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Parity and Sleep Patterns During and After Pregnancy
Abstract
To describe changes in women's sleep patterns from prepregnancy to postpartum.
Polysomnography was done in women's homes for 2 consecutive nights. Forty-five women were studied during the follicular and luteal phases of their menstrual cycles, and 33 conceived and were studied during each trimester of pregnancy. Twenty-nine were studied at 1 and 3 months postpartum.
Compared with prepregnant sleep characteristics, significant changes in sleep patterns were evident by 11-12 weeks' gestation, with a significant increase in total sleep time but less deep sleep and more awakening during sleep. By the third month postpartum, there was improvement in sleep characteristics; however, sleep efficiency remained significantly lower than baseline prepregnancy values.
Sleep disturbance was greatest during the first postpartum month, particularly for first-time mothers.
... Insomnia is one of the most prevalent sleep disorder characterized by sleep difficulty that impairs daily functioning and reduces quality of life 1 . During pregnancy, the majority of women experience alterations in sleep [2][3][4][5][6][7][8][9][10] . Changes in sleep pattern and sleep duration are commonly reported, as are sleep complaints associated with the physical changes of pregnancy. ...
... Sleep disturbances and changes in sleep pattern begin occurring during the first trimester of pregnancy 7,9,10 and are likely to be influenced by some of the dramatic changes in reproductive hormone levels that accompany pregnancy. Levels of oestrogens and progesterone rise throughout pregnancy and peak at term, falling rapidly after delivery 17 . ...
... 8-10 Only 1.9% of women fail to experience nocturnalawakenings in the third trimester of pregnancy 26 . Furthermore, the majority of pregnant women report taking daytime naps 5,7 , which may add more than an hour to the total 24-hour sleep time 7,28 . Thus third trimester total sleep time may exceed prepregnancy sleep time 29 . ...
Purpose: The aim of this study was to evaluate the effect of turquoise color (495 nm) for the treatment of insomnia during pregnancy Material and Methods: This study was carried out in the department of Obstetrics and Gynaecology at Al-Khidmat teaching Mansoorah hospital Lahore affiliated with University College of Medicine and Dentistry, Lahore.60pregnant female patients were included in the study and divided into two groups (mean age 27yrs.). The study population belonged to 20-35 years of age. Parity of the patients ranged from para 0 to para 6. Results: Group 1 acted as control and was not prescribed any medicine or Chromotherapy while group 2 was started with turquoise colour therapy according to the method described earlier During 1st trimester of pregnancy the mean sleep time was enhanced considerably from 4.5 to 5 hours by applying turquoise light. During 2nd trimester of pregnancy the sleep time was increased from 5 to 5.8 hours. During 3rd trimester of pregnancy, the sleep time was again increased from 4.5 to 5 hours. At the end of the study, Group 1 reported an increase in total sleep time, sleep efficiency, decreased Fatigue and day time drowsiness while increased concentration. Conclusion: During pregnancy, insomnia is a difficult condition to treat since all the medicines prescribed have side effects on fetus as well as on the mother, so Chromotherapy is suggested as an easy, safe, cost effective and yet an effective method for treating insomnia.
... The postpartum period is a unique life stage for women, when caring for their infant may cause changes in sleep patterns and sleep deficiency. Compared to during pregnancy, sleep quality tends to worsen in the early postpartum period [5]. Primiparous postpartum women also have worse sleep quality compared to nulliparous women [6]. ...
... Being multiparous was associated with less WASO and greater nighttime % sleep. Previous research has reported similar findings, where in the first few months postpartum primiparous women have shorter sleep duration and worse sleep efficiency compared to multiparous women [5]. Women who were breastfeeding had later waketimes and shorter nap duration. ...
Study Objectives
The postpartum period is a unique time when sleep deficiency often occurs. Black and White adults are reported to have differences in sleep characteristics, but little is known if these differences exist in the postpartum period. Therefore, the purpose of this study was to examine sleep characteristics in a cohort of Black and White women from 6–8 weeks to 12 months postpartum.
Methods
Participants were 49 Black and 85 White women who gave birth to an infant at ≥37 weeks gestation. Participants were instructed to wear an Actiwatch for 7 days at 6–8 weeks, 4, 6, 9, and 12 months postpartum. Mixed-effects linear models with a race by time interaction were used to examine if characteristics differed between races over time.
Results
Only bedtime varied by race. White women had a later bedtime at 6–8 weeks compared to 6 months, but no significant change occurred for Black women. For the entire sample, average nighttime sleep duration increased from 385 minutes at 6–8 weeks to 404 minutes at 4 months postpartum. Percent sleep during the sleep interval and wake after sleep onset (WASO) improved by 6 and 9 months, respectively. However, average WASO remained >45 minutes and sleep efficiency <85% at all timepoints for both Black and White women. Compared to White women, Black women had significantly shorter sleep duration (range: 40.6–59.9 minutes shorter across all timepoints, p<0.0001) and time in bed (range: 17.5–67.6 minutes shorter, p=0.0046), and lower percent sleep (range: 0.7%−1.2% lower, p=0.0407) and sleep efficiency (range: 2.6%−5.7% lower, p=0.0005). Sociodemographic factors were associated with sleep outcomes in Black and White women while behavioral factors were associated with sleep outcomes in White women only.
Conclusion
While there were improvements in nighttime sleep duration and quality, sleep duration remained suboptimal, and quality remained poor throughout the first year postpartum. In this sample, differences existed in factors associated with sleep outcomes between Black and White women.
... Проблемы со сном и изменения в его характере начинаются уже в первом триместре беременности, что связано с быстрыми изменениями уровня репродуктивных гормонов [11]. Уровень прогестерона повышается на протяжении всей беременности. ...
... Повышенная сонливость является распространенной жалобой в первом триместре беременности [13]. Среднее увеличение продолжительности ночного сна более чем на 30 минут было отмечено на сроке от 11 до 12 недель беременности у 33 женщин, прошедших домашнюю полисомнографию до зачатия и в каждом триместре беременности [11]. В первом триместре стадия 1 медленного сна увеличивается, тогда как стадия 3 сокращается, а эффективность сна снижается по сравнению с прегравидарным периодом. ...
Нарушения сна часто встречаются во время беременности. Бессонница при беременности часто объясняется физиологическими изменениями в организме матери. Изменения, связанные с продолжительностью и качеством сна во время беременности, могут быть обусловлены многими предполагаемыми и взаимосвязанными механизмами, такими как гормональные, физиологические, метаболические, психологические изменения и изменения, связанные с осанкой. Бессонница вызывает ухудшение качества жизни. Это становится серьезной проблемой на протяжении всего периода беременности для здоровья матери и плода, негативно влияет на акушерские исходы, увеличивая длительность родов, частоту преждевременных родов и кесарева сечения. Нефармакологическое лечение бессонницы во время беременности считается предпочтительным, включает в себя соблюдение правил гигиены сна, установление регулярных циклов сна и бодрствования, контроль раздражителей, минимизацию потребления жидкости перед сном для уменьшения никтурии, устранение физического дискомфорта, когнитивно-поведенческую терапию. При принятии решений относительно фармакотерапии следует учитывать эффективность нефармакологических вмешательств, влияние заболевания на мать или плод, а также наличие более безопасных альтернатив.
Sleep disturbances are common during pregnancy. Insomnia during pregnancy is often explained by physiological changes in the mother’s body. Changes associated with sleep duration and quality during pregnancy may be due to many hypothesized and interrelated mechanisms, such as hormonal, physiological, metabolic, psychological, and postural changes. Insomnia causes a deterioration in quality of life. It becomes a serious problem throughout pregnancy for maternal and fetal health and negatively affects obstetric outcomes by increasing the length of labor and the incidence of preterm birth and cesarean section. Non-pharmacological treatment for insomnia during pregnancy is considered preferable and includes good sleep hygiene, establishing regular sleep-wake cycles, controlling irritants, minimizing fluid intake before bed to reduce nicturia, eliminating physical discomfort, and cognitive behavioral therapy. Decisions regarding pharmacotherapy should consider the effectiveness of non-pharmacological interventions, the impact of the disease on the mother or fetus, and the availability of safer alternatives.
... These factors include comorbidities such as depression 3,4,6,7,11 , lower back pain (REF) 7 , pelvic girdle pain 7 , high blood pressure 12 and restless-leg-syndrome 6 and pregnancy related factors such as awakening due to foetal movements 13,14 , frequent nocturia 6 , uncomfortable sleeping postures 6 and pre-gestational insomnia 8 . Maternal sleep efficiency also declines 15 throughout the pregnancy 16 due to negative sleep environment 4 and environmental temperature 13 . However, the evidence for many other factors associated with insomnia during pregnancy are equivocal, including for advanced maternal age [3][4][5]7,10,12,17 , educational level 3,18 , having other living children 5,7,8 and disturbed relationship with bed partner 4,13 . ...
... Worry was associated with insomnia in our study, similar to what was previously reported from Lebanon 18 and Iran 30 . Although our findings confirm existing evidence of foetal movements as a risk factor for insomnia 13,14 , the lack of association that we found between frequent nocturnal urinations and insomnia contradicts strong associations detected in studies done in Turkey 6 , USA 13,32 , Poland 16 , and Japan 33 . This is an unusual finding that is difficult to explain but could be due to the low statistical power in our sample to detect this association. ...
Background: Insomnia during pregnancy adversely affects both mother and newborn, but evidence for its proportion and potential risk factors in Sri Lankan pregnant women is limited. Therefore, this study aimed to determine the proportion and factors associated with insomnia during pregnancy.Methods: A descriptive cross-sectional study was conducted among 404 antenatal women who participated in pregnancysupport groups on Facebook during the COVID-19 pandemic. They responded to a self-administered questionnaire that included the Insomnia Severity Index (ISI) to detect insomnia and questions adapted from the Stanford Sleep Questionnaire and an abbreviated version of the Penn State Worry Questionnaire to determine associated factors. Habitual sleep efficiency was calculated using the Pittsburgh Sleep Quality Index (PSQI). Logistic regression models were used to determine the associations of risk factors with insomnia.Results: The proportion of insomnia overall was 32.7%, with proportions of moderate and severe insomnia being 28% and 1.5%, respectively. The proportion of insomnia was lowest in the 1st trimester (19.2%) and highest in the 3rd trimester (42.8%). The risk factors that were associated with insomnia included age ≥30 years (OR = 1.6, 95% CI 1.09-2.52), third trimester (OR = 3.1, 95% CI 1.49-6.56), overweight or obesity in early pregnancy (OR = 1.8, 95% CI 1.04-3.16), irregular sleep routine (OR = 5.2, 95% CI 3.28-8.42), sleeping on lateral position (OR = 1.6, 95% CI 1.03-2.71), trait of worry (OR = 2.4, 95% CI 1.50-4.02), night back pain (OR = 1.7, 95% CI 1.01-2.91), difficulty in breathing (OR = 2.4, 95% CI 1.37-4.39), heart burn and regurgitation (OR = 1.9, 95% CI 1.24-2.99), and awakening due to foetal movements (OR = 1.8, 95% CI 1.14-2.96).Conclusion: Insomnia during pregnancy was high and may have clinical implications for primary antenatal care practice. Many factors associated with insomnia during pregnancy are modifiable and can form the basis for prevention and management.
... High amounts of cortical awakenings and arousals in pregnant women cause sleep fragmentation, with more significant parts of light sleep and less deep sleep [2]. In postpartum, staying asleep is more difficult because of decreases in estrogen and progesterone levels [14]. Evidence consistently indicated that disturbances in sleep during pregnancy were related to adverse health outcomes [15], such as gestational diabetes mellitus [16] or preterm birth and low birth weight [17]. ...
... Consistent with previous findings [7,[13][14][15]28,29], the participants of this study had poor quality sleep. Commonly, poor sleep quality is associated with physiological changes such as an increased need to urinate, lower back pain, or restless leg syndrome [28]. ...
Throughout their life, women should pay attention to their mental health. Evidence indicates that poor sleep quality is related to depressive symptoms in pregnancy, justifying the intervention of health professionals in improving sleep quality to promote the mental health of pregnant women. The objective of our study is to analyze the relationship between sleep quality and perinatal depression, and to identify the obstetric nurse’s intervention in improving sleep quality in the perinatal period. A total of 53 pregnant women between the 28th week of pregnancy and the 7th day after delivery completed the Edinburgh Postnatal Depression Scale (EPDS) and Pittsburgh Sleep Quality Index (PSQI). Women were also asked about the strategies used by the obstetric nurse to improve their quality of sleep. Data analysis was performed using IBM SPSS Statistics software, version 25.0. The Mann–Whitney-U and Kruskal-Wallis tests were carried out. A p-value < 0.05 was considered statistically significant. The median PSQI score was 10 (±3.63), and 9.2% (n = 9) had good quality sleep. The median EPDS score was 12 (±4.43), and 27 participants (50.9%) had probable depression. The women with likely depression had worse sleep quality (p = 0.016). Most participants reported that the obstetric nurse showed no interest in their sleep quality during pregnancy. Women of other nationalities have a higher risk of depression (p = 0.013). Based on our results, it is crucial to assess sleep quality in the perinatal period to promote women’s health during the prenatal and postnatal periods, and more action is needed since we are facing one of the most significant challenges of this century, preventing depression.
... Jodi A.Mindell et al study found that sleep was highly disrupted during pregnancy because of frequent night waking with an average of two to three times per night for over an hour 8 . Duration of sleep decreases in the third trimester on average of 6 to 7hours 12,13 . Insomnia worsens in late pregnancy because of oxytocin which is a wake promoting hormone 17 . ...
Background: Low Birth Weight is a major public health problem since birth weight determines the health and development of a child. There are few studies that have reported that poor sleep quality in pregnancy is associated with adverse fetal outcome. Low Birth Weight is defined by World Health Organization as a neonate weighing less than 2500gm at birth irrespective of the gestational age. Low Birth Weight is the most common adverse fetal outcome that may lead to Perinatal mortality and morbidity. As per the National sleep foundation, about 78% women report sleep disturbance in pregnancy especially during third trimester. Aim: To find out the association between the Sleep quality in late pregnancy and birth weight. Materials and methods: Using Pittsburg Sleep Quality Index (PSQI) questionnaire, Sleep quality for the last one month of pregnancy was assessed and Birth weight of the newborn was recorded from mother's hospital documents in 90 Postnatal mothers who had uneventful Antenatal Period. Association between the sleep quality in late pregnancy and the Birth weight was assessed. Results: The data obtained were analyzed using Statistical Package for Social Sciences (SPSS) version 20. 90 antenatal mothers whose age ranged from 18 to 40 years Participated in the study (M=24.94years, SD=4.42). Correlation coefficient between PSQI score of sleep quality and the birth weight is-0.05. Conclusion: The sleep quality in late pregnancy is inversely related to the birth weight which indicates that poor sleep quality during late pregnancy is a risk factor for Low birth weight. Hence, antenatal interventions to improve the sleep quality during pregnancy can be suggested for better fetal outcome.
... Changes in sleep pattern during pregnancy have a similar result with the midline estimating statistic of rhythm [97]. The feature of sleep pattern in the first trimester of gestation involves shorter sleep latency, and poorer sleep quality compared with those in pre-pregnancy [98,99]. Temporarily improved sleep quality was observed in the mid-trimester gestation [99], while sleep quality could worsen from the 2nd to the 3rd trimester [100]. ...
A cluster of metabolic changes occur to provide energy for fetal growth and development during pregnancy. There is a burgeoning body of research highlighting the pivotal role of circadian rhythms in the pathogenesis of metabolic disorders and lipid homeostasis in mammals. Perturbations of the circadian system and lipid metabolism during gestation might be responsible for a variety of adverse reproductive outcomes comprising miscarriage, gestational diabetes mellitus, and preeclampsia. Growing studies have confirmed that resynchronizing circadian rhythms might alleviate metabolic disturbance. However, there is no clear evidence regarding the specific mechanisms by which the diurnal rhythm regulates lipid metabolism during pregnancy. In this review, we summarize previous knowledge on the strong interaction among the circadian clock, lipid metabolism, and pregnancy. Analyzing the circadian clock genes will improve our understanding of how circadian rhythms are implicated in complex lipid metabolic disorders during pregnancy. Exploring the potential of resynchronizing these circadian rhythms to disrupt abnormal lipid metabolism could also result in a breakthrough in reducing adverse pregnancy outcomes.
... This association is due to the disruption of sleep cycles and the lower quality of the sleep that is obtained. 38 Another possible explanation might be the risk of poor sleep quality in study participants who had poor hygiene practices, which might be justified by poor knowledge regarding the importance of sleep hygiene practices leading to poor sleep quality. 39,40 Finally, compared with their pregnant counterparts who had an unplanned pregnancy, they had an almost 3.0 times greater likelihood of having poor sleep quality. ...
... The most common type of sleep disorder in pregnancy is insomnia [11,12]. Most sleep disorders during pregnancy are experienced by expectant mothers in the third trimester and closer to the end of pregnancy [13][14][15], so in various studies, the prevalence of sleep disorders in the third trimester of pregnancy is reported to be about 75% [14,16]. Unfavorable sleep quality is one of the common complaints during pregnancy [17,18]. ...
... Circadian misalignment is especially prevalent in the postpartum period when caring for the newborn impacts on the parents' sleep and eating habits. The postpartum period is also characterized by a lower total sleep time and regularity, reduced sleep efficiency, and more frequent awakenings [35,36], all of which influence maternal health after delivery. On the other hand, breastfeeding has been shown to help with sleep regulation for both the mother and child [37], and thus may be considered a protective factor. ...
Observational studies have shown a relationship between eating patterns and chronotypes with metabolic health in the general population and in healthy pregnancies. Data are lacking in the postpartum period, which is characterized by an externally driven misalignment of sleep and food intake. We investigated the associations between eating patterns, chronotypes, and metabolic health in the early postpartum period in women who had gestational diabetes mellitus (GDM). We prospectively included 313 women who completed their 6–8 weeks postpartum visit between January 2021 and March 2023 at the Lausanne University Hospital. Women filled questionnaires on the timing of food intake, sleep (a shortened Pittsburgh Sleep Quality Questionnaire), and the chronotype (the Morningness–Eveningness Questionnaire) and underwent HbA1c and fasting plasma glucose measurements. After adjustments for weight, sleep quality, or breastfeeding, the later timing of the first and last food intake were associated with higher fasting plasma glucose and HbA1c levels 6–8 weeks postpartum (all p ≤ 0.046). A higher number of breakfasts per week and longer eating durations were associated with lower fasting plasma glucose levels (all p ≤ 0.028). The chronotype was not associated with metabolic health outcomes. Eating patterns, but not the chronotype, were associated with worsened metabolic health in the early postpartum period in women with previous GDM.
... Additionally, both REM and NREM [136,155,174] sleep decrease throughout pregnancy. In the time immediately following childbirth, hormones typically return to normal levels within 2-5 months [175] and sleep typically returns to normal within 3-5 months [155,176]. Sleep studies in pregnant rodents are all but non-existent, with one study showing increased total sleep and increased NREM sleep during late pregnancy [177]. ...
Alzheimer’s disease (AD) affects more women than men, with women throughout the menopausal transition potentially being the most under researched and at-risk group. Sleep disruptions, which are an established risk factor for AD, increase in prevalence with normal aging and are exacerbated in women during menopause. Sex differences showing more disrupted sleep patterns and increased AD pathology in women and female animal models have been established in literature, with much emphasis placed on loss of circulating gonadal hormones with age. Interestingly, increases in gonadotropins such as follicle stimulating hormone are emerging to be a major contributor to AD pathogenesis and may also play a role in sleep disruption, perhaps in combination with other lesser studied hormones. Several sleep influencing regions of the brain appear to be affected early in AD progression and some may exhibit sexual dimorphisms that may contribute to increased sleep disruptions in women with age. Additionally, some of the most common sleep disorders, as well as multiple health conditions that impair sleep quality, are more prevalent and more severe in women. These conditions are often comorbid with AD and have bi-directional relationships that contribute synergistically to cognitive decline and neuropathology. The association during aging of increased sleep disruption and sleep disorders, dramatic hormonal changes during and after menopause, and increased AD pathology may be interacting and contributing factors that lead to the increased number of women living with AD.
... Pregnant women may also experience sleep disturbances due to physical, psychological or social changes. Sleep quality decreased significantly in women closer to 11 to 12 weeks of pregnancy, second only to postpartum mothers in the first three month [37]. Factors affecting sleep quality in the second and third trimesters may include mood swings caused by fluctuating hormone secretion, symptoms potentially manifested as stress, anxiety, and/or depression, and other physical discomfort caused by increased fetal size (e.g. ...
Introduction
The abundant functions of music and its effects on human’s mental and physical health have been verified since ancient times, but rarely received attention as an alternative obstetric intervention.
Objective
This study aims to investigate the benefits of music therapy on prenatal and delivery experiences of pregnant women.
Method
A systematic search for articles was conducted in electronic databases including CINAHL, Web of Science, PubMed/Medline, and CNKI. A total of 240 articles were identified, and 17 studies were selected for this review. The extracted data included author, year, location, sample size, intervention phase, type of music, music therapy strategy, measuring instruments, and results. The data were organized chronologically based on the publication year of each study.
Result
The articles indicated that music therapy has advantages in reducing pain during childbirth, lowering anxiety and stress levels in mothers, improving sleep quality, and increasing fetal movements, basal fetal heart rate, and accelerations.
Conclusion
Based on the findings, it can be concluded that music therapy is an effective approach to enhance the experience of pregnant women during pregnancy and delivery. Therefore, its implementation in obstetrical clinical practice is highly recommended.
... Additionally, both REM and NREM [136,155,174] sleep decrease throughout pregnancy. In the time immediately following childbirth, hormones typically return to normal levels within 2-5 months [175] and sleep typically returns to normal within 3-5 months [155,176]. Sleep studies in pregnant rodents are all but non-existent, with one study showing increased total sleep and increased NREM sleep during late pregnancy [177]. ...
Background
Fragmentation of the daily sleep‐wake rhythm is a risk factor for Alzheimer’s disease (AD) (Li et al, Lancet Healthy Longev 1:e96‐e105 [2020]). While women have a higher AD incidence than men, whether women are more sensitive to sleep fragmentation (SF) is not known. Studies in female 3xTg‐AD mice (8‐11 months old) show that chronic SF for four weeks alters the daily sleep‐wake rhythm and stimulates AD‐like neuropathology (Duncan et al, Neuroscience 481:111‐122 [2022]).
Method
To investigate possible sex differences in the effects of sleep fragmentation, we studied two AD mouse models and matching wild‐type controls, APPxPS1‐knock‐in mice (6.2‐11 months old; N = 127) and 5XFAD mice (2.3‐3.3 months old; N = 52). All mice were exposed to 3‐4 weeks of SF or undisturbed sleep while individually housed in cages interfaced for piezo electric sleep recording for monitoring of daily sleep‐wake rhythms. SF consisted of four daily sessions (1 hour each) of enforced wakefulness (induced with toys and paintbrush stimulation) that were evenly distributed during the light phase, for 5 days/week. Immediately after the last SF session, mice in both groups were euthanized and cortical and hippocampal tissue was dissected and frozen. Amyloid‐beta levels were determined in soluble fractions using ELISA.
Results
SF redistributed sleep from the light phase (loss) to the dark phase (gain) in APPxPS1‐ki (p<0.0001) and 5XFAD (p<0.05) mice and WT controls. Overall, females slept less than males (p<0.001) and were more affected by SF. Dark phase “rebound” sleep after SF was greater in APPxPS1‐ki females (∼70% of undisturbed controls) than in APPxPS1 males or WT mice of either sex (∼20% of undisturbed controls) (p<0.001). Cortical amyloid‐beta levels were higher in female than male AD mice, but surprisingly, neither cortical nor hippocampal amyloid‐beta levels were affected by SF in either strain.
Conclusion
These findings suggest an interaction between sex, AD mutations, and neuropathology on dark phase rebound sleep after chronic SF. To elucidate this interaction, on‐going studies are investigating the role of amyloid‐beta in sex‐differences in SF‐induced rebound sleep and potential sex differences in SF effects on gene expression in brain regions regulating sleep or circadian rhythms.
... For instance, sleep loss during the postpartum period is very common, with sleep disruption occurring more frequently in the immediate postnatal period, coinciding with the onset of PP [6]. In addition, sleep disturbance, specifically a decrease in total sleep time and sleep efficacy, is most evident during the first month after childbirth, with primiparous women more likely to be affected by these sleep changes [7]. In relation to the specific sleep patterns that occur in mothers with PP, prolonged sleep latency, less total sleep time, more night awakenings, suppression of stage 4 sleep and a reduction of rapid eye movement (REM) sleep during the later stages of pregnancy and the postpartum period have been reported [8]. ...
Sleep problems are extremely common during the postpartum period. The role of sleep in the development of postpartum psychosis (PP) is, however, still under-researched. This narrative review aims to (1) provide a summary of the existing evidence for the associations between sleep problems and PP, (2) discuss the relevant risk factors associated with sleep problems and PP, and (3) suggest future lines of research in this area. Some of the existing literature suggests an association between sleep problems, specifically insomnia, sleep loss and sleep disruption during pregnancy and postpartum, and PP, with the most relevant risk factors including history of bipolar disorder and time of delivery. However, it is still unclear whether the previously mentioned sleep problems are a symptom of, or a trigger for PP. Thus, further research is needed to identify the specific role of sleep problems in PP, using longitudinal designs and more objective measures of sleep. This will allow appropriate detection, intervention and support for women experiencing and/or at risk for PP.
... Además, las multíparas tienen más despertares por la noche y una menor eficiencia del sueño que las primíparas. (2,3,4,5) La prevalencia de los trastornos del sueño en las embarazadas varía en los distintos estudios. Algunos reportan cifras parecidas. ...
Los trastornos del sueño tienen una gran prevalencia en las embarazadas
y se han correlacionado con un mayor riesgo de resultados adversos del embarazo. Debido a los efectos secundarios del tratamiento farmacológico para los citados trastornos, se ha planteado que el ejercicio físico pudiera mejorar el sueño de las gestantes y, por ende, los resultados de embarazo.El objetivo de este artículo fue realizar una revisión de la literatura para analizar los efectos del ejercicio físico sobre la calidad y duración del sueño de la embarazada, así como en el insomnio de la gestante.
Abstract
Sleep disorders are highly prevalent in pregnant women and have been correlated with an increased risk of adverse pregnancy outcomes. Due to the secondary effects of the pharmacological treatment for the aforementioned disorders, it has been proposed that physical exercise could improve the sleep of pregnant women and, therefore, pregnancy outcomes. The objective of this article was to review the literature to analyze the effects of physical exercise on the quality and duration of sleep in pregnant women, as well as on insomnia in pregnant women.
... These include difficulty falling asleep, frequent night waking and restless sleep by the end of pregnancy (7). Pregnant women experience a decrease in restorative deep sleep as early as weeks 11 and 12 of gestation (8), and only 54% of pregnant women sleep for at least 8 hours uninterrupted in the last trimester (9). Many factors contribute to sleep disturbance during pregnancy (9)(10)(11). ...
Background
Both obesity and sleep disorders are common among women during pregnancy. Although prior research has identified a relationship between obesity and sleep disorders, those findings are from women later in pregnancy.
Objective
To explore the relationships between self‐reported sleep duration, insufficient sleep and snoring with body mass index (BMI) among multiethnic women at risk of gestational diabetes mellitus (GDM)in early pregnancy.
Methods
Cross‐sectional study of baseline data from women at risk of GDM enrolled in the Treatment of BOoking Gestational diabetes Mellitus (TOBOGM) multicentre trial across 12 Australian/Austrian sites. Participants completed a questionnaire before 20 weeks’ gestation to evaluate sleep. BMI <25 kg/m ² served as the reference group in multivariable logistic regression.
Results
Among the 2865 women included, the prevalence of overweight and obesity classes I‐III was 28%, 19%, 11% and 12%, respectively. There was no relationship between sleep duration and BMI. The risk of insufficient sleep >5 days/month was higher in class II and class III obesity (1.38 (1.03–1.85) and 1.34 (1.01–1.80), respectively), and the risk of snoring increased as BMI increased (1.59 (1.25–2.02), 2.68 (2.07–3.48), 4.35 (3.21–5.88) to 4.96 (3.65–6.74), respectively)).
Conclusions
Obesity is associated with insufficient sleep among pregnant women at risk of GDM. Snoring is more prevalent with increasing BMI.
... During the transition from pregnancy to 4 months postpartum, mothers in both groups showed a significant deterioration in sleep quality manifested in a significant decrease in actigraphic and diary sleep percent, and a significant increase in the number of actigraphic and diary night-waking. Generally, these findings are consistent with previous studies demonstrating a deterioration in maternal sleep quality from pregnancy to the postpartum (Driver & Shapiro, 1992;Hunter et al., 2009;Ko et al., 2012;Lee et al., 2000). Interestingly, this decrease in the quantified measures of sleep quality was not accompanied by an increase in insomnia or sleepiness symptoms, and mothers in both groups even showed a reduction in these symptoms from pregnancy to 4 months. ...
This longitudinal study examined the development of mother-infant objective and reported sleep quality and duration in solo-mother families (i.e., mothers who decided to parent alone) in comparison to two-parent families. We recruited 134 solo mothers and 161 married mothers during pregnancy, most representing the middle to upper socioeconomic class in Israel. Assessments were conducted during pregnancy and at 4 and 8 months postpartum. Maternal and infant sleep were assessed with actigraphy and sleep diaries for 7 nights. Questionnaires were used to assess maternal insomnia symptoms, sleepiness, sleeping arrangements, and background variables. The comparison of sleep between solo-mother and two-parent families, at each assessment point, showed no differences in sleep duration, and only a few differences in sleep quality measures; these were partially explained by maternal age and breastfeeding. Nevertheless, solo mothers were more likely to share a bed with their infants. In both groups, trajectory analyses showed a decrease in maternal actigraphic and diary sleep quality measures from pregnancy to 4 months, followed by an increase from 4 to 8 months. However, maternal insomnia symptoms first declined, and then increased, and maternal sleep duration first lengthened and then shortened. Infant actigraphic and diary sleep quality increased in both groups from 4 to 8 months, whereas sleep duration decreased only in the "solo" group. In general, the findings suggest that objective and subjective sleep quality and sleep duration of solo-mother families, a growing yet unexplored family structure, do not seem to be significantly affected by the absence of a second parent. (PsycInfo Database Record (c) 2023 APA, all rights reserved).
... However, another study reported that maternal prenatal sleep disorders exerted adverse effects on offspring's presentation of ADHD symptoms, namely both inattention and hyperactivityeimpulsivity, at the age of 4 years [15]. Because sleep duration patterns during and after pregnancy varied between nulliparous and multiparous women [36], the adverse effects of an extremely long decreasing sleep duration pattern during pregnancy on toddler development were especially evident among multiparous women. In addition, new mothers with an "extremely long decreasing" postpartum sleep duration pattern were more likely to have toddlers with suspected overall developmental delays. ...
Background:
Although studies have reported the effects of inadequate sleep on maternal health, few have examined the relationships of maternal sleep patterns with fetal health and early childhood development. This study investigated maternal sleep duration patterns from early pregnancy to 3-years postpartum and their effects on birth outcomes and child development.
Methods:
This study recruited pregnant women and their partners during prenatal visits at five selected hospitals in the Taipei area; follow-up lasted from July 2011 to April 2021. A total of 1178 parents completed self-reported assessments from early pregnancy until childbirth and 544 completed eight assessments up to 3-years postpartum. Generalized estimated equation models were used for analyses.
Results:
Group-based trajectory modeling was used to identify four trajectories of sleep duration patterns. Although maternal sleep duration was not associated with birth outcomes, maternal "short decreasing" and "stably short" sleep patterns were associated with a higher risk of suspected overall developmental delay and language developmental delay, respectively. Furthermore, an "extremely long decreasing" pattern was associated with a higher risk of suspected overall developmental delay, [adjusted odds ratio (aOR) = 2.97, 95% confidence interval (CI):1.39-6.36)], gross motor delay, (aOR = 3.14, 95% CI: 1.42-6.99) and language developmental delay (aOR = 4.59, 95% CI:1.62-13.00). The results were significant for the children of multiparous women.
Conclusions:
We identified a U-shaped distribution of risk between offspring developmental delay and maternal prenatal sleep duration, with the highest risk levels on both ends of the maternal prenatal sleep duration pattern. Interventions for maternal sleep are relatively straightforward to implement and should thus be a key part of standard prenatal care.
... The most cited (246 citations) research paper was "Snoring, pregnancy-induced hypertension, and growth retardation of the fetus," by Franklin et al. (2000), published in Chest Journal. The second most cited study (240 citations) was "Parity and sleep patterns during and after pregnancy" by Lee et al. (2000), published in Obstetrics and Gynecology. The third (227 citations) was "Maternal outcomes at 2 years after planned cesarean Figure 5 shows the co-occurrence network of author keywords that appeared more than three times. ...
Objective: This study uses a systematic review with bibliometric analysis methods to investigate the characteristics of the most cited research papers in the field of nursing fatigue and pregnancy.
Methods: In the Web of Science (WoS) database. We used the keywords “fatigue” and “pregnancy” to search for articles published from 2000 to 2020, limited to SSCI and Science Citation Index (SCI) journal-type articles. This study identifies the most cited studies in the WoS database based on PRISMA guidelines (Preferred reporting items for systematic reviews and meta-analyses). These studies form the research data, then visualized and analyzed using a retrospective bibliometric analysis and VOSviewer.
Results: The studies in the dataset were analyzed in 319 different journals in 51 countries between 2000 and 2020. The study was found that the United States (US) was the country with the highest yield. The most frequent keywords were postpartum, depression, sleep, and postpartum depression.
Conclusion: The research results further laid the foundation of bibliometrics for scholars and identified researchers, scientific journals, countries, and hot topics for fatigue-related pregnancy literature. Journals with high impact factors contain the most cited research and open new horizons for research in the nursing field of pregnancy-related fatigue, thus providing research inspiration for investigators in this field.
... Первобеременные женщины обычно имеют более выраженные нарушения сна, поскольку еще не имеют опыта планирования распорядка дня во время беременности. Они тратят больше сил на адаптацию к новому для них состоянию, особенно во II и III триместрах [9]. Относительно часто нарушения сна возникают, если вторая беременность следует вскоре за первой, и женщине нужно уделять много времени заботе о старшем ребенке. ...
Physiological changes during pregnancy often disrupt women's sleep. If these changes are combined with other factors (obesity, iron or magnesium deficiency, anxiety, etc.), the pregnant woman may develop sleep disorders: obstructive sleep apnoea syndrome, restless legs syndrome, leg cramps, and insomnia. These disorders increase the risk of pregnancy complications, reduce the quality of a woman's life, and form the basis for somatic and mental disorders in the postpartum period. Therefore, the obstetrician has to be familiar with the phenomenology, diagnosis, and treatment of sleep disorders in pregnant women to treat them promptly or to refer a woman to a neurologist or psychiatrist. This review briefly describes the common sleep disorders occurring in pregnant women, especially the various types of insomnia. The main groups of sedative agents are characterized, of which only doxylamine is acceptable for use in routine practice because of its proven efficacy and safety during pregnancy.
... Sleep disturbances are common during pregnancy due to body morphing, hormone shifting, and stress and depression symptoms [9][10][11][12]. The relationship between sleep and diabetes has also been a topic of interest in recent years. ...
Purpose
This study aimed to demonstrate the relationship between poor sleep quality in early pregnancy and the risk of developing gestational diabetes mellitus (GDM).
Methods
We conducted a nested case–control study and performed a 1:3 propensity score (PS) matching to match pregnant women with GDM to women without GDM. After PS matching, logistic regressions were carried out to describe the association between sleep quality (assessed by Pittsburgh Sleep Quality Index [PSQI]) and the risk of GDM. We also performed a second analysis to explore the association in groups divided according to maternal age.
Results
A total of 535 women were enrolled in this study. Of 456 women with complete data, the incidence of GDM was 12.1% (55/456). After PS matching, we found poor sleep quality (PSQI > 5) in early pregnancy was a statistically significant risk factor for GDM (OR 2.03; 95% CI 1.02–4.01; p-value = 0.043). The association of poor sleep quality (PSQI > 5) with GDM was significant among women less than 35 years old (OR 2.72; 95% CI 1.22–6.43; p-value = 0.018) but not among women more than or equal to 35 years old after adjusting for all covariates.
Conclusion
Poor sleep quality in early pregnancy is associated with higher risk of developing GDM, especially for women under 35 years old. Screening expectant mothers with sleep problems in the first trimester is suggested.
... Pregnancy symptoms such as nausea, heartburn, round ligament pain, and increased urinary frequency also contribute to disruptions in sleep during pregnancy 8 . Following delivery, the demands of newborn care significantly disrupt sleep, especially during the first month postpartum 21 . However, there is evidence that in addition to these anatomical and environmental factors, peripartum hormone fluctuations may influence sleep through direct actions on the brain. ...
Sleep disruptions are a common occurrence during the peripartum period. While physical and environmental factors associated with pregnancy and newborn care account for some sleep disruptions, there is evidence that peripartum fluctuations in estrogens may independently impact sleep. We therefore used a hormone-simulated pseudopregnancy in female Syrian hamsters to test the hypothesis that pregnancy-like increases in estradiol decrease sleep in the absence of other factors. Adult female Syrian hamsters were ovariectomized and given daily hormone injections that simulate estradiol levels during early pregnancy, late pregnancy, and the postpartum period. Home cage video recordings were captured at seven timepoints and videos were analyzed for actigraphy. During “late pregnancy,” total sleep time and sleep efficiency were decreased in hormone-treated animals during the white light period compared to vehicle controls. During both “early pregnancy” and “late pregnancy,” locomotion was increased in the white light period for hormone-treated animals; this change continued into the “postpartum period” for animals who continued to receive estradiol treatment, but not for animals who were withdrawn from estradiol. At the conclusion of the experiment, animals were euthanized and cFos expression was quantified in the ventral lateral preoptic area (VLPO) and lateral hypothalamus (LH). Animals who continued to receive high levels of estradiol during the “postpartum” period had significantly more cFos in the VLPO and LH than animals who were withdrawn from hormones or vehicle controls. Together, these data suggest that increased levels of estradiol during pregnancy are associated with sleep suppression which may be mediated by increased activation of hypothalamic nuclei.
... Previous animal studies have demonstrated yolk sac size variation related to environmental factors, e.g., noise, temperature, and nutrition 27,29,30 . Further, women's body composition, i.e., lower weight and height have been linked to larger yolk sac 31 , while human sleep with its large-scale physiologic variation has not been a focus of research 32,33 . ...
The concept of developmental origin of health and disease has ignited a search for mechanisms and health factors influencing normal intrauterine development. Sleep is a basic health factor with substantial individual variation, but its implication for early prenatal development remains unclear. During the embryonic period, the yolk sac is involved in embryonic nutrition, growth, hematopoiesis, and likely in fetal programming. Maternal body measures seem to influence its size in human female embryos. In this prospective, longitudinal observational study of 190 healthy women recruited before natural conception, we assessed the effect of prepregnant sleep duration (actigraphy) on the fetal crown-rump-length (CRL) and yolk sac size (ultrasound). All women gave birth to a live child. The prepregnancy daily sleep duration had an effect on the male yolk sac and CRL at the earliest measurement only (7 weeks). I.e., the yolk sac diameter decreased with increasing sleep duration (0.22 mm·h⁻¹d⁻¹, 95%CI [0.35–0.09], P < 0.01), and CRL increased (0.92 mm·h⁻¹d⁻¹, 95%CI [1.77–0.08], P = 0.03). Since there was no association at the second measurement (10 weeks), and in the group of female fetuses at any measure point, we suggest a sex- and time-dependent embryonic adaptation to sleep generated differences in the intrauterine environment in normal pregnancies.
Importance
Short sleep duration during pregnancy and the perimenopausal period has been associated with adverse cardiometabolic outcomes. However, it remains unclear how sleep duration changes after delivery and whether such changes are associated with the cardiometabolic health of birthing people.
Objective
To investigate whether persistently short sleep during pregnancy and after delivery is associated with incident hypertension and metabolic syndrome.
Design, Setting, and Participants
This secondary analysis of the Nulliparous Pregnancy Outcomes Study: Monitoring Mothers-to-Be Heart Health Study (NuMoM2b-HHS), an ongoing prospective cohort study, was conducted between September 5, 2023, and March 1, 2024, in 8 US academic medical centers. Participants were aged 18 years or older at NuMoM2b enrollment; recruited during their first pregnancy between October 1, 2010, and September 30, 2013; and followed up for a mean (SD) of 3.1 (0.9) years after delivery.
Exposures
Self-reported short sleep duration (<7 hours) during pregnancy and 2 to 7 years after delivery was defined as persistent short sleep.
Main Outcomes and Measures
Incident hypertension and metabolic syndrome (MetS) at follow-up. Regression models were used to estimate relative risks of incident hypertension and MetS by sleep duration pattern. Hypertension analyses excluded participants with hypertension at baseline, and MetS analyses excluded participants with MetS at baseline. Multivariable models included a priori covariates of baseline age and time from delivery to follow-up. Incident hypertension analyses included an additional covariate of body mass index at baseline.
Results
Among 3922 participants (mean [SD] age, 27.3 [5.4] years; 598 Hispanic [15.2%], 485 non-Hispanic Black [12.4%], and 2542 non-Hispanic White [64.8%]), 565 individuals (14.4%) experienced persistent short sleep. Non-Hispanic Black (adjusted odds ratio [aOR], 2.17; 95% CI, 1.59-2.97) and unmarried (aOR, 1.68, 95% CI, 1.29-2.19) participants were significantly more likely to experience persistent short sleep compared with non-Hispanic White and married participants, respectively. Persistent short sleep was associated with higher odds of incident MetS (aOR, 1.60; 95% CI, 1.21-2.11) but not incident hypertension (aOR, 0.91; 95% CI, 0.69-1.19).
Conclusions and Relevance
In this study, short sleep duration that persisted from pregnancy to 2 to 7 years after delivery was associated with a greater risk for adverse cardiometabolic outcomes. Future studies should explore whether sleep-targeted interventions during and after pregnancy are associated with improved cardiometabolic health outcomes, particularly among populations at increased risk.
Sleep differences between genders account for several biological factors impacted by a combination of environmental, social, and cultural influences. Anatomical, physiological, and psychological aspects affect sleep during pregnancy and often persist postpartum. For instance, sleep difficulties are often a common complaint in this vulnerable period of women’s life. While indirect aspects such as back pain, gastroesophageal reflux, increased micturition, and night-time difficulties on repositioning, are frequent complaints among pregnant, there is a significant increase in the prevalence of particular sleep disorders like obstructive sleep apnea and restless leg syndrome. The overlap between symptoms related to pregnancy itself and concomitant affective disorders can seriously affect the mother’s health, also impacting delivery-associated outcomes. As it is well known the putative role of inadequate or insufficient sleep in the cardiometabolic, neurohumoral, and psych-affective domains of mother health is associated with increased rates of illness and death in this population, recognition of this clinical relationship and adequate management of sleep health during pregnancy and postpartum should be a goal to be included as the standard of care. Therefore, in this chapter, the authors summarized the main interactions between sleep, complaints, sleep disorders, and health-related outcomes in pregnancy and postpartum with a focus on the new challenging strategies that may be implemented to guide a successful therapeutic approach.
Objectives
Approximately 75% of women weigh more at 1-year postpartum than pre-pregnancy. More than 47% retain >10 lbs at 1-year postpartum, which is associated with adverse health outcomes for mother and child. Disturbed sleep may contribute to risk of postpartum weight retention (PWR) as short sleep duration is associated with increased risk of obesity. Thus, we investigated whether night-time sleep duration is associated with risk for excessive PWR. We also explored night-time sleep duration and change in postpartum waist circumference.
Methods
This is an ancillary analysis from a prospective cohort study. Participants were healthy primiparous adults with a singleton birth. Excessive PWR at 1-year postpartum was defined as ≥7% of pre-pregnancy weight. Log-binomial and linear regression assessed associations between night-time sleep duration at 6 months postpartum and PWR at 1-year postpartum. Linear regression assessed association between night-time sleep duration and change in postpartum waist circumference.
Results
Mean age of participants (N=467) was 29.51 (SD±4.78) years. Night-time sleep duration by actigraphy or self-report was not associated with risk for excessive PWR (Risk Ratio 0.96, [95%CI 0.87-1.06]; Risk Ratio 0.95 [95%CI 0.83-1.07], respectively) or change in waist circumference.
Conclusion
Night-time sleep duration at 6 months postpartum was not associated with PWR at 1-year postpartum. Mixed findings among our results and previous research could be due to our focus on night-time sleep, and differences in sleep measurement methods and timeframes across studies. More comprehensively assessing sleep, including multiple sleep dimensions, may help advance our understanding of potential links between sleep and PWR.
This chapter discusses the impact of changes in sleep architecture and sleep disorders in pregnancy both on maternal health and health of the baby. Changes in sleep architecture occur as a result of physiological and hormonal reasons as well as a result of the physical discomfort from an enlarging uterus. These changes in sleep architecture have been determined using both subjective and objective measures such as sleep diaries, actigraphy, and polysomnography. Physiological changes during pregnancy and comorbid conditions can lead to sleep fragmentation, changes in timing and duration of sleep, as well as sleep disorders such as sleep disordered breathing (SDB), restless leg syndrome (RLS), and insomnia. Each of these disorders in turn has an adverse impact on maternal and fetal health. Gestational diabetes, hypertensive disorders of pregnancy as well as peripartum depression and postpartum weight retention are well known consequences of SDB, RLS, and insomnia. The pathophysiological mechanisms by which SDB leads to gestational diabetes and hypertension include common pathways of oxidative stress, sympathetic activation, and activation of inflammatory mediators. Fetal consequences include intrauterine growth retardation, preterm births, and low gestational weight. Pregnancy complicates the management of pre-existing sleep disorders such as narcolepsy due to concerns for teratogenicity of drugs used for the treatment. Similarly, treatment of sleep disorders such as RLS and insomnia complicating pregnancy requires special consideration as well. Management of these conditions includes nonpharmacological and carefully considered pharmacological measures so as to ameliorate the effect of these sleep disorders on both the mother and the baby.
Alzheimer’s disease (AD) affects more women than men, with women throughout the menopausal transition potentially being the most under researched and at-risk group. Sleep disruptions, which are an established risk factor for AD, increase in prevalence with normal aging and are exacerbated in women during menopause. Sex differences showing more disrupted sleep patterns and increased AD pathology in women and female animal models have been established in literature, with much emphasis placed on loss of circulating gonadal hormones with age. Interestingly, increases in gonadotropins such as follicle stimulating hormone are emerging to be a major contributor to AD pathogenesis and may also play a role in sleep disruption, perhaps in combination with other lesser studied hormones. Several sleep influencing regions of the brain appear to be affected early in AD progression and some may exhibit sexual dimorphisms that may contribute to increased sleep disruptions in women with age. Additionally, some of the most common sleep disorders, as well as multiple health conditions that impair sleep quality, are more prevalent and more severe in women. These conditions are often comorbid with AD and have bi-directional relationships that contribute synergistically to cognitive decline and neuropathology. The association during aging of increased sleep disruption and sleep disorders, dramatic hormonal changes during and after menopause, and increased AD pathology may be interacting and contributing factors that lead to the increased number of women living with AD.
The perinatal period is a time of vulnerability for psychological distress with increased risk of depressive and anxiety symptoms. However, the most common subjective complaint, particularly during the post-partum period, is that of fatigue. While some fatigue may be normative for all new parents, a minority of women experience sustained fatigue, which interferes with their ability to function, yet this is currently not well addressed within health systems. This chapter provides a brief overview of psychological changes during and after pregnancy and a more detailed focus on post-partum fatigue as it is the most prevalent psychological change during and after pregnancy. We review the development of models of post-partum fatigue over the last decades and document their more recent developments. We also review the scales currently validated to measure post-partum fatigue and the evidence base for available treatment options. We also propose recommendations for improving the understanding and treatment of fatigue during and after pregnancy in the future.
Background:
Sleep disturbances are associated with adverse perinatal outcomes. Thus, it is necessary to understand the continuous patterns of sleep during pregnancy and how moderators such as maternal age and pre-pregnancy body mass index impact sleep.
Objective:
This study aimed to examine the continuous changes in sleep parameters objectively (i.e. sleep stages, total sleep time, and awake time) in pregnant women and to describe the impact of maternal age and/or pre-pregnancy body mass index as moderators of these objective sleep parameters.
Design:
This was a longitudinal observational design.
Methods:
Seventeen women with a singleton pregnancy participated in this study. Mixed model repeated measures were used to describe weekly patterns, while aggregated changes describe these three pregnancy periods (10-19, 20-29, and 30-39 gestational weeks).
Results:
For the weekly patterns, we found significantly decreased deep (1.26 ± 0.18 min/week, p < 0.001), light (0.72 ± 0.37 min/week, p = 0.05), and total sleep time (1.56 ± 0.47 min/week, p < 0.001) as well as increased awake time (1.32 ± 0.34 min/week, p < 0.001). For the aggregated changes, we found similar patterns to weekly changes. Women (⩾30 years) had an even greater decrease in deep sleep (1.50 ± 0.22 min/week, p < 0.001) than those younger (0.84 ± 0.29 min/week, p = 0.04). Women who were both overweight/obese and ⩾30 years experienced an increase in rapid eye movement sleep (0.84 ± 0.31 min/week, p = 0.008), but those of normal weight (<30 years) did not.
Conclusion:
This study appears to be the first to describe continuous changes in sleep parameters during pregnancy at home. Our study provides preliminary evidence that sleep parameters could be potential non-invasive physiological markers predicting perinatal outcomes.
Background:
Although poor sleep health is associated with weight gain and obesity in the non-pregnant population, research on the impact of sleep health on weight change among pregnant people using a multidimensional sleep health framework is needed.
Objectives:
This secondary data analysis of the Nulliparous Pregnancy Outcome Study: Monitoring Mothers-to-be Sleep Duration and Continuity Study (n = 745) examined associations between mid-pregnancy sleep health indicators, multidimensional sleep health and gestational weight gain (GWG).
Methods:
Sleep domains (i.e. regularity, nap duration, timing, efficiency and duration) were assessed via actigraphy between 16 and 21 weeks of gestation. We defined 'healthy' sleep in each domain with empirical thresholds. Multidimensional sleep health was based on sleep profiles derived from latent class analysis and composite score defined as the sum of healthy sleep domains. Total GWG, the difference between self-reported pre-pregnancy weight and the last measured weight before delivery, was converted to z-scores using gestational age- and BMI-specific charts. GWG was defined as low (<-1 SD), moderate (-1 or +1 SD) and high (>+1 SD).
Results:
Nearly 50% of the participants had a healthy sleep profile (i.e. healthy sleep in most domains), whereas others had a sleep profile defined as having varying degrees of unhealthy sleep in each domain. The individual sleep domains were associated with a 20%-30% lower risk of low or high GWG. Each additional healthy sleep indicator was associated with a 10% lower risk of low (vs. moderate), but not high, GWG. Participants with late timing, long duration and low efficiency (vs. healthy) profiles had the strongest risk of low GWG (relative risk 1.5, 95% confidence interval 0.9, 2.4). Probabilistic bias analysis suggested that most associations between individual sleep health indicators, sleep health profiles and GWG were biased towards the null.
Conclusions:
Future research should determine whether sleep health is an intervention target for healthy GWG.
Across the perinatal transition, existing research focuses mainly on significant changes in sleep duration and quality, neglecting sleep timing. This study investigated change trajectories of sleep timing and chronotype from late pregnancy to 2 years postpartum and examined longitudinal associations of chronotype with symptoms of insomnia, daytime sleep-related impairment, and mood. Data were from a two-arm randomised controlled trial testing parent-focused wellbeing interventions. Participants were a community sample of nullipara without severe sleep/mental health conditions. Participants self-reported bedtime, rise-time, chronotype, insomnia symptoms, sleep-related impairment, depression, and anxiety at seven time points: gestation Weeks 30 and 35, and postpartum Months 1.5, 3, 6, 12 and 24. Trajectories were estimated using mixed-effects models with continuous time, quadratic splines, and a knot at childbirth, controlling for age and group allocation. A total of 163 participants (mean [SD] age 33.35 [3.42] years) took part. Bedtime and rise-times delayed during late pregnancy (~8 and ~20 min, respectively) but became progressively earlier (~20 and ~60 min, respectively) over the 2 postpartum years. Chronotype became more eveningness in late pregnancy, and more morningness after childbirth, however changes were small. Controlling for sleep duration and efficiency, greater morningness was associated with significantly less symptoms of insomnia and sleep-related impairment over time (all p < 0.001); longitudinal associations between chronotype and symptoms of depression and anxiety were non-significant (all p > 0.65). Sleep-wake timing and chronotype became progressively earlier from pregnancy to 2 years postpartum. Morningness chronotype may be sleep-protective during the transition from pregnancy to parenthood. Mechanisms underlying these associations require further research.
Objective:
Previous research has indicated that sleep disordered breathing (SDB) can lead to a decreased quality of life in children and their families as compared to children who do not have SDB. The purpose of this study was to examine fatigue levels in parents who had young children who were impacted by sleep symptoms as determined by the OSA-18 scale.
Study design:
Survey.
Setting:
Three pediatric otolaryngology clinics associated with a tertiary care children's hospital in Buffalo, NY.
Methods:
Fatigue levels for parents of children with OSA-18 ≥ 60 were assessed using the Fatigue Severity Scale and the Chalder Fatigue Scale. Consecutive parents with at least one child between the ages of 1 and 10 were recruited. Parents scored their youngest child on the OSA-18 scale.
Results:
Of the 261 respondents included, 37 parents had a child with an OSA-18 score ≥60. The majority, 211 (82.1%), of participants reported 2 caregivers in the household while 30 (11.7%) had 1 caregiver in the household. Parents of children with OSA-18 ≥60 had a significantly higher mean fatigue score, 16.5 ± 5.8, compared to their counterparts, 11.9 ± 5.2, on the Chalder Fatigue Scale (P < .001). Similar results were reported for the total score on the Fatigue Severity Scale, 34.7 ± 10.8 compared to 28.9 ± 12.0 (P = .004).
Conclusion:
Parents of children with OSA-18 score ≥60 are significantly more fatigued than parents of children with lower scores. Recognition of this is important for the health care community as it impacts not just the child with OSA but also their family.
Background
Sleep is a very crucial physiological process for human beings. During pregnancy and the postpartum period, sleep becomes very vital and it needs additional total sleep time for a better pregnancy outcome. However, poor sleep quality remains a major public health concern, particularly for perinatal women. Therefore, the pooled prevalence and risk factors from the study will provide a more conclusive result to take evidence-based measures against poor sleep in perinatal women.
Methods
Ten published studies with a total of 4,297 participants were included. All appropriate databases and grey literature were searched to get relevant articles. Studies reporting the prevalence and associated risk factors of poor sleep quality among perinatal women were included. The quality of each study was assessed using the Newcastle-Ottawa quality assessment Scale (NOS). Data were extracted using Microsoft Excel 2010 and the analysis was done using STATA version 11 software. The pooled prevalence and its associated factors were determined using the random effect model. Heterogeneity between studies was evaluated using the I² test. In addition, Publication bias was checked in subjective technique by funnel plot and using Egger’s statistical test.
Results
The pooled prevalence of poor sleep quality was 44.81% (95% CI = 32.29, 57.34; I² = 99.1%). Depression ((POR) = 3.87: 95% CI: 1.09, 12.40; I² = 0.0%) and third-trimester ((POR) = 4.09: 95% CI: 1.05, 15.39; I² = 0.0%) were risk factors of poor sleep quality.
Conclusion
More than two-thirds of perinatal women were exposed to poor quality of sleep. This indicates poor quality of sleep is a high health burden in women during the perinatal period in Ethiopia. The Government should incorporate maternal mental health policy along with prenatal and postnatal health care services.
Zolpidem is a non-benzodiazepine agent indicated for treatment of insomnia. While zolpidem crosses the placenta, little is known about its safety in pregnancy. We assessed associations between self-reported zolpidem use 1 month before pregnancy through to the end of the third month ("early pregnancy") and specific birth defects using data from two multi-site case-control studies: National Birth Defects Prevention Study and Slone Epidemiology Center Birth Defects Study. Analysis included 39,711 birth defect cases and 23,035 controls without a birth defect. For defects with ≥ 5 exposed cases, we used logistic regression with Firth's penalised likelihood to estimate adjusted odds ratios and 95% confidence intervals, considering age at delivery, race/ethnicity, education, body mass index, parity, early-pregnancy antipsychotic, anxiolytic, antidepressant use, early-pregnancy opioid use, early-pregnancy smoking, and study as potential covariates. For defects with three-four exposed cases, we estimated crude odds ratios and 95% confidence intervals. Additionally, we explored differences in odds ratios using propensity score-adjustment and conducted a probabilistic bias analysis of exposure misclassification. Overall, 84 (0.2%) cases and 46 (0.2%) controls reported early-pregnancy zolpidem use. Seven defects had sufficient sample size to calculate adjusted odds ratios, which ranged from 0.76 for cleft lip to 2.18 for gastroschisis. Four defects had odds ratios > 1.8. All confidence intervals included the null. Zolpidem use was rare. We could not calculate adjusted odds ratios for most defects and estimates are imprecise. Results do not support a large increase in risk, but smaller increases in risk for certain defects cannot be ruled out.
Post-partum depression (PPD) with varying clinical manifestations affecting new parents remains underdiagnosed and poorly treated. This minireview revisits the pharmacotherapy, and relevant etiological basis, capable of advancing preclinical research frameworks. Maternal tasks accompanied by numerous behavioral readouts demand modeling different paradigms that reflect the complex and heterogenous nature of PPD. Hence, effective PPD-like characterization in animals towards the discovery of pharmacological intervention demands research that deepens our understanding of the roles of hormonal and non-hormonal components and mediators of this psychiatric disorder.
Hand surgeons and trainees face many challenges in pursuit of their professional and familial goals. The culture of the training programs must change to aknowledge and address the needs of women as they naviagate career and their childbearing years. Challenges to maternity and family planning dissuade and perhaps prohibit female trainees from choosing surgical specialties and of those who do, from reaching their full professional potential. In the following chapter we will review current data on infertility, obstetrical complications, breastfeeding, maternity leave, career advancement and childcare in an effort to increase support for female trainees and practicing female hand surgeons.
This review provides a summary for Obstetricians, Midwives, other Health professionals and women contemplating pregnancy about the interactions between pregnancy and breathing during sleep. This review will first examine the normal physiological changes of pregnancy and their relationship to sleep-disordered breathing and will then summarise the current knowledge of sleep disordered breathing in pregnancy.
Many changes in the respiratory system during pregnancy, particularly during the third trimester, can alter respiratory function during sleep, increasing the incidence and severity of sleep-disordered breathing. These changes include increased ventilatory drive and metabolic rate, reduced functional residual capacity and residual volume, increased alveolar-arterial oxygen gradients and changes in the upper airway.
The clinical importance of these changes during pregnancy is demonstrated by the increased incidence of snoring and obstructive sleep apnoea hypopnoea syndrome. As sleep disordered breathing is associated with obesity, the increasing incidence of obesity pre-pregnancy will likely increase sleep disordered breathing during pregnancy over the next decade.
For the physician asked to review a pregnant patient, the possibility of sleep-disordered breathing should always be considered.
Pregnant women and their partners often ask healthcare professionals whether sex is safe during pregnancy, and what consequences may result from sexual activity. Many clinicians can also be unsure of the answers to these type of questions, leading to both patient and clinician resorting to the internet for advice, which can be inaccurate and anxiety-inducing. Here, the authors provide clinicians with an insight into the information offered by 'Dr Google' so that they can reassure and advise their patients as necessary. Aimed at obstetricians and other physicians caring for pregnant women, this book reviews the implications of sex during pregnancy such as those complicated by medical conditions, those at risk of preterm birth and multiple pregnancies. Other chapters cover physiological changes during pregnancy that may affect sexual function and intimacy, as well as the differing guidelines provided by various global obstetric societies.
Healthy and restoring sleep is a precondition for well-being, resilience, and mental health. In pregnancy, there are physiological sleep alterations, and with ongoing pregnancy, sleep disturbances become more frequent. The most common sleep disorder is insomnia, which occurs in more than 50%, but other more specific sleep disorders like the restless legs syndrome or sleep apnea are also more common than in non-pregnant fertile women. Moreover, insomnia may be related to anxiety and mood disorders, such as perinatal depression. Further, poor sleep and maternal distress are also expositions to the environment of the fetus and may affect its development. Though sleep disorders could also be addressed by non-pharmacologic strategies very successfully, in acute insomnia there is often a demand for a medication. As evidence on risks and safety of pharmacotherapy in pregnancy and nursing, especially in regard to fetal exposition and child development, is scarce, patients and physicians are usually reluctant. This chapter gives a review on the experience with well-known hypnotics and stimulants in pregnancy and nursing. The presentation of the still rather limited safety experience is meant to support the individual balancing of pros and cons for use of sleep-promoting drugs in pregnancy and nursing.
Physical activity is associated with health benefits during pregnancy, delivery, and the postpartum period. The last three decades produced an increasing amount of scientific evidence on the positive effects of the prenatal physical activity on the maternal and fetal health, as well as in pregnancy outcomes. However, authors from different countries observe insufficient level of physical activity in pregnant women. The lack of information among women on the exercises during pregnancy, and lack of social support are two of the reasons hindering engagement in a prenatal exercise program. According to other studies, the knowledge of health benefits can lead to more favorable attitudes toward exercise during pregnancy, among women, exercise professionals, and healthcare providers. The purpose of this chapter is to review the information provided in the current guidelines for exercise during pregnancy in different countries, regarding the contents related to prenatal exercise programs. We analyzed the changes in recommendations over the past 4 years. Nowadays, experts emphasize the need to limit sedentary behaviors in pregnant women and to individualize exercise, departing from the total limitation of physical activity and bed rest even in complicated pregnancies. There is a more open approach to the continuation of vigorous sports activities during pregnancy by previously physically active women or female athletes.KeywordsGuidelinesExercisePhysical activityPregnancyPostpartum
Physical exercise should be part of an active lifestyle during pregnancy and the puerperium, as shown by growing evidence on its benefits for the health of pregnant women and newborns. Appropriate exercise testing and exercise prescription are needed to tailor effective and safe exercise programs. Exercise testing and prescription in pregnancy is the plan of exercise and fitness-related activities designed to meet the health and fitness goals and motivations of the pregnant woman. It should address the health-related fitness components and the pregnancy-specific conditions, based on previous health and exercise assessments, and take into account the body adaptations and the pregnancy-related symptoms of each stage of pregnancy, in order to provide safe and effective exercise. This chapter reviews the guidelines for exercise testing and prescription of pregnant women to be developed by exercise professionals, following the health screening and medical clearance for exercise by healthcare providers.KeywordsPregnancyPhysical activityExerciseHealth screeningPre-exercise evaluationExercise testingExercise prescriptionSafety
The purpose of this chapter is to identify nutritional requirements for special groups of pregnant exercisers and pregnant athletes such as (1) athletes practicing aesthetic sports, weight competing for sports, and sports of long duration; (2) pregnant exerciser women who restrict or prohibit certain dietary practices or the consumption of important sources of energy and nutrients; (3) adolescent pregnant exercisers; and (4) other pregnant exerciser women in high-risk categories. In addition, risk factors such as low energy availability and eating disorders related to their energy and nutritional requirements are also included. Micronutrients’ needs increase much more than macronutrients. Even prior to conception, an increased average intake of folate, iodine, and iron is recommended. However, only at the beginning of the second trimester, a marked increase in vitamins and minerals is observed. A pregnant exerciser or athlete who continues to train during pregnancy may have a total energy expenditure quite high, which depends on the type, intensity, frequency, and duration of the activities performed. Therefore, dietary intakes before, during, and after physical exercise are crucial for the maintenance of adequate energy availability. In addition, some unhealthy behaviors such as the consumption of alcohol, smoking, and other stimulant substances, and the lack of sleep should be avoided.KeywordsPregnancyNutritionDietary intakesEnergyMacronutrientsMicronutrientsExercisersAthletesEating disordersSleep
There are several guidelines supporting the benefits of exercising during pregnancy and postpartum. Scientific research conducted in the last decades has markedly changed the perception of prenatal physical activity, overlapping the conservative approach presented in the first publications. However, those guidelines contain very general recommendations on physical activity during the postpartum period and little information that exercise professionals could use when programming the contents of targeted exercise classes for early postpartum women. Regarding the physical adaptations that persist for several weeks after birth, the early postpartum period can be assumed as the “fourth trimester.” This chapter addresses the steps for planning, conducting, and monitoring early postpartum exercise classes, aiming to help women to resume exercise and sports practice in a transition stage to “normal” life.KeywordsPostpartumExercisePhysical activityFitnessExercise planning
Background: Sleep disturbances and mood symptoms are common in late pregnancy and according to previous literature, they can affect delivery and newborn outcomes. This study evaluated the effect of sleep and mood symptoms on delivery and newborn health as there is insufficient and partly contradictory studies on the topic.
Methods: A cohort of 1414 mothers was enrolled in the third trimester to this prospective cross-sectional questionnaire study. Validated questionnaires were assessed for measurement of sleep disturbances, depressive and anxiety symptoms. The data on delivery and newborn outcomes was obtained from hospital medical records.
Results. Sleep disturbances were very common during pregnancy. 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, 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 instead, longer sleep duration and longer sleep need with 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 with gestational weeks. Concerning Apgar scores and the umbilical artery pH, no associations were found. Snoring was associated with a shorter duration of the 1st phase (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 delivered more often with elective caesarean 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.
Twelve women in their third trimester of pregnancy and 10 age-matched nonpregnant controls underwent complete polysomnography for one night in the laboratory. Seven of the original women returned for a second study 3-5 months postpartum. During late pregnancy, women showed increased wake after sleep onset (WASO) and a lower sleep efficiency in comparison with the control group. The percentage of rapid eye movement (REM) sleep was significantly decreased and the percentage of stage 1 significantly increased compared to the nonpregnant group. At 3-5 months postpartum, a significant reduction in WASO and increased sleep efficiency were noted. However, only a slight increase was noted in REM sleep during the postpartum period compared to the prepartum period. The most frequent sleep complaints in the pregnant group were restless sleep, low back pain, leg cramps and frightening dreams. In summary, in accordance with their complaints, women in their third trimester demonstrated polysomnographic patterns of sleep maintenance insomnia.
A subjective survey of sleep was carried out on 100 women who were 38 or more weeks pregnant. Sixty-eight reported some change in their sleep, in some cases throughout the pregnancy, but in most cases the change had occurred only in the third trimester. The changes were sufficient for 12 patients to take sleeping tablets at some stage. The reasons given for altered sleep may be considered as falling into the following groups: physiologic, psychological, background (hormonal?) factors, medical symptoms, and environmental factors.
The present investigation provides an accurate description of the EEG sleep pattern characteristics of late pregnancy and early postpartum periods and compares this with age-matched controls. The over-all sleep pattern observed in gestation seemed similar in some respects to insomnia and was characterized by a longer sleep latency, frequent awakenings, shorter sleep time, and a marked reduction of deep sleep (Stage 4). In addition, immediately after delivery, there was a suppression of the dreaming (Stage 1-REM) sleep. By the second postpartum week, these profound sleep changes tended to normalize. Mechanisms of these findings and their possible relationship to postpartum emotional disturbances are discussed.
This book is not meant to be a comprehensive text on sleep, but a selective and personal account giving several hypotheses about a variety of aspects of sleep. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
The Kansas Marital Satisfaction (KMS) Scale is found to correlate substantially with both Spanier's (1976) Dyadic Adjustment Scale (DAS) and Norton's (1983) Quality Marriage Index (QMI), but not to correlate significantly more than those two scales with a variety of other satisfaction items designed to assess the discriminant validity of the KMS scale. Other characteristics of the KMS scale are similar to those reported in previous research and compare favorably with those of the DAS and the QMI, even though the latter scales contain more items than the KMS scale. It is concluded that the KMS scale may serve as a useful brief measure of marital satisfaction in future research with married couples.
This study examined the effects of restricting sleep to the first or second half of the night on the composition of sleep and on performance. Eight young women who regularly slept for 8–8.5 hrs a night had their sleep restricted to the first or second half of the night for two consecutive nights. Performance of a 20-min unprepared simple reaction time task was measured at fixed times of day for the two restricted sleep conditions and for a full night sleep control condition. Restricting sleep to the second half of the night produced higher amounts of REM sleep and Stage 4 sleep and lower amounts of Stage 2 sleep compared to restricting sleep to the first half of the night. Both restricted sleep conditions impaired performance relative to the full night sleep control, and performance was worse after two nights of restricted sleep than after one night of restricted sleep. The results show that the effects of a restricted sleep regime on the composition of sleep are partly a function of the time of night to which sleep is restricted. It is suggested that the performance deficits are due to loss of sleep per se rather than due to any change in the composition of sleep.
Pregnancy, childbirth, and early motherhood physiologically and psychologically affect a woman's sleep. Hormonal alterations during early pregnancy, enlargement of the fetus during late pregnancy, and a newborn with random sleep-wake patterns all contribute to disrupted sleep. Since the initial study of sleep and pregnancy in 1968, fewer than 20 articles have been published which address alterations in sleep architecture related specifically to childbearing women. Furthermore, many of these studies suffer from small sample sizes and lack statistical power for consistent interpretation and replication of findings. While almost all of these studies included both nulliparas and multiparas in their samples, rarely have effects of parity been reported. The majority of older studies were cross-sectional designs, with comparisons to age-matched healthy controls. More recent studies have been longitudinal designs to describe changes in sleep during the course of pregnancy. However, women's baseline, prepregnancy sleep patterns or sleep histories have not been considered. With very few published reports of sleep changes related to mental health outcomes, we are no closer to understanding the implications of altered sleep patterns on postpartum depression or other women's health outcomes than we were when it was originally questioned 30 years ago.
Thesis (M.S.)--University of California, San Francisco, 1996. Includes bibliographical references (leaves 9-11).
The objective of this study was to identify and quantify fetal and maternal heart rate (FHR, MHR) periodicities and to examine their interrelation as well as the relation of fetal cycles with the maternal REM-NREM sleep cycle. Heart rate periodicities of the same subjects after birth were correlated with the neonatal REM-NREM sleep cycle. Sixteen all-night polygraphic recordings were obtained during the last trimester of pregnancy and the 1st week of life in seven subjects. Abdominal leads were used to obtain continuous fetal heart rates. Maternal and infant sleep states were scored according to standard criteria. Minute-by-minute values for maternal, fetal, and neonatal heart rates were analyzed on a PDP-12 computer and subjected to time series analyses including auto spectral techniques and complex demodulation. Period lengths of less than 1 h, between 1 and 2 h, and even longer were present in the tracings of mother, fetus, and neonate. Predictable interaction between maternal and fetal heart rate periodicities could not be established. None of the fetal rhythms bore a consistent relationship with the maternal REM-NREM sleep cycles. Maternal sleep onset or the first sleep cycle was accompanied by an increase in fetal heart rate lasting between 10 and 20 min in six of the nine recordings. Fetal heart rate cycles between 1 and 2 hr are probably early manifestations of the neonatal REM-NREM sleep cycle. The transient rise in fetal heart rate could be an adaptive response to either the fall in blood pressure or the shift in acid-base balance upon maternal sleep onset to which the fetus habituates within a short time.
We conducted a longitudinal polysomnographic study in five healthy primiparous subjects, whose sleep was first recorded between 8 and 16 weeks of gestation, then every 2 months until parturition and at 1 month postpartum. The first 6 hours of sleep were used for statistical analysis. In contrast to previous studies, we found no reduction in stage 4 sleep with pregnancy. Slow-wave sleep (comprising stages 3 and 4), was significantly higher at 27-39 weeks of gestation than at 8-16 weeks, as predicted by the restorative theory of sleep. There was no significant difference in rapid eye movement (REM) sleep time. When compared to a group of normal ovulating women, however, REM sleep time decreased during the last two months of pregnancy and, although there was no change in sleep onset latency, the time spent awake during the first six hours of sleep was increased. Future research into the effects of cortisol and progesterone is indicated.
Self-reported sleep disturbances and levels of vitality and fatigue were studied in a secondary analysis of 25 pregnant and 29 postpartum employed women. Results indicate that pregnant women have problems initiating and maintaining sleep, and postpartum women have problems maintaining sleep, but not falling asleep. The primary reason for midsleep awakenings was urinary frequency among the pregnant women, and child care responsibilities among the postpartum women. Chronic sleep disturbance was indicated by a greater percentage of postpartum women who fell asleep easily, very few who felt highly energetic at work, and most who perceived a high level of fatigue during the past week. Even with these sleep disruptions, no differences occurred in the mean scores for perception of fatigue and vitality between the two groups. Clinicians can use these findings to educate women about some changes they may anticipate and how they might manage them during pregnancy and postpartum.
To explore the incidence and types of sleep disturbances in employed women, 760 registered nurses completed a health survey that included questions about their sleep patterns and sleep quality. Comparisons are made between those nurses working permanent day, permanent evening, permanent night, and rotating shifts. As expected, there were higher incidences of sleep disturbances and excessive sleepiness for women working night and rotating shifts, but age and family factors, rather than caffeine and alcohol intake, contributed to the differences in types of sleep disturbances these women experienced.
A descriptive, correlational study was undertaken to identify nursing diagnoses selected by mothers during the first 72 hours after birth. The convenience sample of 231 women completed questionnaires listing 34 diagnoses. On average, each mother selected nine diagnoses of concern to her since the birth. Alteration in comfort, potential for growth, alteration in body fluids, impaired mobility, and sleep pattern disturbance were the most frequently selected diagnoses. Only 34.5% of the mothers identified knowledge deficit as a concern. Parity, type of delivery, and length of postpartum time influenced the diagnoses selected. The data suggest modifications in the focus of hospital-based, postpartum nursing care.
All-night EEG and EOG recordings were obtained from thirteen female subjects. Ten were studied during later pregnancy and the postpartum period. Three were studied during the entire pregnancy as well as postpartum. Data obtained within the first week after the menses was re-established served as a control baseline. In addition, data were obtained from thirteen age-matched non-pregnant subjects for comparison with the controls.
Among all pregnant subjects the amount of sleep latency, the number of awakenings, and the amount of stage 0 were greater in the prepartum and postpartum periods than in the control period or in the non-pregnant subjects.
Stage 1-REM was lower in the prepartum and postpartum periods than in the non-pregnant subjects. The amount of stage 4 was lower in the prepartum periods than in all the other periods. It increased during the postpartum period, and was even greater in the control period than in the non-pregnant group.
Among the three subjects studied from early pregnancy there was more total sleep time and more naps in early pregnancy than in the other periods. In the third trimester, sleep time decreased below control and non-pregnant levels.
These findings are discussed.
A subjective survey of sleep was carried out on 100 women who were 38 or more weeks pregnant. Sixty-eight reported some change in their sleep, in some cases throughout the pregnancy, but in most cases the change had occurred only in the third trimester. The changes were sufficient for 12 patients to take sleeping tablets at some stage. The reasons given for altered sleep may be considered as falling into the following groups: physiologic, psychological, background (hormonal?) factors, medical symptoms, and environmental factors.
Eight young male subjects were permitted to sleep only 3 hours out of each 24 for 8 days. Electroencephalographic recordings were made during the 3-hour period of sleep. There was an increase in the amount of deep sleep (stage 4) during this period. On a recovery night, the first 6 hours revealed a significant increase in deep sleep, and beyond this period there was a sharp increase in stage 1-rapid eye movement sleep.
The impairment of sleep quality is a common complaint during pregnancy. To investigate the changes in sleep in the course of pregnancy, the sleep electroencephalogram (EEG) was recorded and analyzed in nine healthy women on 2 consecutive nights during each trimester of pregnancy. Waking after sleep onset increased from the second (TR2) to the third (TR3) trimester, whereas rapid eye movement (REM) sleep decreased from the first trimester (TR1) to TR2. Spectral analysis of the EEG in nonrapid eye movement (NREM) sleep revealed a progressive reduction of power density in the course of pregnancy. In comparison to TR1, the values in TR2 were significantly lower in the 10.25-11.0-Hz and 14.25-17.0-Hz bands. In TR3, the significant reduction extended over the ranges of 1.25-12.0 Hz and 13.25-16.0 Hz. The largest decrease (30%) occurred in the 14.25-15.0-Hz band. In REM sleep, the spindle frequency range was not affected, and a minor reduction of power density in some frequency bins below 12 Hz was present only in TR3. The study documents major alterations of the sleep EEG that are not evident from the sleep scores and that may be associated with the characteristic hormonal changes occurring during pregnancy.
Electroencephalographic (EEG) sleep was examined longitudinally in 34 obstetrically healthy volunteers recruited early in pregnancy. All women were free of current psychiatric disorder. Fourteen women had a personal history of affective disorder, and 20 had no history of any psychiatric disorder. EEG sleep was recorded in subjects' homes at specified points from 12 weeks' gestation through 8 months' postpartum to examine the impact of childbearing on sleep and psychiatric symptoms in women with a history of affective disorder. EEG sleep measurements, as well as clinical ratings of sleep, indicated that sleep disturbances were most pronounced over the first 2 to 3 months' postpartum and were characterized primarily by interrupted sleep. The obstetrical course of these women was uneventful, and the outcome with respect to affective disturbances was highly favorable. Nevertheless, childbearing was associated with greater changes in total sleep time and with rapid eye movement (REM) latency reduction in women with a history of affective disorder, even in the absence of clinically significant mood changes. Findings suggest that the sleep system of women with a history of affective disorder may be more sensitive to the psychobiological changes associated with childbearing, as evidenced by earlier onset of sleep disruption over the childbearing course and a reduction in REM latency in the final trimester that persisted throughout the eighth postpartum month.
Psychiatric symptoms and morbidity were examined prospectively in 34 obstetrically healthy volunteers recruited early in pregnancy. All women were free of current psychiatric disorder. Fourteen women had a history of affective disorder, and 20 had no lifetime history of any psychiatric disorder. Symptoms were assessed using both clinician- and self-administered ratings at specified points from 12 weeks of gestation through 8 months' postpartum. All women reported mild symptom elevation during pregnancy and the early puerperium, regardless of psychiatric history. The most frequently endorsed symptoms in both groups were somatic. However, women with a history of affective disorder reported more psychic and somatic distress than women with no psychiatric history. Onset of a psychiatric disorder did not occur during pregnancy in this sample, and only one woman, with both a personal and family history of affective disorder, met criteria for a new episode postpartum. Brief periods of symptom elevation occurred postpartum for 14.7% of the sample (five women, two with and three without a personal history of affective disorder) in the context of additional life stressors combining with the stress of new motherhood. These findings suggest that the impact of childbearing alone on psychiatric symptoms and morbidity is modest among women who are psychiatrically healthy at pregnancy onset and have sound social support networks.
The purpose of this study was to describe the differences between primigravidae and multigravidae women in their experience of sleep efficiency, fatigue and vitality, and level of functioning in the third trimester of pregnancy and the first month postpartum. A secondary analysis of a descriptive, longitudinal study was done. A convenience sample of 31 pregnant women was used to test the hypothesis that multigravidae would have significantly higher levels of functioning in the household, increased fatigue, and decreased sleep efficiency and vitality than primigravidae at both phases of the study. Results indicate, however, that primigravidae experienced significantly more disturbed sleep, with sleep efficiency falling from 89.79% in the third trimester to 77.25% postpartum. Multigravidae had only a minor reduction in sleep efficiency from 86.76% in the third trimester to 83.99% postpartum. Although there was no statistically significant difference in level of vitality, primigravidae experienced more fatigue (73.58 +/- 15.22) than multigravidae (64.35 +/- 18.96) at 1 month postpartum. These results suggest that maternal role "acquisition," experienced by primigravidae, results in more fatigue and sleep disruption than does maternal role "expansion." The significant decrease in sleep efficiency and increase in fatigue in primigravidae after delivery indicate that health care professionals need to provide anticipatory guidance to primigravidae to help smooth the transition from pregnancy to motherhood.
To evaluate the differences in sleep of women throughout pregnancy compared with those of nonpregnant control subjects.
Four pregnant women were studied longitudinally during their pregnancy using inpatient polysomnography. Measurements included electroencephalography, electrocardiography, and continuous-pulse oximetry. Four healthy nonpregnant women matched for age and weight were used as control subjects. The total sleep time was recorded, and percentages of each sleep stage were generated.
Qualitative differences in sleep between pregnancy patients and control subjects were evident. Control subjects displayed a normal appearance of slow-wave sleep in stages 3 and 4 (delta sleep). When pregnant patients did display delta sleep, it appeared abnormal secondary to extensive alpha-wave intrusion. Even when including this abnormal delta sleep in a quantitative comparison, the pregnant patients had a significantly shorter percentage of total sleep time in delta sleep (4.9+/-1.9% vs 21.9+/-6.0%, p=0.03).
Sleep in pregnancy is characterized by loss of normal slow-wave sleep. Thus, sleep stages 3 and 4 are shortened during pregnancy. This sleep alteration is persistent when followed longitudinally during pregnancy.
We studied changes in the sleep patterns of ten young women from late pregnancy (36 weeks) to the sixth postpartum week, focusing on the relationship between the women's sleep patterns and their infants' movements. The mothers' polysomnograms and their infants' ankle actigrams were simultaneously recorded using a Medilog 9000 at home in three sessions, during the first, third, and sixth postpartum weeks. The mother-infant pairs slept in close proximity. Two subjects had difficulty with their infants and were dealt with as a separate group. Analysis for the eight subjects who adapted well to the postpartum period showed that wake time after sleep onset increased significantly during the postpartum period compared with late pregnancy given responsibility for feeding. Stage 3 + 4 and Stage REM did not change across the four sessions (pregnancy, first, third, and sixth postpartum weeks), but Stage 2 decreased significantly from pregnancy to postpartum. There was a high synchronization between infants' movements and mothers' wakefulness. Eight mothers did not complain of sleep disturbance, while the two mothers who had difficulty with their infants did. We suggest that mothers who tolerate well sleep interruption arising from feeding and maintain their Stages 3 + 4 and REM should not be considered as suffering from sleep disturbance. Mothers who have difficulty with their infants and complain of sleep disturbance should be considered as suffering from sleep disturbance.
Changes in sleep patterns of young women from late pregnancy to postpartum: Relationships to their infant's movements Childbearing in women with and without a history of affective disorder. I. Psychiatric symptomatology
- K Nishihara
- Horiuchi
- Reynolds Pa Coble
- Cf
- Dj Kupfer
- Pr Houck
- Nl Day
- Giles
Nishihara K, Horiuchi S. Changes in sleep patterns of young women from late pregnancy to postpartum: Relationships to their infant's movements. Percept Motor Skills 1998;87:1043–56. 19. Coble PA, Reynolds CF, Kupfer DJ, Houck PR, Day NL, Giles DE. Childbearing in women with and without a history of affective disorder. I. Psychiatric symptomatology. Comp Psychiatry 1994; 35:215–24.
Sleep deprivation Principles and practice of sleep medicine
- Bonnet
- Mh
Bonnet MH. Sleep deprivation. In: Kryger MH, Roth T, Dement WC, eds. Principles and practice of sleep medicine. Philadelphia: WB Saunders, 1994:60 – 6.
Principles and practice of sleep medicine
- M H Bonnet
Bonnet MH. Sleep deprivation. In: Kryger MH, Roth T, Dement
WC, eds. Principles and practice of sleep medicine. Philadelphia:
WB Saunders, 1994:60 -6.