Sleep Enhancement Training for Pregnant Women

What the World Needs Now: Lifestyle Medicine for All Women

Over the last several centuries, economic progress has allowed millions of women to move from rural subsistence agriculture to urban, more economically prosperous lifestyles. This trend is set to continue, even accelerate in the next century. Due to changes in diet, activity, and lifestyle, non-communicable diseases, such as cancer and heart disease, will continue to rise for women globally. At this time, we are uniquely positioned to anticipate this impact and empower women in both the developed and the developing world to learn from what has worked. Choosing the best approaches to nutrition, exercise, sleep, connectedness, substances, and stress can optimize women's health span across the globe.

Discrimination is associated with poor sleep quality in pregnant Black American women

BACKGROUND

Heightened exposure to racial/ethnic discrimination is associated with poorer sleep health among non-pregnant adults. This relationship has received limited research attention among pregnant women, despite the importance of prenatal sleep quality for optimal maternal and child health outcomes.

METHODS

We utilized perinatal data from a sample of Black American women (n = 600) participating in a cohort study who reported their lifetime experiences of racial/ethnic discrimination and gendered racial stress during early pregnancy and reported on their sleep quality and depressive symptoms during early and mid-pregnancy. Hierarchical multiple linear regression models were fit to examine associations between lifetime experiences of racial/ethnic discrimination or gendered racial stress and sleep quality during early and mid-pregnancy. We also adjusted for women's concurrent depressive symptoms and tested whether the discrimination/sleep quality association varied by socioeconomic status.

RESULTS

Greater exposure to racial/ethnic discrimination was associated with poorer sleep quality during early (ΔR2 = 0.04, ΔF = 26.08, p < 0.001) and mid-pregnancy (ΔR2 = 0.02, ΔF = 9.88, p = 0.002). Similarly, greater gendered racial stress was associated with poorer sleep quality during early (ΔR2 = 0.10, ΔF = 65.72, p < 0.001) and mid-pregnancy (ΔR2 = 0.06, ΔF = 40.43, p < 0.001. These findings largely held after adjustment for concurrent prenatal depressive symptoms. Socioeconomic status did not modify the observed relationships.

CONCLUSIONS

Efforts to decrease institutional and interpersonal experiences of racial/ethnic discrimination and gendered racism would benefit the sleep quality of pregnant Black American women, particularly during early pregnancy.

Infant sleep and negative reactivity: The role of maternal adversity and perinatal sleep

Sleep during infancy contributes to the development and maintenance of infant regulatory functioning and may be an early risk marker for more difficult temperamental traits like negative reactivity. Further, maternal adverse childhood experiences (ACEs) may predispose individuals to greater sleep disturbances in adulthood and have been linked with sleep disturbances in both mothers and infants. Thus, examining maternal history of ACEs and maternal sleep difficulties during pregnancy and postpartum may provide insight into underlying risk factors affecting infant sleep difficulties and early temperament development. Fifty-nine mothers from a diverse, community sample (44% white) completed questionnaires on ACEs, maternal sleep, infant sleep, and infant temperament at 30-weeks gestation, 6-weeks postpartum, and 16-weeks postpartum. Results indicated that maternal ACES and sleep problems during pregnancy have long term implications for infant negative reactivity at 16-weeks, with significant indirect effects through maternal and infant sleep problems at 6-weeks. Addressing psychosocial functioning and prenatal sleep during pregnancy, particularly among women with high ACEs, may be a target of intervention to improve maternal and infant sleep health during the postpartum, and reduce the risk for difficult infant temperament.

Sleep quality and BMI in pregnancy- a prospective cohort study

Background

Pregnancy associated sleep disturbances is a common pregnancy-related complication which can lead to significant maternal distress and adverse pregnancy outcomes. Sleep quality can be affected by multiple factors and obesity has been recognized as one of them. Various previous studies have demonstrated poorer sleep quality during pregnancy. However, most studies included assessment at only one point of pregnancy. This prospective cohort study aimed to better evaluate the effect of pregnancy on the quality of sleep throughout the antenatal period and how BMI affects antenatal sleep.

Methods

A total of 926 women were recruited before 14 weeks of gestation and followed throughout pregnancy. The Pittsburgh Sleep Quality Index questionnaire (PSQI) was employed to assess sleep quality in 4 antenatal visits throughout pregnancy. Their weight was also recorded at each visit.

Results

The PSQI global score was higher towards the later part of pregnancy (6.4 to 8.0, p < 0.001) and highest at the 4th visit. Sleep latency was longer as pregnancy progressed (18.5 mins to 23.2 mins, p = 0.001). Sleep duration became shorter over time and was the shortest at the 4th visit (7.1 h to 6.5 h, p < 0.001). Sleep efficiency was the lowest at the 4th visit (85.2 to 81.6%, p < 0.001). The same trend was observed for subjects in different BMI groups throughput pregnancy. PSQI score increased and sleep duration decreased as BMI increased. The effect of increasing BMI on PSQI and sleep duration was only observed in the higher BMI groups (> 25 kg/m²).

Conclusions

Our study showed that sleep quality gradually declined throughout pregnancy for all BMI groups. Higher BMI was associated with poorer sleep as represented by PSQI score and sleep duration, particularly in the overweight and obese subgroups.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12884-022-04414-7.

Behavioral interventions to extend sleep duration: A systematic review and meta-analysis

The goal of this study was to examine the effects of behavioral sleep extension interventions on sleep duration outcomes in children and adults ≥ age 12. We conducted a systematic literature review, article extraction and meta-analysis. Our search yielded 42 studies from 14 countries. The majority of studies (n = 19) enrolled adults, 10 studies enrolled college students, 13 enrolled children (high school or middle school aged). Results from the meta-analysis demonstrated behavioral sleep extension resulted in a significantly higher sleep duration as compared to control group or baseline, with pooled standardized mean difference (SMD) that was similar for both two-arm 0.80 (95 % CI 0.28 to 1.31; p < 0.01; I2 = 99.2%) and one-arm studies 0.75 (95% CI 0.39 to 1.11; p < 0.01; I2 = 86%), and there was significant heterogeneity among both study types. Subgroup analyses revealed that studies with direct interventions on sleep duration (i.e., specified the sleep schedule) had larger effects compared to indirect methods (coaching, educational approaches) and a greater number of curriculum components was associated with smaller effects. Results of this review demonstrate that sleep extension studies are effective at extending sleep in a variety of populations but improving the description of intervention methods and use of more rigorous study designs will improve the quality and reproducibility of this area of research.

Poor sleep is associated with higher blood pressure and uterine artery pulsatility index in pregnancy: a prospective cohort study

OBJECTIVE

To elucidate the association between sleep disturbances and blood pressure as well as uterine artery Doppler during pregnancy in women with no pre-existing hypertension.

DESIGN

Prospective cohort study.

SETTING

Outpatient specialist clinics at KK Women's and Children's Hospital, Singapore.

POPULATION

Women with viable singleton pregnancies confirmed by ultrasonography at less than 14 weeks of amenorrhoea at first visit.

METHODS

In all, 926 subjects were recruited for this study in the outpatient specialist clinics at KK Women's and Children's Hospital, Singapore, between 1 September 2010 and 31 August 2014. They were followed up throughout pregnancy with sleep quality, blood pressure and uterine artery Doppler assessed at each visit.

MAIN OUTCOME MEASURES

Sleep quality, blood pressure and uterine artery Doppler.

RESULTS

Sleep progressively worsened as pregnancy advanced. Shorter sleep duration and poorer sleep efficiency were associated with higher blood pressure, especially in the first trimester. Mixed model analysis demonstrated an overall positive association between sleep quality represented by Pittsburgh Sleep Quality Index (PSQI) score and diastolic blood pressure (DBP) (P < 0.001) and mean arterial pressure (MAP) (P = 0.005) during pregnancy after considering all trimesters. Sleep duration was found to be negatively associated with both systolic blood pressure (SBP) (P = 0.029) and DBP (P = 0.002), whereas sleep efficiency was negatively correlated with DBP (P = 0.002) only. Overall poor sleep during pregnancy was also found to be associated with a higher uterine artery pulsatility index.

CONCLUSION

Our prospective study demonstrated that poor sleep quality is significantly associated with higher blood pressure and uterine artery pulsatility index during pregnancy.

TWEETABLE ABSTRACT

Poor sleep quality is significantly associated with higher blood pressure and higher uterine artery pulsatility index during pregnancy.

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

BACKGROUND

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

OBJECTIVES

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

DESIGN

A prospective observational cohort study.

METHODS

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

RESULTS

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

CONCLUSIONS

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

Association Between Recent Experience of Childbirth and Sleep Quality in South Korean Women: Results from a Nationwide Study

INTRODUCTION

Although women commonly report deterioration of sleep quality postpartum, this relationship has been less studied in East Asian countries. This study investigated the association between recent experience of childbirth and sleep quality in South Korean women and additionally examined how healthy practice behavior interplays in the stated relationship.

METHODS

Data from the 2018 Community Health Survey were used. Sleep quality was measured using the Pittsburgh sleep quality index (PSQI). Women who responded to have given birth in the past year were categorized as having a recent experience of childbirth. The general characteristics of the study population were investigated using chi-square test. The association between the dependent and independent variables was analyzed using multivariate logistic regression analysis.

RESULTS

Of a total of 41,708 study participants, 16,877 (40.5%) individuals reported poor sleep quality. Poor sleep quality was more common in women with a recent experience of childbirth (48.4%) than those without (40.0%). Compared to individuals without a recent experience of childbirth, those with such an experience were more likely to show poor sleep quality (OR 1.50, 95% CI 1.34-1.68). Such differences were reduced in individuals with a healthy lifestyle.

CONCLUSION

Recent experience of childbirth was associated with higher likelihoods of poor sleep quality in women. The degree of risks found was reduced in individuals practicing a healthy lifestyle habit. The findings infer the need to monitor and address sleep-related disturbances commonly reported among postpartum women.

Effects of Acupressure and Acupuncture-Like Transcutaneous Electrical Nerve Stimulation on Sleep Quality Among Pregnant Women

BACKGROUND

Despite the adverse consequences of poor sleep during pregnancy, relatively few safe interventions exist for improving sleep among pregnant women. Nonpharmacological interventions are increasingly gaining acceptance. However, the effects of acupressure and acupuncture-like transcutaneous electrical nerve stimulation (ACUTENS) have not been widely reported.

OBJECTIVES

The purpose of this study is to investigate the effects of low-frequency transcutaneous electrical nerve stimulation, otherwise known as ACUTENS, and acupressure on sleep quality among pregnant women.

METHODS

Purposive sampling of 42 pregnant women with sleep disorders was conducted, and the participants were randomized into 3 groups, i.e., acupressure, ACUTENS, and usual care. interventions, which were carried out twice weekly for six weeks. The Pittsburgh Sleep Quality index was used to determine the overall sleep quality.

RESULTS

The preintervention scores of sleep quality were 12.5 (3.75), 12.5 (4.0), and 13.0 (3.5) in the ACUTENS, acupressure, and usual care groups, respectively. The Kruskal-Wallis test did not show any significant difference in the preintervention sleep quality scores (H = 0.379, p = 0.827). Participants in the usual care group recorded the least improvement, with a score of 5.0 (2.25), the ACUTENS group recorded a score of 4.5 (3.0), and the greatest improvement was recorded in the acupressure group, with a score of 4.0 (2.2) after 6 weeks of intervention. The Kruskal-Wallis test did not show any significant difference in the postintervention sleep quality scores among the 3 groups (H = 0.666, p = 0.717).

CONCLUSION

This study showed that ACUTENS and acupressure as an adjunct to usual care are not more effective than usual care alone in improving sleep quality among pregnant women.

A pilot longitudinal sleep education intervention from early pregnancy and its effect on optimizing sleep and minimizing depressive symptoms

OBJECTIVES

Investigate the efficacy of a pilot longitudinal sleep education program for optimizing sleep and minimizing depressive symptoms in nulliparous pregnant women.

DESIGN

Early and longitudinal sleep education intervention pilot study.

SETTING

Community-based convenience sample of New Zealand women.

PARTICIPANTS

15 nulliparous women who were involved in a pilot of a longitudinal sleep education intervention during pregnancy (N = 15) were compared to a comparison group (n = 76) from another observational study with the same time points. Groups were matched on depression history and parity.

INTERVENTION

A longitudinal sleep education program was developed. Women in the intervention group participated in three individualized and trimester specific education sessions designed to increase sleep knowledge and improve sleep practices. The comparison group received no sleep education.

MEASUREMENTS

Self-reports of depressive symptoms and five dimensions of sleep (duration, quality, continuity, latency, daytime sleepiness) were compared between groups using linear mixed model analysis of variance.

RESULTS

At the conclusion of the intervention, the intervention group had fewer depressive symptoms with none experiencing clinically significant depressive symptoms, while 21% of the comparison group were considered to have clinically significant depressive symptoms. The intervention group also had better sleep quality, sleep initiation and sleep continuity than the comparison group at late pregnancy.

CONCLUSIONS

Findings suggest that a longitudinal sleep education intervention commencing early in pregnancy may be effective in optimizing sleep and minimizing depressive symptoms for nulliparous women with a history of depression. Further investigation of sleep education interventions to improve maternal mental health in pregnancy and postnatally is warranted.

A brief sleep focused psychoeducation program for sleep-related outcomes in new mothers: a randomized controlled trial

Study Objectives

Poor sleep is commonly problematic during pregnancy and postpartum and is associated with depression. This trial investigated the efficacy of prenatal brief, group sleep psychoeducation in improving postpartum maternal sleep, and depression.

Methods

A total of 215 healthy expectant first-time mothers were cluster randomized (1:1) to receive either a 2 × 1.5 h psychoeducation intervention and a set of booklets, or a set of booklets only. Participants completed questionnaires during pregnancy (pre-intervention), and 6 weeks and 4 months postpartum. A post hoc subset of questionnaires was collected at 10 months postpartum. The primary hypothesis was the intervention group would have improved postpartum sleep quality, and reduced levels of insomnia symptoms, fatigue, and daytime sleepiness compared to the control group. Secondary outcomes included depression, anxiety, and stress.

Results

Linear mixed model analyses failed to confirm a group by time interaction on primary or secondary outcomes across all time points. There was no effect of the intervention on outcomes at 6 weeks, or 10 months postpartum. A significant time by group interaction was found at 4 months, favoring the intervention for sleep quality (p = 0.03) and insomnia symptoms (p = 0.03), but not fatigue or daytime sleepiness.

Conclusions

Prenatal sleep psychoeducation did not produce a sustained effect on maternal sleep throughout the postpartum period. There was little evidence of benefits on depressive symptoms.

Clinical Trial Registration

ACTRN12611000859987

Feasibility of a pilot, randomized controlled trial using a personalized health monitoring device with pregnant women for behavioral sleep research

Sleep disruptions are common in pregnancy and can have significant maternal and infant health consequences. Management of sleep using a personal health monitoring (PHM) device may be effective in promoting behavior change and contribute to improved pregnancy-related sleep. The purpose of this pilot, randomized controlled trial was to determine the feasibility of recruitment (i.e., recruiting a 20% minority sample, most successful recruitment methods), retention, adherence, and data collection methods with a sample of pregnant women (n = 24) at 24 weeks gestation for a 12-week intervention using a PHM device. Of 24 enrolled participants, 20 (83%) were retained through the 12-week intervention and the follow-up at 2-4 weeks postpartum. The majority of participants had a four-year education and identified as White. Ninety-one percent (n = 11) wore the device for at least ten weeks. Pregnant women may be willing engage in sleep intervention research and wear a PHM to self-monitor sleep during pregnancy. Future research should consider recruitment methods tailored to recruit diverse populations of pregnant women.

Sleep quality and gestational diabetes in pregnant women: a systematic review and meta-analysis

Poor sleep quality is very common among pregnant women. Gestational diabetes mellitus (GDM) has been related to various adverse maternal and neonatal outcomes. The aim of this systematic review was to examine the association between poor sleep quality and gestational diabetes risk. Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, a systematic search was conducted in five electronic databases from inception to February 2019. Studies that examined the relationship between sleep quality and glucose in pregnant women were screened for eligibility. Pooled odds ratio (OR) with 95% confidence interval (CI) was calculated from aggregate data using a fixed-effect model. Thirteen non-experimental studies (n = 21,194 women) were eligible for inclusion. Poor sleep quality was measured using subjective questionnaires in nine studies and objective methods (actigraphy or polysomnography) in four studies. GDM was typically diagnosed following standard guidelines. Eight studies were included in the meta-analysis for GDM. Overall, self-reported poor sleep quality was a significant risk factor for GDM (pooled OR = 1.43, 95%CI: 1.16,1.77, p = 0.001). Three studies examined the association between objective sleep quality and GDM, but no significant relationship was observed. Subjective poor sleep quality was related to an increased risk for GDM, while objectively measured sleep quality was not. This review was limited by the assessment of sleep quality. Future larger studies are warranted to examine the effects of sleep quality on glucose metabolism in pregnancy. Ideally, these studies should measure sleep quality using both validated questionnaires and objective methods. These will provide further directions for improving sleep during pregnancy and exploring its effects on glucose metabolism.

Interventions for sleep problems during pregnancy: A systematic review

Sleep problems during pregnancy are prevalent and could be linked to negative outcomes during pregnancy or post-partum. However, these complaints are often underdiagnosed and undertreated. This review aimed to systematically assess the effectiveness of different interventions to ameliorate poor sleep quality and insomnia during pregnancy. Pubmed, PsycINFO and Medline databases were systematically searched without publication period restriction until 3rd May 2019. Eligible studies had to: include pregnant women of any age and gestational age; use clinical intervention designs targeted at improving sleep outcome; report pre- and post-treatment data for one or more sleep-related outcomes; be published in English, Italian, German, Spanish, or French. Sixteen studies were selected including 1252 expecting mothers. Studies evaluated the efficacy of various interventions: cognitive behavioral interventions for insomnia (4); pharmacotherapy (1); acupuncture (1); mindfulness and yoga (3); relaxation (5) and herbal medication (2). Only six were randomized controlled trials, and only four evaluated longitudinal outcomes. Preliminary support was found for all interventions, but our knowledge is still too limited by lack of evidence. There is an utmost urgency to perform high-quality randomized controlled trials for insomnia interventions during pregnancy and to implement effective programs in standard gynecological care.

Sleep quality is associated with vasopressin methylation in pregnant and postpartum women with a history of psychosocial stress

BACKGROUND

The relationship between disturbed sleep and stress is well-documented. Sleep disorders and stress are highly prevalent during the perinatal period, and both are known to contribute to a number of adverse maternal and foetal outcomes. Arginine vasopressin (AVP) is a hormone and a neuropeptide that is involved in stress response, social bonding and circadian regulation of the sleep-wake cycle. Whether the AVP system is involved in regulation of stress response and sleep quality in the context of the perinatal mental health is currently unknown. The objective of the present study was to assess the relationship between levels of cumulative and ongoing psychosocial risk, levels of disordered sleep and AVP methylation in a community sample of pregnant and postpartum women.

METHODS

A sample of 316 participants completed a battery of questionnaires during the second trimester of pregnancy (PN2, 12-14 weeks gestation), third trimester (PN3, 32-34 weeks gestation), and at 7-9 weeks postpartum (PP). Disordered sleep was measured using the Sleep Symptom Checklist at PN2, PN3 and PP; cumulative psychosocial risk was assessed with the Antenatal Risk Questionnaire (ANRQ) at PN2; salivary DNA was collected at the follow-up (FU, 2.9 years postpartum); and % methylation were calculated for AVP and for two of the three AVP receptor genes (AVPR1a and AVPR1b). Women were separated into high (HighPR) and low (LowPR) psychosocial risk groups, based on their scores on the ANRQ.

RESULTS

Women in the HighPR group had significantly worse sleep disturbances during PN2 (p < .001) and PN3 (p < .001), but not at PP (p = .146) than women in the LowPR group. In HighPR participants only, methylation of AVP at intron 1 negatively correlated with sleep disturbances at PN2 (r_s=-.390, p = .001), PN3 (r_s=-.384, p = .002) and at PP (r_s= -.269, p = .032). There was no association between sleep disturbances and AVPR1a or AVPR1b methylation, or between sleep disturbances and any of the AVP methylation for the LowPR group. Lastly, cumulative psychosocial stress was a moderator for the relationship between AVP intron 1 methylation and disordered sleep at PN2 (p < .001, adjusted R² = .105), PN2 (p < .001, adjusted R² = .088) and PP (p = .003, adjusted R² = .064).

CONCLUSIONS

Our results suggest that cumulative psychosocial stress exacerbates sleep disorders in pregnant women, and that salivary DNA methylation patterns of the AVP gene may be seen as a marker of biological predisposition to stress and sleep reactivity during the perinatal period. Further research is needed to establish causal links between AVP methylation, sleep and stress.

Cognitive Behavioral Therapy for Prenatal Insomnia: A Randomized Controlled Trial

OBJECTIVE

To evaluate the effectiveness of cognitive behavioral therapy for insomnia during pregnancy.

METHODS

Randomized, unmasked, 3-site controlled trial. Participants were randomly allocated to cognitive behavioral therapy for insomnia (a first-line, empirically supported psychosocial intervention that addresses sleep-related behaviors and cognitions) or a control intervention consisting of imagery exercises that paired patient-identified distressing nighttime experiences with patient-identified neutral images. Participants were eligible if they met diagnostic criteria for insomnia disorder and were between 18 and 32 weeks of gestation. Patients were ineligible if they met diagnostic criteria for major psychiatric disorders, including depression, or were receiving nonstudy treatments that could affect sleep (or both). The primary outcome was the Insomnia Severity Index score, a validated brief questionnaire, with scores between 14 and 21 representing clinically meaningful insomnia of moderate severity, scores higher than 21 representing severe insomnia, and scores less than 8 representing no insomnia. Secondary outcomes included remission of insomnia (Insomnia Severity Index score less than 8), objectively measured and self-reported time awake (ie, total wake time), and the Edinburgh Postnatal Depression Scale score. All outcomes were measured weekly. Analysis included 48 participants who did not complete treatment. We estimated that 184 women would be required to have 80% power, with a two-tailed test, to detect a moderate Cohen's d effect size (.5) with α=.05.

RESULTS

Between May 2013 and April 2017, 194 pregnant women were randomized and 149 completed treatment; 179 with available baseline data (92%) were ultimately analyzed, 89 in the cognitive therapy group and 90 in the control group. Women assigned to cognitive behavioral therapy for insomnia experienced significantly greater reductions in insomnia severity (scores decreased from 15.4±4.3 to 8.0±5.2 in the cognitive behavioral therapy group vs from 15.9±4.4 to 11.2±4.9 in the control therapy group [P<.001, d=0.5]). Remission of insomnia (to an Insomnia Severity Index score less than 8) disorder was attained by 64% of women in the cognitive behavioral therapy for insomnia group vs 52% in the control group. Women receiving cognitive behavioral therapy for insomnia experienced faster remission of insomnia disorder, with a median of 31 days vs 48 days in the control therapy (P<.001). Cognitive behavioral therapy for insomnia led to significantly greater reduction in self-reported but not objective total wake time and a small but significantly greater decline in Edinburgh Postnatal Depression Scale scores vs the control group.

CONCLUSION

Cognitive behavioral therapy for insomnia is an effective nonpharmacologic treatment for insomnia during pregnancy.

CLINICAL TRIAL REGISTRATION

ClinicalTrials.gov, NCT01846585.

Objectively measured sleep duration and plasma glucose values following an oral glucose tolerance test amongst pregnant women with obesity in the UK

BACKGROUND/OBJECTIVES

Short sleep duration has been linked to maternal hyperglycaemia following a 1-h 50 g oral glucose tolerance test (OGTT) in observational studies conducted primarily in the USA. Our objective was to examine the relationship between objectively measured sleep duration and plasma glucose values following the 2-h 75 g OGTT routinely used in the UK amongst women with obesity.

METHODS

Sleep and OGTT data were available for 49 pregnant women who wore wrist actigraphs for at least two nights, and took a 2-h 75 g OGTT at the end of their second trimester. Multivariable regression was used to evaluate associations between sleep duration and OGTT results.

RESULTS

Higher 2-h plasma glucose values were significantly associated with shorter sleep duration and higher maternal age and BMI, with no association observed between wake after sleep onset (WASO) and 2-h plasma glucose values. No associations were observed between fasting plasma glucose values and any sleep parameters.

CONCLUSIONS

We found that shorter sleep duration, as measured using actigraphy, is associated with higher 2-h plasma glucose values following a 2-h 75 g OGTT in the UK. These findings are in keeping with those observed elsewhere in the world, employing alternative OGTT protocols. Future studies should investigate sleep extension as a potential candidate for inclusion in future RCTs aiming to improve glucose tolerance and prevent GDM amongst those at risk.

Non-pharmacological interventions for improving postpartum maternal sleep: A systematic review and meta-analysis

Evidence suggests that poor postpartum sleep quality is a risk factor for the development of postpartum depression. As such, non-pharmacological interventions have been developed to help improve sleep in the postpartum period. The primary aims of this systematic review and meta-analysis were to determine if non-pharmacological interventions improved maternal sleep and to compare the effectiveness of different intervention types. Secondary aims included examining effects on maternal mood and infant sleep. We searched MEDLINE, EMBASE, CINAHL, PsycINFO, and Web of Science from their inceptions to September 2017 and found 15 eligible studies. Non-pharmacological sleep interventions were found to improve subjective reports of maternal sleep (Cohen's d = -0.54, 95%CI = -0.88 to -0.19). Massage (Cohen's d = -1.07 95%CI = -1.34 to -0.79) and exercise (Cohen's d = -0.82 95%CI = -1.28 to -0.37) interventions had the largest impact on maternal sleep quality. Positive effects on nocturnal infant sleep were found for interventions overall (Cohen's d = -0.27 95%CI = -0.52 to -0.02) but not for maternal depression (Cohen's d = -0.08 95%CI = -0.28 to 0.12). Despite evidence suggesting improvements in subjective maternal sleep, more research must be conducted on the durability of effects of non-pharmacological interventions using objective measures of sleep quality.

Improving Sleep for Hospitalized Antepartum Patients: A Non-Randomized Controlled Pilot Study

STUDY OBJECTIVES

To evaluate feasibility and efficacy of a hospital-based protocol for improving sleep in high- risk antepartum patients.

METHODS

Sleep measures were compared during 1 week of hospitalization before and after implementing a Sleep Improvement Protocol for Antepartum Patients (SIP-AP). A non-randomized convenience sample of usual care controls was compared to a subsequent intervention sample after the protocol was implemented. Women were eligible if they spoke English, were medically stable, pregnant for at least 20 weeks, and hospitalized at least 24 hours; 25 pregnant women had sufficient data for analyses (11 controls, 14 intervention). Sleep was assessed in 3 ways: the Pittsburgh Sleep Quality Index was completed after obtaining consent to estimate sleep quality prior to hospital admission; sleep diary completed each hospital day; and General Sleep Disturbance Scale completed at 7 days or prior to hospital discharge. Symptoms that could affect sleep were assessed with the Memorial Symptom Assessment Scale.

RESULTS

Both groups recorded similar sleep duration (7 hours) but the intervention group had fewer symptoms and significantly (P = .015) lower sleep disturbance scores (53.1 ± 14.5) than controls (71.9 ± 18.8). Participant feedback about the intervention was positive, although adherence to components of the intervention protocol was variable.

CONCLUSIONS

This pilot study provides evidence of the feasibility and preliminary efficacy of the SIP-AP intervention for reducing symptoms and improving sleep of antepartum patients during hospitalization. Further detailed evaluation of specific components of this protocol is warranted, and other types of hospitalized patients may benefit from unit-based modifications to this SIP-AP protocol.

An International Study on the Determinants of Poor Sleep Amongst 15,000 Users of Connected Devices

BACKGROUND

Sleep is a modifiable lifestyle factor that can be a target for efficient intervention studies to improve the quality of life and decrease the risk or burden of some chronic conditions. Knowing the profiles of individuals with poor sleep patterns is therefore a prerequisite. Wearable devices have recently opened new areas in medical research as potential efficient tools to measure lifestyle factors such as sleep quantity and quality.

OBJECTIVES

The goal of our research is to identify the determinants of poor sleep based on data from a large population of users of connected devices.

METHODS

We analyzed data from 15,839 individuals (13,658 males and 2181 females) considered highly connected customers having purchased and used at least 3 connected devices from the consumer electronics company Withings (now Nokia). Total and deep sleep durations as well as the ratio of deep/total sleep as a proxy of sleep quality were analyzed in association with available data on age, sex, weight, heart rate, steps, and diastolic and systolic blood pressures.

RESULTS

With respect to the deep/total sleep duration ratio used as a proxy of sleep quality, we have observed that those at risk of having a poor ratio (≤0.40) were more frequently males (odds ratio [OR]_{female vs male}=0.45, 95% CI 0.38-0.54), younger individuals (OR_{>60 years vs 18-30 years}=0.47, 95% CI 0.35-0.63), and those with elevated heart rate (OR_{>78 bpm vs ≤61 bpm}=1.18, 95% CI 1.04-1.34) and high systolic blood pressure (OR_{>133 mm Hg vs ≤116 mm Hg}=1.22, 95% CI 1.04-1.43). A direct association with weight was observed for total sleep duration exclusively.

CONCLUSIONS

Wearables can provide useful information to target individuals at risk of poor sleep. Future alert or mobile phone notification systems based on poor sleep determinants measured with wearables could be tested in intervention studies to evaluate the benefits.