SAS) were used for evaluating depression and anxiety status at each trimester; corresponding sleep quality and duration were reported by pregnant women. Ordinary or multilevel linear and logistic regression model were used to estimate the cross-sectional or longitudinal association of sleep with depression and anxiety. The prevalence rates were 35.64, 24.23, and 26.24% for depression and 22.57, 17.41, and 21.04% for anxiety at 1st (T1), 2nd (T2), and 3rd trimester (T3), respectively. Controlling for potential confounders, it revealed significant cross-sectional and longitudinal associations of sleep with depression and anxiety status. In cross-sectional analysis, women who slept less than 8 h/day had higher risk of depression (T1: OR (95%CI) = 1.75 (1.39, 2.20); T2: 1.52 (1.26, 2.05); T3: 1.60 (1.18, 2.05)) and anxiety (T1: 2.00 (1.57, 2.55); T2: 1.86 (1.37, 2.54); T3: 1.33 (0.99, 1.79)). In the longitudinal analysis, multilevel model revealed that women with subjective "fair" or "bad" sleep quality had elevated risk of depression (OR ranging from 1.54 to 3.71) and anxiety (2.38 to 7.53) during pregnancy. Prenatal depression and anxiety status were prevalent in pregnant women. Sleep quality was associated with depression and anxiety status in both cross-sectional and longitudinal analyses, implying that improving sleep quality should benefit for mental health of pregnant women.
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Affiliation(s)
- Yunxian Yu
- Department of Epidemiology and Health Statistics, School of Public Health, School of medicine, Zhejiang University, Hangzhou, Zhejiang, China
| | - Minchao Li
- Department of Epidemiology and Health Statistics, School of Public Health, School of medicine, Zhejiang University, Hangzhou, Zhejiang, China
| | - Liuyan Pu
- Zhoushan Maternal and Child Care Hospital, Zhoushan, Zhejiang, 316000, China
| | - Shuojia Wang
- Department of Epidemiology and Health Statistics, School of Public Health, School of medicine, Zhejiang University, Hangzhou, Zhejiang, China
| | - Jinhua Wu
- Zhoushan Maternal and Child Care Hospital, Zhoushan, Zhejiang, 316000, China
| | - Lingli Ruan
- Zhoushan Maternal and Child Care Hospital, Zhoushan, Zhejiang, 316000, China
| | - Shuying Jiang
- Department of Epidemiology and Health Statistics, School of Public Health, School of medicine, Zhejiang University, Hangzhou, Zhejiang, China
| | - Zhaopin Wang
- Department of Epidemiology and Health Statistics, School of Public Health, School of medicine, Zhejiang University, Hangzhou, Zhejiang, China
| | - Wen Jiang
- Zhoushan Maternal and Child Care Hospital, Zhoushan, Zhejiang, 316000, China.
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Tomfohr-Madsen LM, Clayborne ZM, Rouleau CR, Campbell TS. Sleeping for Two: An Open-Pilot Study of Cognitive Behavioral Therapy for Insomnia in Pregnancy. Behav Sleep Med 2017; 15:377-393. [PMID: 27124405 DOI: 10.1080/15402002.2016.1141769] [Citation(s) in RCA: 49] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Insomnia and disturbed sleep are common during pregnancy. This study investigated the effectiveness of group cognitive-behavioral therapy for insomnia (CBT-I) delivered in pregnancy. Thirteen pregnant women with insomnia participated in five weekly CBT-I group sessions. All participants completed the study and provided baseline and follow-up data. Significant reductions in insomnia symptoms and increases in subjective sleep quality were observed over the course of the study. Diary and actigraphy assessments of sleep also changed, such that participants reported less time in bed (TIB), shorter sleep onset latency (SOL), increased sleep efficiency (SE), and increased subjective total sleep time (TST). Additionally, symptoms of depression, pregnancy-specific anxiety, and fatigue all decreased over the course of treatment. Effect sizes ranged from medium to large. CBT-I delivered during pregnancy was associated with significant improvements in sleep and mood. The next step in this area of inquiry is to better establish effectiveness via a randomized controlled trial.
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Affiliation(s)
- Lianne M Tomfohr-Madsen
- a Department of Psychology , University of Calgary , Calgary , Alberta , Canada.,b Alberta Children's Hospital Research Institute for Child and Maternal Health , Calgary , Alberta , Canada.,c Department of Pediatrics , Alberta Children's Hospital , Calgary , Alberta , Canada
| | - Zahra M Clayborne
- a Department of Psychology , University of Calgary , Calgary , Alberta , Canada
| | - Codie R Rouleau
- a Department of Psychology , University of Calgary , Calgary , Alberta , Canada
| | - Tavis S Campbell
- a Department of Psychology , University of Calgary , Calgary , Alberta , Canada
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Sedov ID, Cameron EE, Madigan S, Tomfohr-Madsen LM. Sleep quality during pregnancy: A meta-analysis. Sleep Med Rev 2017; 38:168-176. [PMID: 28866020 DOI: 10.1016/j.smrv.2017.06.005] [Citation(s) in RCA: 272] [Impact Index Per Article: 38.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2017] [Revised: 05/31/2017] [Accepted: 06/09/2017] [Indexed: 10/19/2022]
Abstract
Women's sleep quality has been reported to change during pregnancy; prevalence estimates of poor sleep quality during pregnancy vary widely. To further understand the observed variation of findings, we conducted a meta-analysis to quantify the prevalence of poor sleep quality during pregnancy. Articles (N = 24) that reported prevalence of poor sleep quality as captured by the Pittsburgh sleep quality index (PSQI) ≥ 5 were included, with a total of 11,002 participants contributing data. PubMed, PsycINFO, and Web of Science databases were systematically searched. Results indicated that the average PSQI score during pregnancy was 6.07, 95% confidence interval (CI) [5.30, 6.85], and 45.7%, 95% CI [36.5%, 55.2%], of pregnant women experienced poor sleep quality. Longitudinal studies indicated that sleep quality decreased from second (M = 5.31, SE = 0.40) to third trimester (M = 7.03, SE = 0.85) by 1.68 points, 95% CI [0.42, 2.94]. Gestational age moderated the average PSQI scores and prevalence of PSQI scores ≥5; older samples reported higher mean PSQI scores and higher prevalence of poor sleep quality. Clinicians should be aware that some reduction in sleep quality is expected during pregnancy, but complaints of very poor sleep quality could require intervention. Future research should examine various factors underlying poor sleep quality during pregnancy.
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Affiliation(s)
- Ivan D Sedov
- Department of Psychology, University of Calgary, Calgary, AB, Canada.
| | - Emily E Cameron
- Department of Psychology, University of Calgary, Calgary, AB, Canada.
| | - Sheri Madigan
- Department of Psychology, University of Calgary, Calgary, AB, Canada; Alberta Children's Hospital Research Institute for Child and Maternal Health (ACHRI), Calgary, AB, Canada.
| | - Lianne M Tomfohr-Madsen
- Department of Psychology, University of Calgary, Calgary, AB, Canada; Alberta Children's Hospital Research Institute for Child and Maternal Health (ACHRI), Calgary, AB, Canada; Department of Pediatrics, Alberta Children's Hospital, Calgary, AB, Canada.
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36
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Manzar MD, Zannat W, Moiz JA, Spence DW, Pandi-Perumal SR, Bahammam AS, Hussain ME. Factor scoring models of the Pittsburgh Sleep Quality Index: a comparative confirmatory factor analysis. BIOL RHYTHM RES 2016. [DOI: 10.1080/09291016.2016.1202375] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- Md. Dilshad Manzar
- Department of Biomedical Sciences, College of Health Sciences, Mizan-Tepi University (Mizan Campus), Mizan, Ethiopia
- Centre for Physiotherapy and Rehabilitation Sciences, Jamia Millia Islamia, New Delhi, India
| | - Wassilatul Zannat
- Centre for Physiotherapy and Rehabilitation Sciences, Jamia Millia Islamia, New Delhi, India
| | - Jamal Ali Moiz
- Centre for Physiotherapy and Rehabilitation Sciences, Jamia Millia Islamia, New Delhi, India
| | | | | | - Ahmed S. Bahammam
- The University Sleep Disorders Center, Department of Medicine, College of Medicine, and National Plan for Science and Technology, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - M. Ejaz Hussain
- Centre for Physiotherapy and Rehabilitation Sciences, Jamia Millia Islamia, New Delhi, India
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Abstract
The perinatal period introduces a myriad of changes. One important but often overlooked change is an increased reporting of sleep disturbance. Although casually regarded as a consequence of pregnancy or postpartum, there is emerging evidence implicating significant sleep disturbance, characterized by insomnia symptoms and/or poor sleep quality, with adverse outcomes, such as an increase in depressive symptomatology or the development postpartum depression (PPD). Significant consequences may arise as a result including issues with maternal-infant bonding, effective care for the infant, and behavioral or emotional difficulties in the infant. This review discusses the relevant literature as to how disturbed sleep during pregnancy as well as in the postpartum may increase the risk for PPD.
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Affiliation(s)
- Michele L Okun
- University of Colorado Colorado Springs, 1420 Austin Bluffs Parkway Osborne Center A-408, Colorado Springs, CO, 80918, USA.
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Ashley JM, Harper BD, Arms-Chavez CJ, LoBello SG. Estimated prevalence of antenatal depression in the US population. Arch Womens Ment Health 2016; 19:395-400. [PMID: 26687691 DOI: 10.1007/s00737-015-0593-1] [Citation(s) in RCA: 61] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2015] [Accepted: 12/07/2015] [Indexed: 11/28/2022]
Abstract
The purpose of this study is to determine the prevalence of minor and major depression among pregnant women in the USA. Also, we compare prevalence of depression among pregnant and non-pregnant women while controlling for relevant covariates. A population-representative sample of pregnant women (n = 3010) surveyed for the 2006 Behavioral Risk Factor Surveillance System was compared to a sample of women who were not pregnant (n = 68,620). Binary logistic regression was used to determine prevalence ratios of depression for pregnant and non-pregnant women while controlling for the effects of age, race, annual income, employment status, educational level, marital status, general health, and availability of emotional support. Depression was measured by the Patient Health Questionnaire-8 (PHQ-8). The prevalence of major depression was no greater among pregnant women (6.1%) compared to non-pregnant women (7%; adjusted prevalence ratio (PR) = 1.1, 95% confidence interval (CI) .8 and 1.5). The prevalence of minor depression was greater among pregnant women (16.6%) compared to non-pregnant women (11.4%; adjusted PR = 1.5, 95% CI 1.2 and 1.9). Prevalence ratios are adjusted for the effects of covariates noted above. Prevalence of major depression is not associated with pregnancy, but minor depression is more likely among women who are pregnant.
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Affiliation(s)
- June M Ashley
- Department of Psychology, Now at University of Denver, 2155 S. Race St., Denver, CO, 80208, USA
| | - Bridgette D Harper
- Department of Psychology, Auburn University Montgomery, Montgomery, Alabama, USA
| | | | - Steven G LoBello
- Department of Psychology, Auburn University Montgomery, Montgomery, Alabama, USA.
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Crowley SK, O’Buckley TK, Schiller CE, Stuebe A, Morrow AL, Girdler SS. Blunted neuroactive steroid and HPA axis responses to stress are associated with reduced sleep quality and negative affect in pregnancy: a pilot study. Psychopharmacology (Berl) 2016; 233:1299-310. [PMID: 26856852 PMCID: PMC4803569 DOI: 10.1007/s00213-016-4217-x] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2015] [Accepted: 01/14/2016] [Indexed: 01/24/2023]
Abstract
RATIONALE Anxiety during pregnancy has been linked to adverse maternal health outcomes, including postpartum depression (PPD). However, there has been limited study of biological mechanisms underlying behavioral predictors of PPD during pregnancy. OBJECTIVES Considering the shared etiology of chronic stress amongst antenatal behavioral predictors, the primary goal of this pilot study was to examine associations among stress-related physiological factors (including GABA-ergic neurosteroids) and stress-related behavioral indices of anxiety during pregnancy. METHODS Fourteen nulliparous women in their second trimester of a singleton pregnancy underwent speech and mental arithmetic stress, following a 2-week subjective and objective recording of sleep-wake behavior. RESULTS Lower cortisol, progesterone, and a combined measure of ALLO + pregnanolone throughout the entire stressor protocol (area under the curve, AUC) were associated with greater negative emotional responses to stress, and lower cortisol AUC was associated with worse sleep quality. Lower adrenocorticotropic hormone was associated with greater anxious and depressive symptoms. Stress produced paradoxical reductions in cortisol, progesterone, and a combined measure of allopregnanolone + pregnanolone, while tetrahydrodeoxycorticosterone levels were elevated. CONCLUSIONS These data suggest that cortisol, progesterone, and ALLO + pregnanolone levels in the second trimester of pregnancy are inversely related to negative emotional symptoms, and the negative impact of acute stress challenge appears to exert its effects by reducing these steroids to further promote negative emotional responses.
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Affiliation(s)
- Shannon K. Crowley
- Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599-7175, USA
| | - Todd K. O’Buckley
- Bowles Center for Alcohol Studies, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599-7175, USA
| | - Crystal E. Schiller
- Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599-7175, USA
| | - Alison Stuebe
- Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599-7175, USA
- Department of Maternal and Child Health, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599-7175, USA
| | - A. Leslie Morrow
- Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599-7175, USA
- Bowles Center for Alcohol Studies, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599-7175, USA
- Department of Pharmacology, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599-7175, USA
| | - Susan S. Girdler
- Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599-7175, USA
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Chang MW, Brown R, Nitzke S, Smith B, Eghtedary K. Stress, sleep, depression and dietary intakes among low-income overweight and obese pregnant women. Matern Child Health J 2016; 19:1047-59. [PMID: 25102810 DOI: 10.1007/s10995-014-1604-y] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
This study investigated the mediating roles of sleep and depression on the relationships between stress, fat intake, and fruit and vegetable intake among low-income overweight and obese pregnant women by trimesters. Participants (N = 213) completed a self-administered survey including stress (exogenous variable), depression, sleep (mediators), fat intake, and fruit and vegetable intake (endogenous variables). Path analysis was performed to compare mediation effects among pregnant women in each trimester. Consistently across three trimesters, stress was related to depression but not sleep duration, night time sleep disturbance, sleep quality, sleep latency or fat intake. Sleep duration was not associated with depression. Depending on trimester, night time sleep disturbance, sleep quality, and sleep latency were related to depression; night time sleep disturbance and depression affected fat intake; stress influenced fruit and vegetable intake. Sleep duration, sleep disturbance, sleep quality, sleep latency and depression did not mediate the relationships between stress, fat intake, and fruit and vegetable intake in the second and third trimesters. However, depression mediated the relationship between stress and fat intake in the first trimester. Stress management interventions may help low-income overweight and obese pregnant women decrease depressive symptoms and therefore contribute to overall nutritional health.
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Affiliation(s)
- Mei-Wei Chang
- College of Nursing, Michigan State University, 1355 Bogue Street, RM C346, East Lansing, MI, 48824, USA,
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41
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Construct validity and factor structure of the Pittsburgh Sleep Quality Index among pregnant women in a Pacific-Northwest cohort. Sleep Breath 2016; 20:293-301. [PMID: 26810497 DOI: 10.1007/s11325-016-1313-4] [Citation(s) in RCA: 69] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2015] [Revised: 12/29/2015] [Accepted: 01/07/2016] [Indexed: 02/04/2023]
Abstract
PURPOSE Poor sleep quality during pregnancy is associated with adverse obstetric and neuropsychiatric outcomes. Despite its routine use as a sleep quality assessment scale among men and non-pregnant women, the psychometric properties of the Pittsburgh Sleep Quality Index (PSQI) have not been assessed among US pregnant women. We sought to evaluate the construct validity and factor structure of the PSQI among 1488 pregnant women. METHODS A structured interview was used to collect information about demographics and sleep characteristics in early pregnancy. The Patient Health Questionnaire-9 (PHQ-9) and the Depression, Anxiety, and Stress Scale-21 (DASS-21) were used to assess symptoms of depression, anxiety, and stress. Consistency indices, exploratory and confirmatory factor analyses (EFA and CFA), correlations, and logistic regression procedures were used. RESULTS The reliability coefficient, Cronbach's alpha for the PSQI items was 0.74. Results of the EFA showed that a rotated factor solution for the PSQI contained two factors with eigenvalues >1.0 accounting for 52.8 % of the variance. The PSQI was significantly positively correlated with the PHQ-9 (r s = 0.48) and DASS-21 (r s = 0.42) total scores. Poor sleepers (PSQI global score >5) had increased odds of experiencing depression (OR = 6.47; 95 % CI = 4.56-9.18), anxiety (OR = 3.59; 95 % CI = 2.45-5.26), and stress (OR = 4.37; 95 % CI = 2.88-6.65) demonstrating evidence of good construct validity. CFA results corroborated the two-factor structure finding from the EFA and yielded reassuring measures indicating goodness of fit (comparative fit index = 0.975) and accuracy (root mean square error of approximation = 0.035). CONCLUSIONS The PSQI has good construct validity and reliability for assessing sleep quality among pregnant women.
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Simpson W, Frey BN, Steiner M. Mild Depressive Symptoms During the Third Trimester of Pregnancy Are Associated with Disruptions in Daily Rhythms but Not Subjective Sleep Quality. J Womens Health (Larchmt) 2015; 25:594-8. [PMID: 26544506 DOI: 10.1089/jwh.2015.5404] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Recent research in major depressive disorder suggests that dysregulation of the circadian system may be a core pathophysiological component. In pregnancy, women often experience significant disruptions in their daily rhythms, including changes in day-to-day schedule and sleep habits. Current evidence suggests that these disruptions in daily rhythms may adversely affect underlying circadian rhythmicity. The purpose of our study was to examine whether subjectively rated daily rhythm disruptions were associated with a greater incidence of depressive symptoms during the third trimester. METHOD Our study was a cross-sectional design, assessing sleep quality, symptoms of depression, and daily rhythm disruptions in 51 pregnant women in their third trimester. RESULTS We observed a significant relationship between mild depressive symptoms and disruptions in daily rhythms. While we initially observed a strong correlation between subjective sleep quality and depressive symptoms, this was attenuated after accounting for daily rhythm disruptions. Disruptions in daily social rhythms, eating patterns, and general activity were all significantly associated with depressive symptomatology. CONCLUSION Our findings point to a strong correlation between daily rhythm disruptions and prenatal depressive symptoms. Given that these daily rhythms are known to act as zeitgebers, longitudinal studies examining the directionality of this relationship between circadian rhythms and depressive symptoms during pregnancy are warranted.
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Affiliation(s)
- William Simpson
- 1 McMaster Integrated Neuroscience Discovery and Study (MiNDS), McMaster University , Hamilton, Ontario, Canada .,3 Women's Health Concerns Clinic, St. Joseph's Healthcare Hamilton , Hamilton, Ontario, Canada
| | - Benicio N Frey
- 1 McMaster Integrated Neuroscience Discovery and Study (MiNDS), McMaster University , Hamilton, Ontario, Canada .,2 Department of Psychiatry and Behavioural Neuroscience, McMaster University , Hamilton, Ontario, Canada .,3 Women's Health Concerns Clinic, St. Joseph's Healthcare Hamilton , Hamilton, Ontario, Canada
| | - Meir Steiner
- 1 McMaster Integrated Neuroscience Discovery and Study (MiNDS), McMaster University , Hamilton, Ontario, Canada .,2 Department of Psychiatry and Behavioural Neuroscience, McMaster University , Hamilton, Ontario, Canada .,3 Women's Health Concerns Clinic, St. Joseph's Healthcare Hamilton , Hamilton, Ontario, Canada .,4 Institute of Medical Sciences, University of Toronto , Toronto, Ontario, Canada
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43
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Abstract
PURPOSE OF REVIEW The perinatal period introduces a myriad of changes. One important but often overlooked change is the increased risk for sleep disturbance. Although casually regarded as a consequence of pregnancy or postpartum, there is emerging evidence to suggest that women with significant sleep disturbance, characterized by insomnia symptoms and/or poor sleep quality, are more likely to report an increase in depressive symptomatology or develop postpartum depression (PPD). Significant consequences may arise as a result including issues with maternal-infant bonding, effective care for the infant and behavioral or emotional difficulties in the infant. This review discusses the relevant literature as to how disturbed sleep during pregnancy as well as in the postpartum may increase the risk for PPD. RECENT FINDINGS Symptoms of insomnia and poor sleep quality are independently associated with greater depressive symptoms across pregnancy and throughout postpartum. Likewise, both can negatively impact the ability to mother effectively. SUMMARY The presence of insomnia or sleep disturbance during the perinatal period is a risk factor for depressive symptoms. Women with depression are at an increased risk of developing sleep disturbance thereby increasing depressive symptomatology. This bidirectional and additive relationship needs more clinical attention as both sleep disturbance and depression are noted risk factors for adverse pregnancy outcomes.
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Tomfohr LM, Buliga E, Letourneau NL, Campbell TS, Giesbrecht GF. Trajectories of Sleep Quality and Associations with Mood during the Perinatal Period. Sleep 2015; 38:1237-45. [PMID: 25845691 PMCID: PMC4507729 DOI: 10.5665/sleep.4900] [Citation(s) in RCA: 101] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2014] [Accepted: 02/18/2015] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVE The aim of this study was to investigate trajectories of sleep quality and associations with mood in the perinatal period. Although it is commonly accepted that subjective sleep quality declines during pregnancy and the transition to parenthood, some women may follow qualitatively distinct trajectories. DESIGN, SETTING, AND PARTICIPANTS Sleep quality was assessed by the Pittsburgh Sleep Quality Index (PSQI). Data were collected from 293 women at four time points: during early pregnancy, at Time 1 (T1; < 22 w gestational age [GA]; late pregnancy, at Time 2 (T2; 32 w GA); during the postnatal period at Time 3 (T3; 3 mo postpartum); and Time 4 (T4; 6 mo postpartum). A group-based semiparametric mixture model was used to estimate patterns of sleep quality throughout the perinatal period. RESULTS Four trajectory groups were identified, including patterns defined by high sleep quality throughout (21.5%), mild decrease in sleep quality (59.5%), significant decrease in sleep quality (12.3%) and a group with poor sleep quality throughout (6.7%). Women who had the worst sleep quality at Time 1 and those who experienced significant increases in sleep problems throughout pregnancy were also the groups who reported the highest levels of anxiety and depressive symptoms in early pregnancy and the lowest levels of social support. After controlling for covariates, the groups with worst subjective sleep quality during pregnancy were also the most likely to experience high symptoms of depression in the postpartum period. CONCLUSIONS Most of the women in our sample reported mild sleep disturbances through the perinatal period. A subgroup of women reported a significant decline in sleep quality from early to late pregnancy and another reported poor subjective sleep quality throughout pregnancy; these groups had the greatest risk of experiencing high symptoms of depression in the postpartum period.
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Affiliation(s)
- Lianne M. Tomfohr
- Department of Psychology, University of Calgary, Calgary, AB, Canada
- Alberta Children's Hospital Research Institute for Child and Maternal Health (ACHRI), Calgary, AB, Canada
- Department of Pediatrics, Alberta Children's Hospital, Calgary, AB, Canada
| | - Elena Buliga
- Department of Psychology, University of Calgary, Calgary, AB, Canada
| | | | - Tavis S. Campbell
- Department of Psychology, University of Calgary, Calgary, AB, Canada
| | - Gerald F. Giesbrecht
- Department of Psychology, University of Calgary, Calgary, AB, Canada
- Alberta Children's Hospital Research Institute for Child and Maternal Health (ACHRI), Calgary, AB, Canada
- Department of Pediatrics, Alberta Children's Hospital, Calgary, AB, Canada
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Tzeng YL, Chen SL, Chen CF, Wang FC, Kuo SY. Sleep Trajectories of Women Undergoing Elective Cesarean Section: Effects on Body Weight and Psychological Well-Being. PLoS One 2015; 10:e0129094. [PMID: 26066326 PMCID: PMC4466331 DOI: 10.1371/journal.pone.0129094] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2015] [Accepted: 05/05/2015] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND After cesarean section (CS), women may be at great risk for sleep disturbance, but little is known about temporal changes in their sleep patterns and characteristics. We had two aims: 1) to identify distinct classes of sleep-disturbance trajectories in women considering elective CS from third-trimester pregnancy to 6 months post-CS and 2) to examine associations of sleep trajectories with body mass index (BMI), depressive symptoms, and fatigue scores. METHODS We analyzed data from a prospective cohort study of 139 Taiwanese pregnant women who elected CS. Sleep components were assessed using the Pittsburgh Sleep Quality Index in third-trimester pregnancy, 1 day, 1 week, 1 month, and 6 months post-CS. Data were collected on depressive symptoms, fatigue symptoms, and BMI. Sleep-quality trajectories were identified by group-based trajectory modeling. RESULTS We identified three distinct trajectories: stable poor sleep (50 women, 36.0%), progressively worse sleep (67 women, 48.2%), and persistently poor sleep (22 women, 15.8%). Poor sleep was significantly associated with pre-pregnancy BMI and more baseline (third-trimester pregnancy) depressive and fatigue symptoms. At 6 months post-CS, women classified as progressively worse or persistently poor sleepers showed a trend toward higher BMI (p<0.03), more depressive symptoms (p<0.001), and higher fatigue scores (p<0.001) than those with stable poor sleep. CONCLUSIONS Women had three distinct sleep-disturbance trajectories before and after elective CS. These poor-sleep courses were associated with BMI and psychological well-being. Our findings suggest a need to continuously assess sleep quality among women considering elective CS and up to 6 months post-CS.
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Affiliation(s)
- Ya-Ling Tzeng
- School of Nursing, China Medical University and China Medical University Hospital, Taichung, Taiwan
| | - Shu-Ling Chen
- Department of Nursing, Hungkuang University, Taichung, Taiwan
| | - Chuen-Fei Chen
- Department of Medicine, Mackay Medical College, New Taipei City, Taiwan
| | - Fong-Chen Wang
- School of Nursing, China Medical University and China Medical University Hospital, Taichung, Taiwan
| | - Shu-Yu Kuo
- School of Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan
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Bei B, Coo S, Trinder J. Sleep and Mood During Pregnancy and the Postpartum Period. Sleep Med Clin 2015; 10:25-33. [DOI: 10.1016/j.jsmc.2014.11.011] [Citation(s) in RCA: 57] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
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47
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McPhie S, Skouteris H, Fuller-Tyszkiewicz M, Hill B, Jacka F, O׳Neil A. Relationships between mental health symptoms and body mass index in women with and without excessive weight gain during pregnancy. Midwifery 2015; 31:138-46. [DOI: 10.1016/j.midw.2014.07.004] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2014] [Revised: 06/20/2014] [Accepted: 07/13/2014] [Indexed: 11/28/2022]
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Palagini L, Gemignani A, Banti S, Manconi M, Mauri M, Riemann D. Chronic sleep loss during pregnancy as a determinant of stress: impact on pregnancy outcome. Sleep Med 2014; 15:853-9. [DOI: 10.1016/j.sleep.2014.02.013] [Citation(s) in RCA: 95] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2013] [Revised: 02/08/2014] [Accepted: 02/11/2014] [Indexed: 10/25/2022]
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Mellor R, Chua SC, Boyce P. Antenatal depression: an artefact of sleep disturbance? Arch Womens Ment Health 2014; 17:291-302. [PMID: 24793592 DOI: 10.1007/s00737-014-0427-6] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2013] [Accepted: 04/07/2014] [Indexed: 01/11/2023]
Abstract
Research indicates that poor sleep quality is linked to and may precede depressive symptomatology in pregnancy, complicating screening for either condition. Pregnancy onset may also contribute to the development of sleep-disordered breathing (SDB). For the first time, the link between SDB and depression was examined in pregnancy. A total of 189 pregnant women completed the Edinburgh Postnatal Depression Scale (EPDS), Pittsburgh Sleep Quality Index (PSQI) for sleep quality and the Berlin Questionnaire for SDB. Women were also asked what they felt was the cause of their symptoms. PSQI-assessed poor sleep quality and self-perceived depression were strongly associated with EPDS scores of probable depression (X (2) 13.39; p < 0.001). Berlin-assessed risk of SDB was also associated with probable depression (X (2) 9.20 p < 0.01), though this was attenuated following multivariate analysis. There was a significant relationship between total PSQI score and the tendency for participants to attribute 'sleep-related causes' to their low mood (X (2) 20.78; p < 0.001). This study confirms the link between PSQI-assessed poor sleep quality and depressive symptoms in pregnancy, suggesting the two questionnaires assess the same or overlapping conditions. Although there was a relationship between probable depression and high risk SDB, the effect was attenuated after accounting for other depression risk factors, including body mass index (BMI).
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Affiliation(s)
- R Mellor
- The University of Sydney, Sydney, NSW, Australia,
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50
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Coo S, Milgrom J, Trinder J. Mood and objective and subjective measures of sleep during late pregnancy and the postpartum period. Behav Sleep Med 2014; 12:317-30. [PMID: 24128191 DOI: 10.1080/15402002.2013.801348] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
This study examined the association between measures of objective sleep (OS) and subjective sleep (SS) to postpartum mood in healthy women from the third trimester of pregnancy to 10 to 12 weeks postpartum. Twenty-nine pregnant women completed self-report measures of mood and SS, and wore actigraphs for 7 continuous days during the third trimester (Time 1), within 15 days (Time 2), and 10 to 12 weeks postpartum (Time 3). The subjective perception of marked daytime dysfunction was associated with low mood during Time 1 and Time 3. Poor nighttime SS was related to low mood only at Time 2, whereas poor nighttime OS influenced stress during the same assessment time. These data indicate a stronger association between postpartum mood and the subjective perception of sleep than with OS quality and duration in healthy, non-depressed women, and highlight the awareness of poor daytime functioning as a significant contributor to new mothers' emotional wellbeing.
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Affiliation(s)
- Soledad Coo
- a Melbourne School of Psychological Sciences University of Melbourne
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