Sleep disturbances in late pregnancy: associations with induction of labor

PURPOSE

Sleep disturbances, which are common during pregnancy, may compromise labor. Nevertheless, little is known about associations between sleep disturbances and the likelihood of ending up induction of labor (IOL). Accordingly, we aimed to evaluate the connections between sleep disturbances during pregnancy and IOL.

METHODS

Altogether 1778 women from the FinnBrain Birth Cohort Study with gestation weeks over 37 + 6 were enrolled in the study. The women were divided into IOL (n = 331) and spontaneous onset of labor (SOL, n = 1447) groups. Sleep disturbances in late pregnancy were evaluated using the Basic Nordic Sleep Questionnaire. Logistic regression analyses were conducted with adjustments for age, body mass index, parity, smoking, and depressive symptoms.

RESULTS

Sleep disturbances were frequent in both IOL and SOL groups. In the IOL group 43.0% and in the SOL group 39.0% had poor general sleep quality (P = 0.186). Nocturnal awakenings occurred most commonly, in 94.0% and 93.9%, respectively (P = 0.653). In the IOL group, more women (22.7%) were habitual snorers than in the SOL group (17.0%, P = 0.017), however, the difference lost the statistical significance in adjusted analysis (P = 0.848). Women in the IOL group were more likely to be short sleepers (< 7 h) compared to those in the SOL group (20.2% and 15.4%, respectively, P = 0.034) with no difference after adjustment (P = 0.133). The two groups showed no differences in sleep loss (P = 0.252).

CONCLUSIONS

Deterioration in sleep quality was noticeable in pregnant women, but it was unconnected with IOL. As the frequency of IOL is increasing, more research for related risk factors is needed.

Is it safe to operate selected low-risk endometrial cancer patients in secondary hospitals?

INTRODUCTION

The aim of this study was to assess the accuracy of a preoperative screening algorithm in identifying low-risk endometrial cancer (EC) patients to ensure optimal care.

METHODS

A total of 277 patients with primary EC confirmed through biopsy underwent magnetic resonance imaging (MRI). Patients with risk factors for advanced high-risk EC, such as non-endometrioid histology, high-grade differentiation status, deep myometrial invasion, or spread beyond the uterine corpus, were systematically excluded. The remaining preoperatively screened patients with stage IA low-grade endometrioid EC (EEC) (n = 93) underwent surgery in a tertiary hospital. The accuracy of the preoperative diagnosis was evaluated by comparing the findings with the postoperative histopathological results. Disease-free survival (DFS) and overall survival (OS) were analyzed using 8-year follow-up data.

RESULTS

Postoperative histopathological analysis revealed that all patients had grade 1-2 EEC localized to the corpus uteri. Only three patients had deep myometrial invasion (stage IB), but they remained disease-free after 6-9 years of follow-up. The median follow-up time for all patients was 8.7 years. The DFS was 7.6 years, and the OS was 8.6 years. Two patients with stage IA grade 1 EEC experienced relapse and, despite treatment, died of EC. No other EC-related deaths occurred.

CONCLUSIONS

The screening algorithm accurately identified low-risk EC patients without compromising survival. Therefore, the algorithm appears to be feasible for selecting patients for surgery in secondary hospitals.

Hyperemesis gravidarum and eating disorders before and after pregnancy: A register-based study

OBJECTIVE

Hyperemesis gravidarum (HG) is a severe form of excessive vomiting during pregnancy. The connection between psychiatric morbidity and HG has been debated, but only a few studies have focused on eating disorders (EDs). The objective of this study was to evaluate the association between HG and both pre-pregnancy and new post-pregnancy EDs.

METHODS

A register-based controlled study. HG diagnoses were retrieved from healthcare registers between 2005 and 2017. Women with HG in their first pregnancy resulting in delivery were chosen as cases (n = 4265; the HG group) and women with no HG as controls (n = 302,663; the non-HG group). The associations between EDs and HG were analyzed by binary logistic regression, adjusted with age, body mass index, smoking, socioeconomic status, and pre-pregnancy psychiatric diagnoses.

RESULTS

In the HG group, 1.6% and in the non-HG group, 0.2% had a pre-pregnancy ED. Women with ED were more likely to have HG in their first pregnancy compared with women with no history of EDs (adjusted odds ratio [AOR] 9.4, 95% CI 6.52-13.66, p < .0001). Moreover, 0.4% of the women in the HG group and 0.1% of the women in the non-HG group had a new ED diagnosis after pregnancy, and thus the women in the HG group were more likely to have an ED diagnosis after pregnancy (AOR I 3.5, 95% CI 1.71-7.15, p < .001, AOR II 2.7, 95% CI 1.30-5.69, p = .008).

DISCUSSION

We found a bidirectional association between ED and HG, suggesting a shared etiology or risk factors between these disorders. This finding emphasizes the importance of collaboration across various specialties when treating these patients.

PUBLIC SIGNIFICANCE

Our findings suggest a bidirectional association between HG and EDs before and after pregnancy. This finding provides essential information for healthcare professionals working with pregnant women. As both of these disorders are known to have far-reaching effects on the lives of both the mother and her offspring, our results help clinicians to target special attention and interventions to the patients suffering from these disorders.

Recalling the severity of nausea and vomiting of pregnancy - a study using Pregnancy-Unique Quantification of Emesis Questionnaire

The accuracy of the recall of the severity of nausea and vomiting of pregnancy (NVP) with Pregnancy-Unique Quantification of Emesis (PUQE) questionnaire has been questioned. We aimed to compare PUQE scores of women recalling the worst episode of NVP of their current pregnancy in different gestational weeks (gwks). Total of 2343 pregnant women (gwks 7-40) were recruited. Four groups were formed according to the gwks at reply: ≤16 gwks (n = 554), ≤20 gwks (n = 1209), >20 gwks (n = 1134) and ≥24 gwks (n = 495). PUQE scores were similar between the groups. Consequently, consistency of PUQE scores across the groups endorses the useability of the PUQE questionnaire in retrospective assessment of the overall severity of NVP in different gwks, regardless of passing of the peak NVP symptoms.Impact statementWhat is already known on this subject? Retrospective evaluation of the severity of nausea and vomiting of pregnancy (NVP) has been argued to be disposed to recall bias. Structured Pregnancy-Unique Quantification of Emesis (PUQE) questionnaire is a validated tool for assessing the severity of NVP.What do the results of this study add? When the women recalled the most severe NVP symptoms of their current pregnancy, no differences in the PUQE scores were found despite different gestational weeks at reply. Of distinct PUQE questions, women answering in early pregnancy reported longer duration of nausea than women answering in late pregnancy, but other questions were rated similarly.What the implications are of these findings for clinical practice and/or further research? Our aim was to compare the PUQE scores between the women who filled in the PUQE questionnaire in early or in late pregnancy, instructed to recall their worst symptoms in their current pregnancy. As there were no differences between the groups in total PUQE scores, our results support the application of PUQE questionnaire to assess the severity of NVP during pregnancy not only concurrent to the peak symptoms but also retrospectively.

The Relationship Between Mood and Sleep in Different Female Reproductive States

Mood and sleep are tightly interrelated. Mood and sleep symptoms and disorders are more common in women than in men and often associated with reproductive events. This article reviews the current literature on the reciprocal relationships between mood and sleep across reproductive phases in women, such as menstrual cycle and related disorders, pregnancy, climacteric, and use of hormonal contraception and hormone replacement therapy. Mood and sleep symptoms seem to covary in relation to physiologic and pathologic reproductive conditions, although the relationship seems more clear for subjective than objective sleep.

Overnight Heart Rate Variability During Sleep Disturbance In Peri- And Postmenopausal Women

OBJECTIVES

Disturbed sleep, common during the climacteric, is associated with increased sympathetic activity, a cardiovascular risk factor. We evaluated sleep disturbance effect on autonomic nervous function in climacteric women.

METHODS

Seventeen perimenopausal and 18 postmenopausal women underwent a sleep study protocol: an adaptation night, a reference night, and a sleep disturbance night, with a hand loosely tied to the bed to allow blood sampling. This procedure was repeated after six months of menopausal hormone therapy (MHT) or placebo. Sleep disturbance and MHT effects on overnight heart rate variability (HRV) were analyzed.

RESULTS

At baseline, sleep disturbance increased vagal HRV in postmenopausal women, but no changes were seen in perimenopausal women. At six months, sleep disturbance increased total HRV power in the perimenopausal placebo group, and increased nonlinear vagal HRV in the postmenopausal placebo group, but no other changes were seen. MHT did not have any effects on HRV, neither at perimenopause nor at postmenopause.

CONCLUSIONS

External sleep disturbance had only minor effects on HRV across menopause. MHT had no detectable HRV effects.

Comorbidity of Urogynecological and Gastrointestinal Disorders in Female Patients With Lichen Sclerosus

OBJECTIVE

Lichen sclerosus (LS) is a chronic inflammatory disease with a significant impact on quality of life. The aim of this cross-sectional case-control study was to characterize concomitant urogynecological and gastrointestinal disorders in female patients with LS.

METHODS

A medical records search between 2004 and 2012 yielded 455 women and girls (mean age 64 years) with LS. The study cohort was compared with a 10-fold age- and sex-matched control cohort. Gynecological cancers and their precursors; gynecological, urinary, and gastrointestinal disorders; and pain syndromes were evaluated.

RESULTS

The well-known association between LS and increased risk of vulvar cancer and its precursors was also found in our study (relative risk [RR] = 100.0; p < .001 and high-grade squamous intraepithelial lesions RR = 110.0; p < .001, respectively), but we also found an increased risk for cervical cancer (RR = 6.0; p = .005) and endometrial cancer (RR = 2.9; p < .001). Gynecological pain syndromes such as dyspareunia (RR = 20.0; p < .001) and interstitial cystitis (RR = 5.0; p < .001) and urinary incontinence (RR = 4.8; p < .001) were also increased. Among gastrointestinal disorders, we found increased risk for celiac disease (RR = 6.8; p < .001), diverticular intestine diseases (RR = 1.9; p < .001), functional intestinal disorders (RR = 2.3; p = .003), and anal and rectal fissures (RR = 2.4; p = .046).

CONCLUSIONS

We found that female patients with LS have an increased risk for gynecological cancers as well as for several urogynecological and gastrointestinal disorders. Increased awareness is required to identify and treat these concomitant disorders.

Depressive symptoms and sleep disturbances in late pregnancy: Associations with experience of induction of labor with a catheter

OBJECTIVE

Depressive symptoms and sleep disturbances have been found to be associated with negative labor experiences, particularly an increased level of pain. However, the associations between maternal depressive symptoms and sleep disturbances and the experience of induction of labor (IOL) remain unknown. In this study, we evaluated these associations with balloon catheter IOL.

STUDY DESIGN

A prospective study was conducted on 106 women with planned IOL. Depressive symptoms were evaluated with The Edinburg Postnatal Depression Scale (EPDS) and sleep disturbances with the Basic Nordic Sleep Questionnaire (BNSQ) at the beginning of IOL. The IOL experience was investigated both during the IOL and postpartum with the same nine visual analogue scale (VAS) questions.

RESULTS

Regarding sleep disturbances, during the IOL, women with worse general sleep quality were less satisfied (P = 0.019), less relaxed (P = 0.008), experienced more pain in general (P = 0.002) and reported higher contraction frequency (P = 0.003). Furthermore, women who experienced difficulties falling asleep were less relaxed (P = 0.009), reported more general pain (P < 0.001) and contraction pain (P = 0.005), while those with more daytime sleepiness reported less contraction pain (P = 0.033). In postpartum, women with worse general sleep quality reported more general pain (P = 0.003), while women with longer sleep duration and those with higher sleep loss reported more anxiety (P = 0.009 and P = 0.024, respectively). Additionally, women who woke up too early in the morning were less satisfied (P = 0.042), less relaxed (P = 0.004) and reported more general pain (P = 0.018). However, those who experienced more frequent nocturnal awakenings reported being more relaxed (P = 0.014) and having less general pain (P = 0.033). Higher depressive symptoms were associated with a higher frequency of contractions during IOL (P = 0.030), but with less general pain in postpartum (P = 0.027).

CONCLUSIONS

Women with sleep disturbances during pregnancy were more likely to report more negative experiences during the IOL. Specifically, they reported more pain, feeling less relaxed and they were less satisfied with IOL. Conversely, the association between depressive symptoms and the experience of IOL seemed weaker. Thus, the quality of sleep of pregnant women is important for a better experience of IOL.

Effect of external sleep disturbance on sleep architecture in perimenopausal and postmenopausal women

OBJECTIVE

This study aimed to use external sleep disturbance as a model to evaluate sleep architecture in climacteric women before and after menopausal hormone therapy (MHT).

METHODS

Seventeen perimenopausal and 18 postmenopausal women underwent a polysomnography protocol: an adaptation night, a reference night and a sleep disturbance night with one hand loosely tied to the bed for blood sampling. The sleep architecture of the reference and disturbance nights were compared. The 24-h urinary free cortisol concentration (UFC) was measured. The procedure was repeated after 6 months on MHT or placebo.

RESULTS

Fifteen perimenopausal and 17 postmenopausal women completed the study. The perimenopausal and postmenopausal groups were combined. During external sleep disturbance, sleep was shorter and more fragmented; with less stage 2, slow-wave and rapid eye movement (REM) sleep and more wake time and awakenings, both at baseline and after the treatment period. Compared to the placebo group, sleep disturbance was minor for women on MHT: sleep was not shortened and the amount of slow-wave sleep did not decrease. Increased 24-h UFC was observed only during MHT.

CONCLUSIONS

Sleep in climacteric women is easily disturbed, leading to shorter and more fragmented sleep with less deep sleep and REM sleep. Six months of MHT attenuates the observed sleep disturbance.

Sleep disturbances and depressive and anxiety symptoms during pregnancy: associations with delivery and newborn health

BACKGROUND

Sleep disturbances and mood symptoms are common in late pregnancy; according to the literature, they can affect delivery and newborn outcomes. This study evaluated the effect of sleep and mood symptoms on delivery and newborn health, because there are insufficient and partly contradictory studies on the topic.

METHODS

A cohort of 1414 mothers in their third trimester was enrolled in this prospective cross-sectional questionnaire study. Validated questionnaires were assessed for the measurement of sleep disturbances and depressive and anxiety symptoms. The data on delivery and newborn outcomes were obtained from hospital medical records.

RESULTS

Sleep disturbances were very common. A higher insomnia score (β = - 0.06, p = 0.047) and longer sleep need (β = 0.07, p = 0.047) were related to delivery at a lower gestational age. In addition, a higher insomnia score (β = - 28.30, p = 0.010) and lower general sleep quality (β = - 62.15, p = 0.025) were associated with lower birth weight, but longer sleep duration and longer sleep need with a higher birth weight (β = 28.06, p = 0.019; β = 27.61, p = 0.028, respectively). However, the findings regarding birth weight lost their significance when the birth weight was standardized by gestational weeks. Concerning Apgar scores and umbilical artery pH, no associations were found. Snoring was associated with a shorter duration of the first phase of delivery (β = - 78.71, p = 0.015) and total duration of delivery (β = - 79.85, p = 0.016). Mothers with higher insomnia, depressive, or anxiety symptoms were more often treated with oxytocin (OR 1.54 95% CI 1.00-2.38, p = 0.049, OR 1.76, 95% CI 1.02-3.04, p = 0.049 and OR 1.91, CI 95% 1.28-2.84, p < 0.001, respectively) and those with higher depressive and anxiety symptoms were delivered more often with elective cesarean section (OR 4.67, 95% CI 2.04-12.68, p < 0.001 and OR 2.22, 95% CI 1.03-4.79, p = 0.042).

CONCLUSIONS

Maternal sleep disturbances and mood symptoms during pregnancy are associated with delivery and newborn health. However, nearly, all the outcomes fell within a normal range, implying that the actual risks are low.

Usability of Pregnancy-Unique Quantification of Emesis questionnaire in women hospitalised for hyperemesis gravidarum: a prospective cohort study

OBJECTIVES

Pregnancy-Unique Quantification of Emesis (PUQE) questionnaire is mainly used in outpatient care to assess the severity of nausea and vomiting of pregnancy (NVP). Our aim was to evaluate the usability of the Finnish-translated PUQE in hospitalised women with hyperemesis gravidarum (HG).

DESIGN

Prospective cohort study.

SETTING

University hospital in Finland.

PARTICIPANTS

Ninety-five women admitted due to HG for at least overnight.

PRIMARY AND SECONDARY OUTCOME MEASURES

Categorised and continuous PUQE scores, physical and mental quality of life (QoL) and urine ketones at admission and at discharge, analysing the first admission and readmissions separately.

RESULTS

The most common PUQE categories at admission were 'moderate' and 'severe', whereas at discharge they were 'mild' and 'moderate'. Likewise, continuous PUQE scores improved between admission and discharge (p<0.0001). At admission, women rating worse physical QoL (first admission adjusted OR (AOR) 1.09; 95% CI 1.03 to 1.16; readmissions AOR 1.13; 95% CI 1.02 to 1.25) and women with ketonuria of +++ (first admission AOR 16.00; 95% CI 1.44 to 177.82) fell into higher PUQE score category. On discharge day, women with better physical QoL had lower PUQE score category (first admission AOR 0.94; 95% CI 0.91 to 0.98; readmissions AOR 0.93; 95% CI 0.90 to 0.97). The results between physical QoL and continuous PUQE scores were similar. Concerning readmissions, better mental QoL was associated with lower PUQE score category at discharge (AOR 0.93; 95% CI 0.89 to 0.97). As for continuous PUQE score, worse mental QoL was associated with higher score at admission (readmissions, p=0.007) and better mental QoL with lower score at discharge (readmissions, p=0.007).

CONCLUSIONS

PUQE scores reflected alleviation of NVP severity in women hospitalised due to HG. Further, the decrease in PUQE score was associated with improved physical QoL and partly also with improved mental QoL. We therefore suggest PUQE as a complementary instrument for inpatient setting.

Associations Between Delivery Modes, Birth Outcomes and Offspring Anxiety Disorders in a Population-Based Birth Cohort of Children and Adolescents

OBJECTIVE

Mode of delivery and well-being markers for newborn infants have been associated with later psychiatric problems in children and adolescents. However, only few studies have examined the association between birth outcomes and anxiety disorders and the results have been contradictory.

METHODS

This study was a Finnish population-based register study, which comprised 22,181 children and adolescents with anxiety disorders and 74,726 controls. Three national registers were used to collect the data on exposures, confounders and outcomes. Mode of delivery, the 1-min Apgar score, umbilical artery pH and neonatal monitoring were studied as exposure variables for anxiety disorders and for specific anxiety disorders. Conditional logistic regression was used to examine these associations.

RESULTS

Unplanned and planned cesarean sections increased the odds for anxiety disorders in children and adolescents (adjusted OR 1.08, 95% CI 1.02-1.15 and aOR 1.12, 95% CI 1.05-1.19, respectively). After an additional adjustment for maternal diagnoses, unplanned cesarean sections remained statistically significant (aOR 1.11, 95% CI 1.04-1.18). For specific anxiety disorders, planned cesarean sections and the need for neonatal monitoring increased the odds for specific phobia (aOR 1.21, 95% CI 1.01-1.44 and aOR 1.28, 95% CI 1.07-1.52, respectively).

CONCLUSIONS

Birth by cesarean section increased the odds for later anxiety disorders in children and adolescents and unplanned cesarean sections showed an independent association. Further studies are needed to examine the mechanisms behind these associations.

General practitioners' self-reported competence in the management of sexual health issues - a web-based questionnaire study from Finland

Objective Although sexual problems are common, they are rarely brought up in appointments with general practitioners (GPs). We aimed to assess the barriers that hinder GPs from bringing up sexual health issues and to evaluate the need for education on sexual medicine. Design A web-based questionnaire was used. Setting Four fields were included: A) the self-reported competence in discussing sexual health and treating patients with these issues, B) the barriers to bringing up patients' sexual health problems, C) the source of education on sexual medicine and D) the need for education on sexual medicine. Subjects A random sample of 1000 GPs in Finland (a response rate of 43.5%, n = 402). Main outcome measures GPs' self-assessed competence in discussing and treating sexual health issues, related barriers to bringing up the topic and the reported need for education. Results The main reasons reported for not bringing up sexual health issues were shortness of the appointment time (85.6%), a lack of knowledge (83.6%) and a lack of experience with sexual medicine (81.8%). The male GPs reported better competence in discussing the issues and treating male patients, whereas the female GPs reported better competence in discussing the issues with female patients. No differences emerged between genders regarding treating female patients. Nearly 90% of the GPs expressed needing more education about sexual medicine. Conclusions Although the GPs reported good competence in discussing sexual health issues with their patients, several barriers to bringing up sexual health issues emerged. Continuing education was desired and could lessen these barriers.Key pointsOnly a few studies have evaluated the competence of general practitioners (GPs) in addressing sexual health issues with their patients.In our study, the GPs reported a high competence in discussing patients' sexual health issues regardless of the patient's gender.However, several barriers to bringing up sexual health issues in appointments emerged.A majority of the GPs expressed a need for continuing education about sexual medicine.

Sleep during menopausal transition: a 10-year follow-up

Study Objectives

A 10-year observational follow-up study to evaluate the changes in sleep architecture during the menopausal transition.

Methods

Fifty-seven premenopausal women (mean age 46 years, SD 0.9) were studied at baseline and after a 10-year follow-up. At both time points, polysomnography (PSG) was performed, and the serum follicle-stimulating hormone (S-FSH) concentration was measured. Linear regression models were used to study the effects of aging and menopause (assessed as change in S-FSH) on sleep.

Results

After controlling for body mass index, vasomotor, and depressive symptoms, higher S-FSH level was associated with longer sleep latency (B 0.45, 95% confidence interval [CI]: 0.07 to 0.83). Aging of 10 years was associated with shorter sleep latency (B −46.8, 95% CI: −77.2 to −16.4), shorter latency to stage 2 sleep (B −50.6, 95% CI: −85.3 to −15.9), decreased stage 2 sleep (B −12.4, 95% CI: −21.4 to −3.4), and increased slow-wave sleep (B 12.8, 95% CI: 2.32 to 23.3) after controlling for confounding factors.

Conclusions

This study suggests that PSG measured sleep of middle-aged women does not worsen over a 10-year time span due to the menopausal transition. The observed changes seem to be rather age- than menopause-dependent.

Sleep quality in women with nausea and vomiting of pregnancy: a cross-sectional study

BACKGROUND

Nausea and vomiting of pregnancy (NVP) deteriorates many aspects of daily lives of women. However, little is known about associations between NVP and sleep quality.

METHODS

Women attending to routine mid-pregnancy visits in maternity health care clinics in Turku city area and surrounding municipalities, Finland, during 2011-2014, were invited to participate. A cohort of 1203 volunteers (mean age 30 years, mean gestational week 16.6, mean BMI 24.4 kg/m2, nulliparous 46%) was recruited. The severity of NVP in the worst 12-h period of current pregnancy was assessed with Pregnancy Unique Quantification of Emesis Questionnaire (PUQE) and categorized accordingly into no/mild/moderate and severe NVP. Sleep disturbances during the past 3 months were assessed with selected questions (difficulty falling asleep, night awakenings, too early morning awakenings and sleepiness during the day) from Basic Nordic Sleep Questionnaire (BNSQ). In addition, general sleep quality, as well as physical and mental quality of life (QoL) were rated with three visual analog scales (VAS). Associations between PUQE categories (severity of NVP) and sleep disturbances, general sleep quality, physical QoL and mental QoL were evaluated with multinomial regression analysis.

RESULTS

According to PUQE, NVP was most frequently moderate (n = 629, 52.3%), followed by mild (n = 361, 30.0%) and severe (n = 77, 6.4%). Only 11.3% had no NVP (n = 136). The most frequent sleep disturbance was night awakenings (69.9%, n = 837), followed by sleepiness during the day (35.7%, n = 427), too early morning awakenings (12.0%, n = 143) and difficulty falling asleep (7.1%, n = 81). In adjusted analysis (age, parity, body mass index, smoking, employment), more severe NVP was associated with night awakenings (AOR 3.9, 95% CI 1.79-8.47, P < 0.0001) and sleepiness during the day (AOR 4.7, 95% CI 2.20-9.94, P < 0.0001). In VAS, women with more severe NVP rated worse general sleep quality and worse physical and mental QoL. However, in multivariable analysis, the association between the severity of NVP and physical and mental QoL was stronger than that of sleep .

CONCLUSIONS

More severe NVP is associated with sleep disturbances and in close relation to lower physical and mental QoL. Thus, in comprehensive care of women with NVP, also sleep quality should be evaluated.

Nighttime melatonin secretion and sleep architecture: different associations in perimenopausal and postmenopausal women

BACKGROUND

Sleep quality typically decreases after menopause, but the underlying mechanisms are poorly understood. Concentrations of melatonin are lower and its secretion profiles different before and after menopause. However, whether and how melatonin and sleep architecture are associated in women of different reproductive states have not been examined to date.

METHODS

Overnight serum melatonin samples were taken from 17 perimenopausal and 18 postmenopausal healthy women. Sleep quality was measured with all-night polysomnography recordings.

RESULTS

Melatonin concentrations tended to be the lowest during NREM sleep, and were associated with higher odds of transitions from wake to NREM sleep. The curves of predicted overnight melatonin values from linear mixed models varied according to sleep phases (NREM, REM, Wake) in perimenopausal, but not in postmenopausal women. In perimenopause higher melatonin area under curve (AUC) correlated with higher slow-wave activity (p = 0.043), and higher minimum concentrations with shorter slow-wave sleep (SWS) latency (p = 0.029). In postmenopause higher mean and maximum melatonin concentrations and AUC correlated with lower SWS percentage (p = 0.044, p = 0.029, p = 0.032), and higher mean (p = 0.032), maximum (p = 0.032) and minimum (p = 0.037) concentrations with more awakenings from REM sleep. In the age- and BMI- adjusted regression models, the association between higher maximum (p = 0.046) melatonin concentration and lower SWS percentage remained.

CONCLUSIONS

The relationship between melatonin and sleep architecture differed in perimenopausal and postmenopausal women. After menopause, high melatonin concentrations were associated with worse sleep. Whether these different patterns are related to aging of the reproductive system, and to decrease in menopausal sleep quality, remains to be elucidated.

Estimating the cumulative risk of postnatal depressive symptoms: the role of insomnia symptoms across pregnancy

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.

Experiences of induction of labor with a catheter - A prospective randomized controlled trial comparing the outpatient and inpatient setting

INTRODUCTION

Approximately every fourth labor is induced. In Finland, when labor is induced, it is commonly carried out with a catheter in the inpatient (IP) setting. However, in uncomplicated, full-term pregnancies, induction of labor (IOL) in the outpatient (OP) setting is also possible. Nevertheless, there is only a limited amount of information about the experiences of IOL in OP setting. Our study compared the experiences of catheter IOL in OP and IP settings.

MATERIAL AND METHODS

We performed a prospective randomized study, including 113 women with uncomplicated full-term pregnancies with planned IOL. After catheter insertion, women were randomized into OP or IP settings: after dropouts, there were 53 women in the OP group and 54 in the IP. The experiences of IOL were evaluated with three sets of visual analog scale (VAS) questionnaires: the general experience questionnaire (eight questions), the concurrent induction experience questionnaire (1, 5, 9, 13 hours; nine questions) and the postpartum experience questionnaire (14 questions).

RESULTS

Both groups had low VAS scores, indicating good experiences of IOL. Women in the OP group were less satisfied (mean VAS difference Δ = 7.8, P = .015) and more anxious (Δ = 4.8, P = .008) than were women in the IP group. In the course of the IOL, all women became less satisfied (Δ = 8.4, P = .001), had more contraction pain (Δ = 8.9, P = .020) and had a higher frequency of contractions (Δ = 9.9, P = .004) but they were more relaxed and experienced less fear (Δ = 6.9, P = .036, Δ = 5.3, P = .001, respectively). There was no interaction between group and time. According to the postpartum experience questionnaire, both groups had a similar good general experience of IOL (P = .736) but the OP group had more fear (Δ = 9.5, P = .009) and was more anxious (Δ = 9.0, P = .007). Most of the women would choose catheter IOL in a subsequent pregnancy (OP 82.6%, IP 87.0%).

CONCLUSIONS

The women in the OP setting were less satisfied and more anxious than were the women in the IP setting. However, the differences were marginal and the general experience after IOL was good. IOL in an OP setting is thus a viable option in low-risk full-term pregnancies. Therefore, when using catheter IOL, both setting options should be available.

Nausea and vomiting of pregnancy: associations with personal history of nausea and affected relatives

PURPOSE

To examine whether personal history of nausea or history of nausea and vomiting of pregnancy (NVP) in relatives are risk factors for a woman to suffer from NVP. Further, to evaluate if these factors are associated with the severity of NVP.

METHODS

Cohort study of 2411 pregnant women recruited from maternity health care clinics. The severity of NVP was categorized according to Pregnancy-Unique Quantification of Emesis (PUQE) questionnaire into no/mild/moderate/severe NVP. History of nausea was assessed in connection with motion sickness, seasickness, migraine or other kinds of headache, after anesthesia, related to the use of contraceptives, and other kinds of nausea. History of NVP in relatives was categorized into first-degree (mother/sister) and second-degree relatives (more distant).

RESULTS

In multivariable analysis including previous personal history of nausea, motion sickness (OR 3.17, 95% CI 1.81-5.56, p < 0.0001) and nausea in migraine (OR 3.18, 95% CI 1.86-5.45, p < 0.0001) were associated with severe NVP. History of nausea in other kinds of headache was associated with moderate NVP (OR 1.91, 95% CI 1.34-2.72, p = 0.001). Women with affected first-degree relatives had higher odds for moderate (OR 3.84, 95% CI 2.72-5.40) and severe (OR 3.19, 95% CI 1.92-5.28) NVP (p < 0.0001). All these results remained significant after adjusting for parity, body mass index, smoking, employment and age.

CONCLUSION

Women with personal history of nausea or family history of NVP have an increased susceptibility of NVP. This information is useful in pre-pregnancy counselling.

Maternal sleep quality during pregnancy is associated with neonatal auditory ERPs

Poor maternal sleep quality during pregnancy may act as a prenatal stress factor for the fetus and associate with neonate neurocognition, for example via fetal programming. The impacts of worsened maternal sleep on neonatal development and, more specifically on neonatal auditory brain responses, have not been studied. A total of 155 mother-neonate dyads drawn from the FinnBrain Birth Cohort Study participated in our study including maternal self-report questionnaires on sleep at gestational week 24 and an event-related potential (ERP) measurement among 1-2-day-old neonates. For sleep quality assessment, the Basic Nordic Sleep Questionnaire (BNSQ) was used and calculated scores for (1) insomnia, (2) subjective sleep loss and (3) sleepiness were formed and applied in the analyses. In the auditory ERP protocol, three emotionally uttered pseudo words (in happy, angry and sad valence) were presented among neutrally uttered pseudo words. To study the relations between prenatal maternal sleep quality and auditory emotion-related ERP responses, mixed-effects regression models were computed for early (100–200 ms) and late (300–500 ms) ERP response time-windows. All of the selected BNSQ scores were associated with neonatal ERP responses for happy and angry emotion stimuli (sleep loss and sleepiness in the early, and insomnia, sleep loss and sleepiness in the late time-window). For sad stimuli, only maternal sleep loss predicted the neonatal ERP response in the late time-window, likely because the overall ERP was weakest in the sad condition. We conclude that maternal sleep quality during pregnancy is associated with changes in neonatal auditory ERP responses.

Insomnia symptoms increase during pregnancy, but no increase in sleepiness - Associations with symptoms of depression and anxiety

OBJECTIVE

To evaluate alteration in insomnia and sleepiness symptoms during pregnancy and assess early pregnancy risk factors for these symptoms, especially depressive and anxiety symptoms.

METHODS

A cohort of 1858 women was enrolled from the FinnBrain Birth Cohort Study. Insomnia and sleepiness symptoms were measured in early, mid- and late pregnancy with the Basic Nordic Sleep Questionnaire. Depressive symptoms were measured using the Edinburgh Postnatal Depression Scale and anxiety symptoms with the Symptom Checklist-90/Anxiety Scale. General linear models for repeated measures were conducted.

RESULTS

General sleep quality decreased (p < 0.001) and all insomnia types (p < 0.001) and sleep latencies (p < 0.001) increased as pregnancy proceeded. Snoring increased, but witnessed apneas remained rare. Nevertheless, morning (p = 0.019) and daytime (p < 0.001) sleepiness decreased from early to both mid-pregnancy and late pregnancy (p = 0.006 and p = 0.039). Women took more naps in early and late pregnancy compared to mid-pregnancy (both p < 0.001). Women with higher baseline anxiety symptoms had greater increase in sleep latency. At each pregnancy point, higher depressive and anxiety symptoms were associated with higher insomnia (p < 0.001) and sleepiness scores (p < 0.001) and higher depressive symptoms with longer sleep latencies (p < 0.001).

CONCLUSION

We found a marked increase in insomnia symptoms throughout pregnancy. However, sleepiness symptoms did not increase correspondingly. Both depressive and anxiety symptoms in early pregnancy were associated with higher insomnia and sleepiness symptoms in later stages of pregnancy which emphasizes the importance of their assessment in early pregnancy.

Incidence and risk factors of hyperemesis gravidarum: A national register-based study in Finland, 2005-2017

INTRODUCTION

Hyperemesis gravidarum is the most common reason for hospitalization in early pregnancy in pregnancies resulting in delivery. Several associative factors indicate that the etiology is likely to be multifactorial. To assess this, we used a unique procedure to compare hyperemetic pregnancies with non-hyperemetic pregnancies both in different women and in the same women's different pregnancies.

MATERIAL AND METHODS

Data about all pregnancies resulting in delivery in Finland in 2005-2017 were retrieved from healthcare registers. Women who had a diagnosis of hyperemesis gravidarum in any pregnancy in the Finnish Hospital Discharge Register were chosen as cases (n = 9315) and other women (n = 428 150) as the reference group. The incidence of hyperemesis gravidarum was calculated and associations between hyperemesis and maternal, environmental and pregnancy-related factors were analyzed in a novel setting by comparing case women's pregnancies diagnosed with hyperemesis to (1) reference group women's pregnancies and (2) case women's non-hyperemetic pregnancies.

RESULTS

Of the 437 465 women who had at least one pregnancy resulting in delivery during the study period, 9315 women had at least one hyperemetic pregnancy. The total number of pregnancies resulting in delivery was 741 387 and 9549 of those were diagnosed with hyperemesis gravidarum; thus the incidence of hyperemesis gravidarum was 1.3%. In comparison (1), case women's hyperemetic pregnancies vs reference group's pregnancies, younger maternal age, higher gravidity, underweight and overweight were associated with increased risk of hyperemesis; in contrast, in comparison (2), case women's hyperemetic pregnancies vs their non-hyperemetic pregnancies, higher age and obesity were associated with higher risk of hyperemesis, whereas the risk was lower as gravidity and parity increased. In both comparisons, smoking was associated with lower risk, whereas higher municipality population, assisted reproductive technology, multiple gestation and female sex of the fetus were associated with increased risk of hyperemesis.

CONCLUSIONS

Our novel study setting provided new insights about risk factors: hyperemetic pregnancies differ both from pregnancies of women who had never been diagnosed with hyperemesis and from hyperemetic women's non-hyperemetic pregnancies. The incidence of hyperemesis gravidarum in Finland was comparable to that in other countries.

Multinucleation in Day Two Embryos Is Not Associated with Multinucleation in Sibling Embryos After Freezing and Thawing

BACKGROUND

Multinucleated embryos exhibit impaired implantation potential, but whether the presence of multinucleated embryos in an embryo cohort reflects the quality of the entire cohort is controversial. No data exists on multinucleation rate among frozen-thawed embryos.

METHODS

De novo multinucleation and the number of multinucleated embryos on day two of embryo culture before freezing (D2) (n=415), at thawing (D2t) (n=320) and after an overnight culture after thawing (D3t) (n=265) was recorded. Associations between multinucleation before and after cryopreservation, female age and ovarian sensitivity to hormonal stimulation were assessed.

RESULTS

The occurrence of at least one multinucleated embryo per embryo cohort was 62.4% on D2, 16.3% on D2t and 31.7% on D3t. The presence of multinucleated embryos prior to freezing was not associated with de novo multinucleation during post-thaw culture (p=0.845). On D2, multinucleation was high in young women, irrespective of the number of collected oocytes (p=0.702). In older age groups, multinucleation was highest if >17 oocytes were obtained (p<0.001) and the odds for multinucleation was the lowest if the consumption of recombinant follicle-stimulating hormone was >238 IU/oocyte (In the age group of 30-35 years OR 0.25 [0.13-0.47], and the age group of 36-40 years OR 0.35 [0.20-0.63].

CONCLUSION

Multinucleation is commonly seen in embryos and good-quality day two embryo cohorts before freezing. The presence of multinucleated embryos prior to freezing does not illustrate multinucleation in sibling embryos after thawing. Embryo multinucleation is associated with factors related to good prognosis in assisted reproduction treatments.

Maternal tiredness and cytokine concentrations in mid-pregnancy

OBJECTIVE

Sleep disturbances relate to altered levels of inflammatory mediators in general population, but not much is known about the associations between sleep disturbances and inflammatory mediators during pregnancy. The present exploratory study investigated whether insomnia, tiredness, general sleep quality, and insufficient sleep duration during pregnancy relate to the concentrations of maternal peripheral circulating cytokines. As sleep disturbances are frequently observed in mood disorders, the results were controlled for symptoms of depression and anxiety.

METHODS

137 participants were randomly drawn from a representative FinnBrain Birth Cohort. Serum concentrations of selected cytokines were analyzed using Multiplex bead arrays from blood samples drawn at the gestational week 24. The sleep disturbances were evaluated using the Basic Nordic Sleep Questionnaire. Depressive and anxiety symptoms were measured with the Edinburgh Postnatal Depression Scale and the anxiety subscale of the self-rated Symptom Checklist 90, respectively.

RESULTS

Enhanced tiredness was associated with cytokine concentrations of IL-2, IL-10, IL-12, IL-13, and TNF-α. The observed associations resembled a reversed U-shaped curve rather than being linear. Having a good general sleep quality was associated with higher logarithmic cytokine concentrations of IL-2, IL-4, IL-6, IL-10, IL-12, IL-13, and IFN-γ. There was no evidence for associations between insomnia or sleep loss and cytokines.

CONCLUSIONS

Maternal subjective tiredness and good general sleep quality were associated with altered levels of immunological markers during pregnancy. The association was independent from symptoms of depression and anxiety.

Sleeping problems during pregnancy-a risk factor for postnatal depressiveness

In the general population, sleeping problems can precede an episode of depression. We hypothesized that sleeping problems during pregnancy, including insomnia symptoms, shortened sleep, and daytime tiredness, are related to maternal postnatal depressiveness. We conducted a prospective study evaluating sleep and depressive symptoms, both prenatally (around gestational week 32) and postnatally (around 3 months after delivery) in the longitudinal CHILD-SLEEP birth cohort in Finland. Prenatally, 1667 women returned the questionnaire, of which 1398 women participated also at the postnatal follow-up. Sleep was measured with the Basic Nordic Sleep Questionnaire (BNSQ) and depressive symptoms with a 10-item version of the Center for Epidemiological Studies Depression Scale (CES-D). Altogether, 10.3% of the women had postnatal depressiveness (CES-D ≥ 10 points). After adjusting for main background characteristics and prenatal depressiveness (CES-D ≥ 10), poor general sleep quality (AOR 1.87, 95% CI 1.21-2.88), tiredness during the day (AOR 2.19, 95% CI 1.41-3.38), short sleep ≤ 6 and ≤ 7 h, sleep latency > 20 min, and sleep loss ≥ 2 h were associated with postnatal depressiveness (all p < .050). Postnatally, after the adjustment for background characteristics, virtually all sleeping problems (i.e., difficulty falling asleep (AOR 7.93, 95% CI 4.76-13.20)), except frequent night awakenings per week or severe sleepiness during the day, were related to concurrent postnatal depressiveness. Thus, several prenatal and postnatal sleeping problems are associated with increased depressive symptoms 3 months postnatally. Screening of maternal prenatal sleeping problems, even without depressive symptoms during pregnancy or lifetime, would help to identify women at an increased risk for postnatal depressiveness.

Recurrence patterns of hyperemesis gravidarum

BACKGROUND

Hyperemesis gravidarum, excessive vomiting in pregnancy, affects approximately 0.3-3.0% of all pregnancies, but the risk is considerably higher in pregnancies following a hyperemetic pregnancy. The reported recurrence rate of hyperemesis gravidarum is wide, ranging from 15-81%, depending on study settings. Factors affecting recurrence of hyperemesis gravidarum are as yet insufficiently studied.

OBJECTIVE

We sought to evaluate the recurrence rate of hyperemesis gravidarum in subsequent pregnancies, to elucidate chronological patterns of recurrence of the condition, and to analyze maternal, environmental, and pregnancy-related factors associated with recurring hyperemesis gravidarum.

STUDY DESIGN

Out of all pregnancies ending in delivery in Finland from 2004 through 2011, data of women who had at least 1 pregnancy ending in delivery following a pregnancy diagnosed with hyperemesis gravidarum were retrieved from hospital discharge register and medical birth register (1836 women, 4103 pregnancies; 1836 index pregnancies and 2267 subsequent pregnancies). The first pregnancy with hyperemesis gravidarum diagnosis was chosen as the index pregnancy, and recurrence rate was calculated by comparing the number of hyperemetic pregnancies that followed the index pregnancy to the total number of pregnancies that followed the index pregnancy. Recurrence patterns of hyperemesis gravidarum were illustrated by presenting the chronological order of the women's pregnancies beginning from the index pregnancy to the end of the follow-up period. The associations between recurring hyperemesis and age, parity, prepregnancy body mass index, smoking, marital and socioeconomic status, domicile, month of delivery, assisted reproductive technology, sex, and number of fetuses were analyzed in both the index pregnancies and in pregnancies following the index pregnancy.

RESULTS

There were 544 pregnancies with a hyperemesis diagnosis and 1723 pregnancies without a hyperemesis diagnosis following the index pregnancies. The overall recurrence rate of hyperemesis gravidarum in pregnancies following the index pregnancy was 24%. In case of >1 subsequent pregnancy, 11% of women were diagnosed with hyperemesis in all of their pregnancies. In the index pregnancies, recurrence of hyperemesis gravidarum was more common among women with parity of 2 than parity of 1 (adjusted odds ratio, 1.33, P = .046). Overweight women (adjusted odds ratio, 0.58, P = .036) or women who smoked after the first trimester (adjusted odds ratio, 0.27, P < .001) had lower recurrence of hyperemesis. In the comparison of the subsequent pregnancies, quitting smoking in the first trimester (adjusted odds ratio, 0.32, P = .010) and smoking continued after the first trimester (adjusted odds ratio, 0.38, P = .002) were associated with lower odds of recurring hyperemesis. Female sex of the fetus was associated with higher odds of recurring hyperemesis (adjusted odds ratio, 1.29, P = .012).

CONCLUSION

In the majority of pregnancies following an earlier hyperemetic pregnancy, hyperemesis gravidarum does not recur, but hyperemetic pregnancies occur in the next pregnancies with little predictability. Only few factors associated with recurring hyperemesis could be identified. Although estimating the probability of recurrence of hyperemesis gravidarum in a subsequent pregnancy based on a woman's first hyperemetic pregnancy turned out not to be feasible, it is reassuring to know that hyperemesis does not appear to become more likely with each pregnancy and that after 1 pregnancy with hyperemesis, the following pregnancy may be different.

Nausea and vomiting of pregnancy: A study with pregnancy-unique quantification of emesis questionnaire

OBJECTIVES

Nausea and vomiting of pregnancy (NVP) is frequent, affecting up to 70-85% of pregnant women. However, severity of NVP especially in clinical practice is often uncertainly assessed and thus both under- and overdiagnosing is probable. Furthermore, risk factors for NVP, although recognized, are not well established. The aim of our study was to evaluate the severity of NVP with a structured questionnaire and evaluate associative risk factors.

STUDY DESIGN

Sample of 2411 women were recruited from maternity health care clinics. Severity of NVP was assessed with pregnancy-unique quantification of emesis (PUQE) questionnaire. Age, previous pregnancies, previous deliveries, previous miscarriages including ectopic pregnancies, previous pregnancy terminations, nationality, pre-pregnancy body mass index, smoking, marital status and employment were used as explanatory factors.

RESULTS

Altogether 88.0% of the women reported some level of NVP, of which 6.4% was severe, 52.2% moderate and 29.4% mild. Daily duration of NVP was ≥ four hours in 12 h in 45.0%. Further, 18.8% of the women had vomiting episodes ≥ three times and 37.4% retching episodes ≥ three times in 12 h. Women with ≥ two previous pregnancies had increased risk for more severe NVP (OR 2.17, 95%CI; 1.34-3.51, p <  0.0001). Older women had increased daily duration of nausea (OR 1.03, 95%CI; 1.00-1.06, p = 0.004) but lower number of vomits (OR 0.93, 95%CI; 0.93-0.97, p < 0.0001) and lower number of retching (OR 0.93, 95%CI; 0.90-0.96, p < 0.0001). Smokers had shorter daily duration of nausea (OR 0.49, 95%CI; 0.33-0.73, p < 0.0001), but higher number of vomiting episodes compared to non-smokers (OR 1.83, 95%CI; 1.26-2.66, p = 0.021).

CONCLUSIONS

Women suffered from NVP very frequently. The daily duration of NVP was moderately long, in nearly half of the women four hours or more. In addition, retching was more frequent than vomiting. From studied risk factors, few associations with different aspects of NVP emerged, but only multiparity was associated with the severity of NVP. As NVP affects several women during pregnancy, in future, the impact of NVP on quality of life, future family planning and health costs should be evaluated.

Sleep and Sleep Disorders in the Menopausal Transition

The menopausal transition is associated with an increase in insomnia symptoms, especially difficulty staying asleep, which negatively impacts quality of life. Vasomotor symptoms are a key component of sleep disruption. Findings from polysomnographic studies are less consistent in showing disrupted sleep in menopausal transition independent of aging; further prospective studies are needed. Hormone therapy alleviates subjective sleep disturbances, particularly if vasomotor symptoms are present. However, because of contraindications, other options should be considered. Further work is needed to develop preventive and treatment strategies for alleviating sleep disturbances to ensure better health, quality of life, and productivity in midlife women.

First-Night Effect on Sleep in Different Female Reproductive States

OBJECTIVES

In sleep laboratory studies, the new environment is generally considered to disturb sleep during the first night. However, older women have rarely been studied. Although menopause and hormone therapy affect sleep, their impact on the first-night effect is virtually unknown.

PARTICIPANTS

Four groups of women with no sleep laboratory experience: young on hormonal contraceptives (n = 11, 23.1 [0.5] years), perimenopausal (n = 15, 48.0 [0.4] years), postmenopausal without hormone therapy (HT; off-HT, n = 22, 63.4 [0.8] years) and postmenopausal with HT (n = 16, 63.1 [0.9] years).

PROCEDURE

A cross-sectional study.

METHODS

Polysomnography was performed over two consecutive nights and the first-night effect and group differences were evaluated. Questionnaire-based insomnia and sleepiness scores were correlated to sleep variables and their between-night changes.

RESULTS

Although sleep in young women was deeper and less fragmented than in the other groups, first-night effect was similar in all study groups. Total sleep time, sleep efficiency, and S1 and S2 sleep increased, and wake after sleep onset, awakenings per hour of sleep, S2 and REM latencies, and percentage of SWS decreased from the first to the second night. Perimenopausal women had more insomnia complaints than other women. Insomnia complaints were associated with more disturbed sleep but not with the first-night effect.

CONCLUSIONS

A first night in a sleep laboratory elicits a marked interference of sleep architecture in women of all ages, with a carryover effect of lighter sleep on the second study night. Menopausal state, HT use, or insomnia complaints do not modify this effect.

First-night effect on cardiac autonomic function in different female reproductive states

Decreases in heart rate variability, a marker of autonomic nervous system function, are associated with increased cardiovascular mortality. Heart rate variability increases in non-rapid eye movement sleep, peaking in slow-wave sleep. Therefore, decreasing the amount of deep sleep, for example, by introducing patients to a sleep laboratory environment, could decrease heart rate variability, increasing cardiovascular risk. We studied four groups of women with no previous sleep laboratory experience: young [n = 11, 23.1 (0.5) years]; perimenopausal [n = 15, 48.0 (0.4) years]; postmenopausal without hormone therapy [n = 22, 63.4 (0.8) years]; and postmenopausal on hormone therapy [n = 16, 63.1 (0.9) years], using a cross-sectional design. Polysomnography including electrocardiogram was performed over two consecutive nights. Heart rate variability was assessed overnight, and the first-night effect on heart rate variability was analysed. Furthermore, correlations between heart rate variability and sleep variables were analysed. Using combined groups, only minor changes were observed in non-linear heart rate variability, indicating increased parasympathetic tone from the first to the second night. No group differences in first-night effect were seen. Heart rate variability and sleep variables were not significantly correlated. Heart rate variability decreased with increasing age, and it was lowest in the postmenopausal women on hormone therapy. We conclude that a first night in a sleep laboratory elicits only minimal changes in overnight vagally mediated non-linear heart rate variability in women irrespective of reproductive state. This finding warrants further analyses in different sleep stages, but suggests that changes in sleep architecture per se do not predict the autonomic strain of a poor night.

Sleep quality during pregnancy: associations with depressive and anxiety symptoms

INTRODUCTION

Sleep disturbances are common during pregnancy, yet underdiagnosed and under-investigated. We evaluated sleep quality during pregnancy and assessed associated factors, especially depressive and anxiety symptoms.

MATERIAL AND METHODS

A total of 78 healthy pregnant women from the FinnBrain Birth Cohort Study were studied twice prospectively during pregnancy (in mid-pregnancy and late pregnancy). Sleep quality was evaluated by the Basic Nordic Sleep Questionnaire, depressive symptoms by the Edinburgh Postnatal Depression Scale, and anxiety symptoms by the State-Trait Anxiety Inventory.

RESULTS

Poor general sleep quality, difficulty falling asleep, the number of nocturnal awakenings per night, and too-early morning awakenings increased in late pregnancy compared with mid-pregnancy (all p-values < 0.020). The total insomnia score (p < 0.001) and sleep latency increased (p = 0.005), but sleep duration and preferred sleep duration did not change. Women tended to snore more often in late pregnancy, but apneas remained rare. Almost one-fourth of the women reported both morning and daytime sleepiness, but the frequencies did not increase during the follow up. In late pregnancy, depressive and anxiety symptoms were cross-sectionally related to sleep disturbances, but depressive or anxiety symptoms in mid-pregnancy were not associated with sleep disturbances in late pregnancy.

CONCLUSIONS

We found deterioration in sleep quality across pregnancy. However, no increase in negative daytime consequences was found, presumably indicating a compensatory capacity against sleep impairment. Additionally, depressive and anxiety symptoms and sleep disturbances were only cross-sectionally associated. Our study calls for further research on the factors that influence sleep disturbances during pregnancy.

Effect of mid-luteal phase GnRH agonist on frozen-thawed embryo transfers during natural menstrual cycles: a randomised clinical pilot study

This prospective randomised crossover study evaluated the effect of mid-luteal single-dose gonadotropin-releasing hormone agonist (triptoreline) on pregnancy outcomes in natural-cycle frozen embryo transfers (FETs). Ninety-eight women were randomised to receive either standard luteal support with vaginal micronised progesterone or an additional single dose of 0.1 mg triptoreline at the time of implantation. The intervention group was composed of 65 FET cycles and the control group of 62 cycles. In the intervention group, there were more positive pregnancy tests, clinical pregnancies and live births, but the differences did not reach statistical significance. The mean beta human chorionic gonadotropin (β-hCG) concentration of singleton pregnancies was significantly lower in the intervention group compared to the control group (p = 0.048). No difference was detected in the median birth weight of the newborns.

Sleep and Menopause

Sleeping problems are a serious public health problem, imposing a substantial burden on individuals and society. Although sleeping problems occur throughout the lifespan, and in both sexes, menopause can be considered as one important milestone of increasing occurrence in sleeping problems. However, to determine whether sleeping problems are caused by the menopause or merely occur by coincidence during the menopause is not always easy because several, particularly age-related, changes take place at the same time. The most important factors are general diseases, medications, weight changes and mood symptoms. According to women's own judgment, hormone therapy significantly improves sleep quality. Hormone therapy can thus be considered as a first-line treatment for climacteric sleeping problems. If sleeping problems are accompanied by other disorders, hormone therapy should be kept in mind as an adjuvant therapy. According to worldwide consensus on hormone therapy, the main indication of hormone therapy is alleviation of climacteric symptoms, including climacteric sleeping problems. However, when choosing hormone therapy for a patient, contraindications and possible long-term side effects should be individually considered. This review illustrates the effect of menopause on sleep and evaluates different treatment options, especially hormone therapy, in alleviation of symptoms.

Climacteric symptoms in middle-aged women with chronic somatic diseases

OBJECTIVES

Chronic diseases may aggravate or simulate climacteric symptoms. Although acknowledged in clinical practice, there is a lack of research systematically analysing the association between chronic diseases and climacteric symptoms.

STUDY DESIGN AND MAIN OUTCOME MEASURES

Our study was a cross-sectional population-based study, which included 3421 women, aged 41-54 years. Climacteric symptoms were evaluated using the Women's Health Questionnaire (WHQ), of which we included seven symptom domains (vasomotor, sleep, depressive, anxiety/fears, cognitive, sexual, and menstrual) and a question concerning whether the women were worried about growing old. The occurrence of various diseases (cardiovascular, neurological, sensory organ, bronchopulmonary, musculoskeletal, gastrointestinal, urological, dermatological, and thyroid disease, diabetes, and cancer) was recorded. The associations between the diseases and symptoms were defined with multivariable analyses, adjusting for various confounding factors.

RESULTS

The women with the diseases had more symptoms. Vasomotor symptoms and sleep problems were associated only with gastrointestinal diseases, and lower sexual functioning only with diabetes. The remaining symptoms were associated with several diseases, except being worried about growing old, which was not associated with any.

CONCLUSIONS

Many symptoms connected to the climacteric may manifest also due to chronic diseases. Thus, health-care professionals should consider the origin of the symptoms when treating middle-aged women with chronic diseases.

Cardiac autonomic changes after 40 hours of total sleep deprivation in women

OBJECTIVES

The effect of total sleep deprivation on heart rate variability (HRV) in groups of postmenopausal women on oral hormone therapy (HT) (on-HT, n = 10, 64.2 (1.4) years), postmenopausal women without HT (off-HT, n = 10, 64.6 (1.4) years) and young women (n = 11, 23.1 (0.5) years) was studied using a prospective case-control setup.

METHODS

Polysomnography was performed over an adaptation night, a baseline night, and a recovery night after 40 h of total sleep deprivation. Time and frequency domain and nonlinear HRV from overnight electrocardiogram recordings were compared between groups during baseline and recovery nights. Further, the changes in HRV from baseline to recovery were analysed and compared between groups. Finally, correlations of HRV to percentages of sleep stages and measures of sleep fragmentation were analysed during baseline and recovery.

RESULTS

Young women had higher HRV than older women; the most marked difference was between young and on-HT postmenopausal women. Sleep deprivation induced a decrease in frequency domain HRV in young and in off-HT women, an increase in α2 in off-HT women, and an increase in mean heart rate in on-HT women. The sleep deprivation effect was mainly uncorrelated to changes in sleep parameters.

CONCLUSIONS

Acute total sleep deprivation has a deleterious effect on the autonomic nervous system in young women, but an even more pronounced effect in postmenopausal women. Hormone therapy use in late postmenopause does not give protection against these changes. These harmful effects may partly explain the increased cardiovascular morbidity and overall mortality associated with sleep loss.