Factors related to insomnia and sleepiness in the late third trimester of pregnancy

Obstetrics and Gynecology Department, Hospital Torrecárdenas, Almeria, Spain.
Archives of Gynecology (Impact Factor: 1.36). 02/2012; 286(1):55-61. DOI: 10.1007/s00404-012-2248-z
Source: PubMed


To assess the presence of insomnia and sleepiness and related factors in the late third trimester of pregnancy.
A total of 370 singleton gravids completed a general questionnaire containing personal data, the Insomnia Severity Index (ISI) and the Epworth Sleepiness Scale (ESS). In addition, maternal anthropometry was recorded upon survey.
Median [interquartile range] maternal age and gestational age upon survey was of 31 [7.0] years and 39 [1.8] weeks, respectively. A 73.5% of women displayed some degree of insomnia (Total ISI score 8-28) and 22.2% sleepiness (Total ESS score ≥10). Determined rho Spearman coefficients showed significant correlations between ISI scores and gestational age at survey and survey to birth interval (weeks) and between ESS scores and maternal weight and arm circumference at survey and neonatal birth weight. Multiple linear regression analysis found that smoking habit, higher blood pressure and shorter survey to birth interval (weeks) significantly predicted higher ISI scores, and hence a higher risk of insomnia. Employed status, increased arm circumference and neonatal weight predicted higher ESS scores (sleepiness).
Insomnia and sleepiness were prevalent in the late third trimester of pregnancy in which lifestyle factors and maternal and neonatal body composition were significant predictors.

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Available from: Faustino R Perez-Lopez, Oct 25, 2014
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    • "Changes in sleep pattern during pregnancy have been widely described in all three trimesters of pregnancy since 1968 [for overviews see 3–10]. Conditions of sleep loss such as short sleep duration [37] [38] [39], poor sleep quality [4,13,38–51], poor sleep efficiency with an increase in time spent awake during the night [13] [42] [46], and insomnia [38] [52] characterize the sleep of pregnant women during the period of pregnancy. The most frequent adverse outcomes include conditions related to mother morbidity such as prenatal depression, gestational diabetes, and pre-eclampsia. "
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    ABSTRACT: Objectives Short sleep duration, poor sleep quality, and insomnia frequently characterize sleep in pregnancy during all three trimesters. We aimed to review: (i) the clinical evidence of the association between conditions of sleep loss during pregnancy and adverse pregnancy outcomes; and (ii) to discuss the potential pathophysiological mechanisms that may be involved. Methods A systematic search of cross-sectional, longitudinal studies, using Medline, Embase, and PsychINFO, using MeSH headings and key words for conditions of sleep loss such as ‘insomnia’ or ‘poor sleep quality’ or ‘short sleep duration’ and ‘pregnancy outcome’ was made for papers published between January 1, 1960 and July 2013. Results Twenty studies met inclusion criteria for sleep loss and pregnancy outcome: seven studies on prenatal depression, three on gestational diabetes, three on hypertension, pre-eclampsia/eclampsia, six on length of labor/type of delivery, eight on preterm birth and three on birth grow/birth weight. Two main results emerged: (i) conditions of chronic sleep loss are related to adverse pregnancy outcomes; (ii) chronic sleep loss yields a stress-related hypothalamic–pituitary–adrenal axis and abnormal immune/inflammatory, reaction, which, in turn, influences pregnancy outcome negatively. Conclusion Chronic sleep loss frequently characterizes sleep throughout the course of pregnancy and it may contribute to adverse pregnancy outcomes. Common pathophysiological mechanisms emerged as being related to stress system activation. We propose that according to the allostatic load hypothesis, chronic sleep loss in pregnancy may also be regarded as both a result of stress and as a physiological stressor per se, leading to stress ‘overload’. It may account for adverse pregnancy outcomes and somatic and mental disorders in pregnancy.
    Sleep Medicine 08/2014; 15(8). DOI:10.1016/j.sleep.2014.02.013 · 3.15 Impact Factor
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    ABSTRACT: Loss of sleep can result from multiple medical and psychiatric conditions as well as from primary sleep disorders. Large epidemiological studies indicate that obstructive sleep apnea a higher risk of stroke and cardiovascular disease. Insomnia, as well as sleep restriction may increase worsen cardiac disease. Metabolic consequences of poor sleep include higher risk of diabetes and obesity. Parasomnias may be seen in association with various conditions, for example of REM behavior disorder is frequently associated with Parkinson's disease. Tables with specific research studies and their main findings are provided for detail.
    Minerva pneumologica 12/2012; 51(4):141-52.
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    ABSTRACT: Background: The management of pregnancy in patients with narcolepsy poses many questions regarding therapy, including the risk to the mother and fetus related to the disease, potential risks at the time of conception, the risk to both the mother and the fetus of the medications used to treat narcolepsy, and the risk to the infant from medications that might be secreted in breast milk. There are no detailed practice parameters on the treatment of narcolepsy patients during pregnancy. We surveyed narcolepsy specialists from around the world to determine their clinical approach to the management of patients with narcolepsy at the time of conception, during pregnancy and while breastfeeding. Methods: Survey invitations were sent via e-mail to 75 clinicians worldwide between 2/2011 and 3/2011 with 34 responses (USA, n=10; Brazil, n=3; Czech Republic, n=2; France, n=2; Italy; n=2; Netherlands, n=2; Canada, n=1; Denmark, n=1; Finland, n=1; Germany, n=1; Japan, n=1; Spain, n=1; unknown n=7). Responders who completed the survey had 20 years (median range, 5-35) of experience in sleep medicine practice with a median number of five narcolepsy patients seen per week. The number of pregnant narcoleptic patients followed per physician was five (median range 1-40). Results: The survey results indicated that the management of patients with narcolepsy varies greatly from clinician to clinician and from country to country. The majority of the clinicians stopped the narcolepsy medications at the time of conception, during pregnancy, and during breastfeeding some reduced the dose and others did not change the dosage, depending on the particular medication. Conclusions: The findings from our survey and literature review suggest that the perceived risks of narcolepsy medication during pregnancy to the mother and the fetus usually are overestimated, as the risk for teratogenic effects from narcolepsy medications in therapeutic doses is essentially nonexistent. However, the potential for rare complications during pregnancy and congenital abnormalities cannot be excluded. Most narcolepsy patients have vaginal delivery without complications. In rare cases patients had cataplexy that interfered with delivery, but if caesarian is required there appears to be no increased anaesthetic or surgical risks. Further prospective information for the appropriate treatment of narcolepsy patients during pregnancy is needed.
    Sleep Medicine 02/2013; 14(4). DOI:10.1016/j.sleep.2012.11.021 · 3.15 Impact Factor
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