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Panelli DM, Miller HE, Simpson SL, Hurtado J, Shu CH, Boncompagni AC, Chueh J, Barwick F, Carvalho B, Sultan P, Aghaeepour N, Druzin ML. Evaluation of Sleep in Pregnant Inpatients Compared With Outpatients. Obstet Gynecol 2024; 143:803-810. [PMID: 38663016 PMCID: PMC11098687 DOI: 10.1097/aog.0000000000005591] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2024] [Accepted: 03/14/2024] [Indexed: 05/18/2024]
Abstract
OBJECTIVE To evaluate whether antepartum hospitalization was associated with differences in sleep duration or disrupted sleep patterns. METHODS This was a prospective cohort study with enrollment of pregnant people aged 18-55 years with singleton gestations at 16 weeks of gestation or more between 2021 and 2022. Each enrolled antepartum patient was matched by gestational age to outpatients recruited from obstetric clinics at the same institution. Participants responded to the ISI (Insomnia Severity Index) and wore actigraph accelerometer watches for up to 7 days. The primary outcome was total sleep duration per 24 hours. Secondary outcomes included sleep efficiency (time asleep/time in bed), ISI score, clinical insomnia (ISI score higher than 15), short sleep duration (less than 300 minutes/24 hours), wakefulness after sleep onset, number of awakenings, and sleep fragmentation index. Outcomes were evaluated with multivariable generalized estimating equations adjusted for body mass index (BMI), sleep aid use, and insurance type, accounting for gestational age correlations. An interaction term assessed the joint effects of time and inpatient status. RESULTS Overall 58 participants were included: 18 inpatients and 40 outpatients. Inpatients had significantly lower total sleep duration than outpatients (mean 4.4 hours [SD 1.6 hours] inpatient vs 5.2 hours [SD 1.5 hours] outpatient, adjusted β=-1.1, 95% CI, -1.8 to -0.3, P =.01). Awakenings (10.1 inpatient vs 13.8, P =.01) and wakefulness after sleep onset (28.3 inpatient vs 35.5 outpatient, P =.03) were lower among inpatients. There were no differences in the other sleep outcomes, and no interaction was detected for time in the study and inpatient status. Inpatients were more likely to use sleep aids (39.9% vs 12.5%, P =.03). CONCLUSION Hospitalized pregnant patients slept about 1 hour/day less than outpatients. Fewer awakenings and reduced wakefulness after sleep onset among inpatients may reflect increased use of sleep aids in hospitalized patients.
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Affiliation(s)
- Danielle M Panelli
- Division of Maternal-Fetal Medicine and Obstetrics, Department of Obstetrics and Gynecology, the Division of Sleep Medicine, Department of Psychiatry and Behavioral Sciences, the Division of Obstetric Anesthesia, Department of Anesthesiology, Perioperative, and Pain Medicine, and the Department of Pediatrics, Stanford University, and Stanford University School of Medicine, Palo Alto, and the Department of Biomedical Data Science, Stanford University, Stanford, California
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Fischer AR, Doudell KR, Cundiff JM, Green SRM, Lavender CA, Gunn HE. Maternal Sleep Health, Social Support, and Distress: A Mixed-Methods Analysis of Mothers of Infants and Young Children in Rural US. Behav Sleep Med 2024:1-24. [PMID: 38600856 DOI: 10.1080/15402002.2024.2339818] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/12/2024]
Abstract
OBJECTIVES The purpose of this study was to explore sleep health in rural maternal populations through a social-ecological framework and identify risk and protective factors for this population. METHODS 39 individuals who are mothers of infants or children under the age of 5 years completed an online survey, 35 of which completed a subsequent semi-structured interview. Recruitment was limited to one rural community and was in partnership with community healthcare providers. Results were integrated using a convergent, parallel mixed-methods design. RESULTS Poor sleep health and high prevalence of insomnia symptoms in rural mothers were evident and associated with social support and maternal distress. Qualitative content from interviews indicated that well-established precipitating and perpetuating factors for insomnia may contribute to poor maternal sleep health. Results also revealed a gap in knowledge and language surrounding sleep health among rural mothers. CONCLUSIONS Sleep health is challenged during the transition to motherhood and rural mothers have less access to specialized perinatal and behavioral health care than their urban counterparts. In this sample, poor sleep was attributable to distress in addition to nocturnal infant and child sleep patterns which has implications for psychoeducation and promotion of sleep health in mothers. Sleep is a modifiable health indicator that is associated with several other maternal health outcomes and should be considered an element of a comprehensive maternal health for prevention and intervention across individual, interpersonal, and societal domains of the social-ecological model of sleep health.
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Affiliation(s)
| | - Kelly R Doudell
- Department of Psychology, University of Alabama, Tuscaloosa, AL, USA
| | - Jenny M Cundiff
- Department of Psychology, University of Alabama, Tuscaloosa, AL, USA
| | | | - Catherine A Lavender
- College of Community Health Sciences, University of Alabama, Tuscaloosa, AL, USA
| | - Heather E Gunn
- Department of Psychology, University of Alabama, Tuscaloosa, AL, USA
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Zhu J, Li Y, Wang R, Zhang J, Liu C, Li H, Yang D, Ma S, Guan S. The Mediating Role of Family Functions Between Pregnancy-Related Anxiety and Sleep Quality: A Cross-Sectional Study. Nat Sci Sleep 2024; 16:279-289. [PMID: 38495839 PMCID: PMC10944293 DOI: 10.2147/nss.s443612] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Accepted: 02/18/2024] [Indexed: 03/19/2024] Open
Abstract
Objective To examine the relationship between pregnancy-related anxiety, family functions, and sleep quality, and to determine whether family functions mediate the relationship between pregnancy-related anxiety and sleep quality. Methods A cross-sectional survey was conducted on pregnant women between April to August in 2022 in the obstetrics outpatient clinic of a tertiary care hospital in the Ningxia Hui Autonomous Region of China. A total of 1014 pregnant women aged 18 years and older were surveyed. They completed questionnaires, including: general demographic characteristics, the Pregnancy-related anxiety scale (PAQ), the Family Adaptation, Partnership, Growth, Affection, and Resolve (APGAR), and the Pittsburgh Sleep Quality Index Questionnaire (PSQI). Model 4 in PROCESS was used to analyze the relationships among pregnancy-related anxiety, family functions, and sleep quality, with family functions as a mediator. Results Among the 1014 pregnant women, the pregnancy-related anxiety scale score was (21.84 ± 5.64). The total score of the family functions scale was (8.10±2.26), and the overall sleep quality scale score was (7.89±2.99). When participants were grouped according to different socio-demographic characteristics, the study showed that all variables differed from anxiety, family functions or sleep quality, except for age, pre-pregnancy BMI and whether or not they had a first birth, which was not associated with anxiety, family functions, or sleep quality (P<0.05). The pregnancy-related anxiety was positively associated with sleep quality (P<0.01), while family functions were negatively associated with sleep quality (P<0.01). In addition, family functions mediate the relationship between pregnancy-related anxiety and sleep quality during pregnancy, on the first and second trimesters, intermediation rate is 9.31% (P<0.05), and on the third trimesters, intermediation rate is 21.38% (P<0.05). Conclusion Pregnancy- related anxiety is a risk factor for sleep quality, however, family functions are protective factors for sleep quality. Family functions play an intermediary role in sleep quality caused by pregnancy-related anxiety, especially on the third trimesters. This finding may provide a scientific basis for developing intervention strategies to improve the sleep quality of pregnant women.
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Affiliation(s)
- Jiashu Zhu
- School of Public Health, Ningxia Medical University, Yinchuan City, Ningxia, People’s Republic of China
| | - Ye Li
- School of Public Health, Ningxia Medical University, Yinchuan City, Ningxia, People’s Republic of China
| | - Rui Wang
- School of Public Health, Ningxia Medical University, Yinchuan City, Ningxia, People’s Republic of China
| | - Jinfang Zhang
- Obstetric Clinic, General Hospital of Ningxia Medical University, Yinchuan City, Ningxia, People’s Republic of China
| | - Can Liu
- School of Public Health, Ningxia Medical University, Yinchuan City, Ningxia, People’s Republic of China
| | - Hongyu Li
- School of Public Health, Ningxia Medical University, Yinchuan City, Ningxia, People’s Republic of China
| | - Deguang Yang
- School of Public Health, Ningxia Medical University, Yinchuan City, Ningxia, People’s Republic of China
| | - Shuqin Ma
- Obstetric Clinic, General Hospital of Ningxia Medical University, Yinchuan City, Ningxia, People’s Republic of China
| | - Suzhen Guan
- School of Public Health, Ningxia Medical University, Yinchuan City, Ningxia, People’s Republic of China
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Monirian F, Soltani F, Samavati S, Aghababaei S, Tapak L. Pregnancy Concerns as Predictors of Sleep Quality in Primigravid Women: A Cross-Sectional Study. Cureus 2024; 16:e55442. [PMID: 38567213 PMCID: PMC10985564 DOI: 10.7759/cureus.55442] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/01/2024] [Indexed: 04/04/2024] Open
Abstract
Introduction Poor sleep quality may be a risk factor for adverse pregnancy outcomes. Identifying the predictors of sleep disorders can help design effective interventions. The present study aimed to evaluate the impact of pregnancy concerns on the sleep quality of primigravid women. Methods This cross-sectional study was conducted on 220 primigravid women referred to health centers in Hamadan, Iran. In addition to completing the demographic characteristics questionnaire, the Parkinson's Disease Questionnaire (PDQ) questionnaire was completed to determine the level of pregnancy concerns, and the Pittsburgh Sleep Quality Index (PSQI) questionnaire was completed to determine the quality of sleep by pregnant women. Data were analyzed using descriptive statistics, the Pearson correlation coefficient, independent t-test, and univariate and multivariate logistic regression models with a backward method at a 95% confidence level. Results Pregnant women's total PSQI score was 13.8 ± 3.08, and with a PSQI ≥ 5 as a cut-off point, 76.3% of the study's participants had poor sleep quality. There was a significant direct correlation between the total score of PDQ and its subscales with the total PSQI score (P < 0.05). The adjusted regression logistic model showed a significant relationship between the PDQ scores, women's educational level (adjusted odds ratio (AOR) 1.19; confidence interval (CI) 95%: 0.19-2.18), and their spouse's educational level (AOR 1.03; CI 95%: 0.02-2.03) with sleep quality scores. Conclusion Pregnancy concerns, including concerns about birth and the baby, concerns about physical symptoms and body image, and concerns about emotions and relationships, can reduce the sleep quality of primigravid women. Designing and implementing effective interventions to reduce or modify these common concerns can improve the sleep quality of pregnant women and prevent the adverse effects of poor sleep quality on pregnancy outcomes.
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Affiliation(s)
- Fahimeh Monirian
- Family Medicine, Hamadan University of Medical Sciences, Hamadan, IRN
| | - Farzaneh Soltani
- Mother and Child Care Research Center, Hamadan University of Medical Sciences, Hamadan, IRN
| | - Saman Samavati
- Family Medicine, Hamadan University of Medical Sciences, Hamadan, IRN
| | - Soodabeh Aghababaei
- Mother and Child Care Research Center, Hamadan University of Medical Sciences, Hamadan, IRN
| | - Lili Tapak
- Department of Biostatistics, School of Public Health, Hamadan University of Medical Sciences, Hamadan, IRN
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Shang X, Ye L, Wang MP, Lam TH, Lai AYK. A comprehensive insight on cognitive behavioral therapy for insomnia in pregnant women: A systematic review and meta-analysis. Sleep Med 2023; 112:322-332. [PMID: 37952481 DOI: 10.1016/j.sleep.2023.11.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Revised: 10/23/2023] [Accepted: 11/01/2023] [Indexed: 11/14/2023]
Abstract
BACKGROUND Cognitive behavioral therapy for insomnia (CBT-I) as a first-line treatment may improve insomnia in pregnant women. The efficacy of the components, modalities, doses, and effectiveness of CBT-I in pregnant women at follow-up remains unclear. OBJECTIVES To assess the effectiveness of CBT-I in pregnant women and identify effective intervention components, modalities, and doses. DESIGN Systematic review and meta-analysis. METHODS Six English databases (PubMed, Embase, Cochrane Library, Web of Science, PsycINFO, CINAHL) and four Chinese databases (CNKI, WanFang Data, SinoMed, and CQVIP) were searched from inception to 10 January 2023. Randomized controlled trials (RCTs) on CBT-I in pregnant women with outcomes of insomnia severity measured by Insomnia Severity Index (ISI) or sleep quality measured by Pittsburgh Sleep Quality Index (PSQI). Two reviewers independently completed records selection, data extraction, and study quality assessment. The fixed-effect or random-effect model was used for pooled analyses. Subgroup analyses were conducted based on different delivery types and intervention duration. The GRADE approach was used to evaluate the certainty of the evidence. Narrative analyses were used when meta-analysis was not appropriate. Mean differences with 95% CIs of insomnia severity and sleep quality scores were the main outcomes (greater scores indicating greater severity). RESULTS Nine RCTs (N = 978) meeting the inclusion criteria were included. These trials included individual- (n = 6) or group-based (n = 3) interventions, which were conducted via face-to-face (n = 5), digital (n = 3) or telephone and e-mail (n = 1) formats. Six studies stated intervention components specific to pregnant women. CBT-I improved insomnia severity (MD = -2.69, 95% CI: -3.41 to -1.96, P < 0.001, high quality evidence; MD = -3.69, 95% CI: -5.91 to -1.47, P = 0.001, moderate quality evidence) and sleep quality (MD = -2.85, 95% CI: -4.73 to -0.97, P = 0.003, moderate quality evidence; MD = -1.88, 95% CI: -2.89 to -0.88, P < 0.001, moderate quality evidence) immediately after intervention (<1-month) and at short-term (≥1 month to <6 months) follow-up, respectively. Two RCTs reported no effectiveness on insomnia severity at medium-term (≥6 months to<12 months) follow-up. Only 1 RCT showed reduced insomnia severity at long-term (≥12 months) follow-up. One RCT reported no effectiveness in sleep quality at medium-term follow-up and effectiveness at long-term follow-up was not reported. CONCLUSIONS Pregnant women may benefit from CBT-I to improve short-term insomnia, but long-term effectiveness is unclear. Rigorous RCTs with long-term follow-ups are warranted.
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Affiliation(s)
- Xingchen Shang
- School of Nursing, The University of Hong Kong, 3 Sassoon Road, Pokfulam, Hong Kong, China; School of Nursing, Yangzhou University, No.136 Jiangyang Middle Road, Yangzhou, Jiangsu Province, China.
| | - Linfei Ye
- School of Nursing, Yangzhou University, No.136 Jiangyang Middle Road, Yangzhou, Jiangsu Province, China.
| | - Man Ping Wang
- School of Nursing, The University of Hong Kong, 3 Sassoon Road, Pokfulam, Hong Kong, China.
| | - Tai Hing Lam
- School of Public Health, The University of Hong Kong, 7 Sassoon Road, Pokfulam, Hong Kong, China.
| | - Agnes Yuen Kwan Lai
- School of Nursing and Health Studies, Hong Kong Metropolitan University, 1 Sheung Shing Road, Homantin, Kowloon, Hong Kong, China.
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Chen X, Liu Y, Liu M, Min F, Tong J, Wei W, Sun L, Zhang T, Meng Q. Prevalence and associated factors of insomnia symptoms among pregnant women in the third trimester in a moderately developing region of China. BMC Public Health 2023; 23:2319. [PMID: 37996812 PMCID: PMC10668519 DOI: 10.1186/s12889-023-17269-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Accepted: 11/20/2023] [Indexed: 11/25/2023] Open
Abstract
BACKGROUND Insomnia is the most common sleep disorder in the general population, especially among pregnant women, and it is considered a major public health issue. Not only can it cause mental and physical problems in pregnant women, but it may also affect the growth of the fetus. However, there are few reports on the prevalence and influencing factors of insomnia symptoms in third-trimester women in China. The objective of this study was to assess the prevalence of insomnia symptoms among pregnant women in the third trimester in a moderately developing region of China and to further explore the associated factors of insomnia symptoms from various aspects. METHODS A cross-sectional survey was conducted among eligible pregnant women in the third trimester from December 2022 to February 2023. Data on socio-demographic characteristics, clinical characteristics, and behavioral and psychological characteristics of pregnant women were collected through a structured questionnaire. The Chi-square test and multivariate logistics regression were applied to explore the associated factors of insomnia symptoms. RESULTS A total of 535 pregnant women in the third trimester were included in this study, and the prevalence of insomnia symptoms was 59.8%. Multivariate logistic regression analysis revealed that pregnant women who lived together with elders (OR: 0.58, 95% CI: 0.40-0.86), had low perceived stress (OR: 0.58, 95% CI: 0.35-0.97), had no threatened abortion (OR: 0.55, 95% CI: 0.32-0.93) and had good doctor-patient communication (OR: 0.66, 95% CI: 0.45-0.98) were more likely to stay away from insomnia symptoms. However, pregnant women with anxiety symptoms (OR: 2.27, 95% CI: 1.28-4.03), fear of childbirth (OR: 1.63, 95% CI: 1.11-2.40) and a high experience of COVID-19 fear (OR: 1.61, 95% CI: 1.03-2.54) tended to have insomnia symptoms. CONCLUSIONS The prevalence of insomnia symptoms in pregnant women is high in Lianyungang city in eastern China in the third trimester. Insomnia symptoms is influenced by multiple factors. There is an urgent need to develop interventions to reduce the prevalence of insomnia symptoms in the third trimester and to focus on pregnant women with risk factors for insomnia symptoms.
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Affiliation(s)
- Xu Chen
- Lianyungang Maternal and Child Health Hospital, 669 Qindongmen Street, Haizhou District, Lianyungang, Jiangsu, China
| | - Yuan Liu
- Lianyungang Maternal and Child Health Hospital, 669 Qindongmen Street, Haizhou District, Lianyungang, Jiangsu, China
| | - Meilin Liu
- Lianyungang Maternal and Child Health Hospital, 669 Qindongmen Street, Haizhou District, Lianyungang, Jiangsu, China
| | - Fanli Min
- Lianyungang Maternal and Child Health Hospital, 669 Qindongmen Street, Haizhou District, Lianyungang, Jiangsu, China
| | - Jiao Tong
- Lianyungang Maternal and Child Health Hospital, 669 Qindongmen Street, Haizhou District, Lianyungang, Jiangsu, China
| | - Wei Wei
- Lianyungang Maternal and Child Health Hospital, 669 Qindongmen Street, Haizhou District, Lianyungang, Jiangsu, China
| | - Lizhou Sun
- First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
| | - Teng Zhang
- Lianyungang Maternal and Child Health Hospital, 669 Qindongmen Street, Haizhou District, Lianyungang, Jiangsu, China.
| | - Qian Meng
- Lianyungang Maternal and Child Health Hospital, 669 Qindongmen Street, Haizhou District, Lianyungang, Jiangsu, China.
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Palagini L, Cipriani E, Caruso V, Sharma V, Gemignani A, Bramante A, Miniati M, Riemann D. Insomnia During the Perinatal Period and its Association with Maternal and Infant Psychopathology: A Systematic Review and Meta-Analysis. Curr Psychiatry Rep 2023; 25:617-641. [PMID: 37819491 DOI: 10.1007/s11920-023-01463-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/06/2023] [Indexed: 10/13/2023]
Abstract
PURPOSE OF REVIEW While sleep serves important regulatory functions for mental health, sleep disturbances, in particular insomnia, may contribute to mental disorders. Since insomnia symptoms are frequent during the perinatal period, the aim of this work is to systematically review the potential association between perinatal insomnia and maternal and infant psychopathology. RECENT FINDINGS A systematic search was conducted according with PRISMA guidelines, and meta-analytic calculations were conducted. Totally, 34 studies were included and involved 835,021 perinatal women. Four meta-analysis yielded four statistically significant random-effect models. All models show that women with perinatal symptoms of insomnia possess increased odds of developing clinically relevant symptoms of depression OR = 3.69, p = 0.001 and anxiety OR = 2.81; p < 0.001, as well as increased suicidal risk OR = 3.28; p < 0.001, and distress in the newborn OR = 2.80 (P = 0.007). These findings emphasize the role of assessing and addressing insomnia during the perinatal period to mitigate its negative effect on maternal and infant mental health via sleep regulation.
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Affiliation(s)
- Laura Palagini
- Department of Experimental and Clinic Medicine, Section of Psychiatry, University of Pisa, Via Roma 67, 56100 Pisa, Italy.
| | - Enrico Cipriani
- Department of Surgical, Medical, Molecular, and Critical Area Pathology, University of Pisa, Via Savi, 10-56126 Pisa, Italy
| | - Valerio Caruso
- Department of Experimental and Clinic Medicine, Section of Psychiatry, University of Pisa, Via Roma 67, 56100 Pisa, Italy
| | - Verinder Sharma
- Department of Psychiatry, Western University, London, ON, Canada
- Department of Obstetrics & Gynaecology, Western University, London, ON, Canada
- Parkwood Institute Mental Health, St. Joseph's Health Care, London, ON, Canada
| | - Angelo Gemignani
- Department of Surgical, Medical, Molecular, and Critical Area Pathology, University of Pisa, Via Savi, 10-56126 Pisa, Italy
| | - Alessandra Bramante
- President of the Italian Section Marcè Society for Perinatal Psychopathology, Milan, Italy
| | - Mario Miniati
- Department of Experimental and Clinic Medicine, Section of Psychiatry, University of Pisa, Via Roma 67, 56100 Pisa, Italy
| | - Dieter Riemann
- Department of Psychiatry and Psychotherapy, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
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Kember AJ, Elangainesan P, Ferraro ZM, Jones C, Hobson SR. Common sleep disorders in pregnancy: a review. Front Med (Lausanne) 2023; 10:1235252. [PMID: 37671402 PMCID: PMC10475609 DOI: 10.3389/fmed.2023.1235252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Accepted: 08/02/2023] [Indexed: 09/07/2023] Open
Abstract
In this review, we provide a comprehensive overview of common sleep disorders during pregnancy, including their characterization, prevalence, risk factors, and possible contribution to maternal and fetal outcomes. We conducted a quasi-systematic literature search of the MEDLINE database and identified 744 studies from 1991 through 2021, inclusive, that met our inclusion criteria. We synthesized the existing literature on sleep disorders during pregnancy and highlighted controversies, research gaps, and needed clinical developments. Our review covers a range of sleep disorders, including insomnia, obstructive sleep apnea, restless legs syndrome, and circadian rhythm disorders. We discuss the prevalence of these disorders in pregnancy and their potential impact on maternal and fetal health outcomes. We also explore the relationship between sleep disorders, pre-pregnancy comorbidities such as obesity, and pregnancy-related conditions such as gestational diabetes mellitus and preeclampsia. In addition to summarizing the existing literature on sleep disorders during pregnancy, we also highlight opportunities for further research in this area. We suggest that future studies should strive to employ validated and objective measurement tools for sleep disorders and prioritize utilization of longitudinal methods with participant follow-up through postpartum, mid-life, menopause, and beyond. We also put forward investigation into the impact of circadian rhythm disruption on reproductive physiology and early pregnancy outcomes as an area of important work. Overall, our review provides valuable insights on sleep and reproduction and into common sleep disorders during pregnancy and their potential impact on maternal and fetal health outcomes.
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Affiliation(s)
- Allan J. Kember
- Department of Obstetrics and Gynaecology, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Dalla Lana School of Public Health, Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, ON, Canada
- Shiphrah Biomedical Inc., Toronto, ON, Canada
| | - Praniya Elangainesan
- Temerty Faculty of Medicine, Medical Education, University of Toronto, Toronto, ON, Canada
| | - Zachary M. Ferraro
- Department of Obstetrics and Gynaecology, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Claire Jones
- Department of Obstetrics and Gynaecology, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Division of Reproductive Endocrinology and Infertility, Mount Sinai Hospital, Toronto, ON, Canada
| | - Sebastian R. Hobson
- Department of Obstetrics and Gynaecology, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Dalla Lana School of Public Health, Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, ON, Canada
- Temerty Faculty of Medicine, Medical Education, University of Toronto, Toronto, ON, Canada
- Temerty Faculty of Medicine, Institute of Medical Science, University of Toronto, Toronto, ON, Canada
- Maternal-Fetal Medicine Division, Mount Sinai Hospital, Toronto, ON, Canada
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Mulcahy M, Long C, Morrow T, Galbally M, Rees C, Anderson R. Consensus recommendations for the assessment and treatment of perinatal obsessive-compulsive disorder (OCD): A Delphi study. Arch Womens Ment Health 2023; 26:389-399. [PMID: 37138166 PMCID: PMC10155656 DOI: 10.1007/s00737-023-01315-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Accepted: 04/09/2023] [Indexed: 05/05/2023]
Abstract
The perinatal period is one of increased vulnerability to parents experiencing the onset of, or an increase of existing, obsessive-compulsive disorder (OCD) symptoms. Existing OCD and perinatal mental health best practice guidelines do not detail specific considerations relevant to OCD in the perinatal period ('Perinatal OCD'). Perinatal OCD risks being undiagnosed or misdiagnosed, and subsequently untreated or mistreated, with potential negative impacts for individuals and families experiencing this problem, highlighting the importance of specific guidance. This study employed a modified Delphi survey methodology to establish recommended best practice for the assessment and treatment of perinatal OCD. A literature review identified 103 initial best practice recommendations, and participants suggested 18 further recommendations. These recommendations were rated for importance over three survey rounds by two expert panels, comprising of 15 professionals with clinical or research expertise in perinatal OCD and 14 consumers with lived experience of perinatal OCD. One-hundred and two statements were endorsed for inclusion in the final set of recommendations for clinical best practice with perinatal OCD. These recommendations inform practice across eight themes; psychoeducation, screening, assessment, differential diagnosis, case care considerations, treatment, partners & families, and culture & diversity. This novel study is the first to collate and outline a set of clinical best practice recommendations, developed using the consensus perspectives of both individuals with lived experience and professionals with relevant expertise, for supporting individuals with perinatal OCD and their families. Differences between panel perspectives, and directions for future research are also discussed.
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Affiliation(s)
- Melissa Mulcahy
- Discipline of Psychology, School of Population Health, enAble Institute, Faculty of Health Sciences, Curtin University, Perth, WA, Australia.
| | - Christian Long
- Discipline of Psychology, School of Population Health, enAble Institute, Faculty of Health Sciences, Curtin University, Perth, WA, Australia
| | - Teagan Morrow
- Discipline of Psychology, School of Population Health, enAble Institute, Faculty of Health Sciences, Curtin University, Perth, WA, Australia
| | - Megan Galbally
- College of Science, Health, Engineering and Education, Murdoch University, King Edward Memorial Hospital for Women, WA, Perth, Australia
| | - Clare Rees
- Discipline of Psychology, School of Population Health, enAble Institute, Faculty of Health Sciences, Curtin University, Perth, WA, Australia
| | - Rebecca Anderson
- Discipline of Psychology, School of Population Health, enAble Institute, Faculty of Health Sciences, Curtin University, Perth, WA, Australia
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Nevarez-Brewster M, Aran Ö, Narayan AJ, Harrall KK, Brown SM, Hankin BL, Davis EP. Adverse and Benevolent Childhood Experiences Predict Prenatal Sleep Quality. ADVERSITY AND RESILIENCE SCIENCE 2022; 3:391-402. [PMID: 36968335 PMCID: PMC10035559 DOI: 10.1007/s42844-022-00070-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 07/13/2022] [Indexed: 11/28/2022]
Abstract
The objective of the study was to investigate whether adverse and benevolent childhood experiences were associated with trajectories of sleep quality throughout pregnancy. The study was conducted at obstetrics and gynecology clinics in the Rocky Mountain region of the USA. The participants of the study were pregnant individuals (N = 164). Sleep quality was measured with the Pittsburgh Sleep Quality Index at three gestational time points, and adverse childhood experiences (ACEs) and benevolent childhood experiences (BCEs) were assessed once. Multilevel models were conducted to examine the trajectory of sleep quality across gestation in relation to ACEs and BCEs. Sleep quality was similar in early to mid-pregnancy, with a worsening of sleep quality late in pregnancy, following a quadratic trajectory. Higher levels of ACEs predicted poorer prenatal sleep quality (b = 0.36, SE = 0.13, p = .004) throughout pregnancy, while higher levels of BCEs predicted better sleep quality (b = -0.60, SE = 0.17, p < .001) throughout pregnancy. Examination of ACEs subtypes revealed that childhood maltreatment predicted poor sleep quality (b = 0.66, SE = 0.18, p < .001), while childhood household dysfunction was not significantly associated (b = 0.33, SE = 0.21, p = .11). Associations remained after covarying for socioeconomic status and current stressful life events. Both adverse and benevolent childhood experiences predict sleep health during pregnancy. Prevention and intervention strategies targeting resilience and sleep quality during pregnancy should be implemented to promote prenatal health and well-being.
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Affiliation(s)
| | - Özlü Aran
- Department of Psychology, University of Denver, 2155 S Race St, Denver, CO 80208, USA
| | - Angela J. Narayan
- Department of Psychology, University of Denver, 2155 S Race St, Denver, CO 80208, USA
| | - Kylie K. Harrall
- Lifecourse Epidemiology of Adiposity and Diabetes (LEAD) Center, Colorado School of Public Health, Aurora, USA
- Department of Epidemiology, Colorado School of Public Health, Aurora, USA
| | | | - Benjamin L. Hankin
- Department of Psychology, University of Illinois at Urbana-Champaign, Champaign, USA
| | - Elysia Poggi Davis
- Department of Psychology, University of Denver, 2155 S Race St, Denver, CO 80208, USA
- Department of Pediatrics, University of California, Irvine, Irvine, USA
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11
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Kendle AM, Salemi JL, Jackson CL, Buysse DJ, Louis JM. Insomnia during pregnancy and severe maternal morbidity in the united states: nationally representative data from 2006 to 2017. Sleep 2022; 45:zsac175. [PMID: 35901516 PMCID: PMC9548669 DOI: 10.1093/sleep/zsac175] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Revised: 06/08/2022] [Indexed: 07/30/2023] Open
Abstract
STUDY OBJECTIVES Using a large, nationally representative database, we aimed to estimate the prevalence and trends of insomnia among pregnant women over a 12-year period. In addition, we aimed to examine the interplay among insomnia, maternal comorbidities, and severe maternal morbidity (SMM). METHODS We conducted a serial cross-sectional analysis of pregnancy-related hospitalizations in the United States from the 2006 to 2017 National Inpatient Sample (NIS). ICD-9 and ICD-10 codes were used to capture diagnoses of insomnia and obstetric comorbidities during delivery and non-delivery hospitalizations. The primary outcome was the diagnosis of SMM at delivery. We used logistic regression to assess the association between insomnia and SMM. Joinpoint regression was used to estimate trends in insomnia and SMM. RESULTS Of nearly 47 million delivery hospitalizations, 24 625 women had a diagnosis of insomnia, or 5.2 per 10 000 deliveries. The annual incidence increased from 1.8 to 8.6 per 10 000 over the study period. The crude rate of insomnia was 6.3 times higher for non-delivery hospitalizations. Patients with insomnia had more comorbidities, particularly neuromuscular disease, mental health disorders, asthma, and substance use disorder. Prevalence of non-blood transfusion SMM was 3.6 times higher for patients with insomnia (2.4% vs. 0.7%). SMM increased annually by 11% (95% CI = 3.0% to 19.7%) in patients with insomnia. After adjusting for comorbidities, there remained a 24% increased likelihood of SMM for patients with insomnia. CONCLUSIONS Coded diagnosis of insomnia during pregnancy has increased over time, and this burden disparately affects women of low socioeconomic status. Diagnosis of insomnia is an independent predictor of SMM.
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Affiliation(s)
- Anthony M Kendle
- Corresponding author: Anthony M. Kendle, 2 Tampa General Circle, Tampa, FL 33606, USA.
| | - Jason L Salemi
- Department of Obstetrics and Gynecology, Morsani College of Medicine, University of South Florida, Tampa FL, USA
- College of Public Health, University of South Florida, Tampa FL, USA
| | - Chandra L Jackson
- Epidemiology Branch, National Institute of Environmental Health Sciences, National Institutes of Health, Department of Health and Human Services, Research Triangle Park, NC, USA
- Division of Intramural Research, National Institute on Minority Health and Health Disparities, National Institutes of Health, Department of Health and Human Services, Bethesda, MD,USA
| | - Daniel J Buysse
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA,USA
| | - Judette M Louis
- Department of Obstetrics and Gynecology, Morsani College of Medicine, University of South Florida, Tampa FL, USA
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12
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Abstract
PURPOSE OF REVIEW This article will provide a brief review of most recent findings of sleep, insomnia, obstructive sleep apnea, and restless leg syndrome during pregnancy. RECENT FINDINGS Recent meta-analyses have found that 38.2% of pregnant women experience insomnia, 15% experience obstructive sleep apnea, and 20% experience restless leg syndrome. Poor sleep during pregnancy is associated with increased odds of preterm birth, cesarean section, hypertension, gestational diabetes, and longer deliveries. OSA is also associated with poor outcomes such as maternal hypertension, gestational diabetes, preterm birth, and low infant Apgar score. Incidence of new-onset RLS increases with parity, gestational age, maternal age, and increased maternal adiposity. Typical treatments have been found to be effective for treating sleep disorders in pregnant women. Obtaining sufficient sleep quality and quantity in addition to assessing and treating sleep disorders should be a priority for pregnant women and their providers.
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Affiliation(s)
- Jessica M Meers
- Department of Medicine, Baylor College of Medicine, Houston, USA.,Center of Innovation in Quality, Effectiveness, and Safety, Michael E. DeBakey Veterans Affairs Medical Center, 2450 Holcombe Blvd., Suite 01Y, Houston, TX, 77030, USA.,South Central Mental Illness Research Education Clinical Center, Department of Veterans Affairs, Houston, USA
| | - Sara Nowakowski
- Department of Medicine, Baylor College of Medicine, Houston, USA. .,Center of Innovation in Quality, Effectiveness, and Safety, Michael E. DeBakey Veterans Affairs Medical Center, 2450 Holcombe Blvd., Suite 01Y, Houston, TX, 77030, USA. .,South Central Mental Illness Research Education Clinical Center, Department of Veterans Affairs, Houston, USA.
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13
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Jones K, Harrison V, Moulds ML, Lazard L. A qualitative analysis of feelings and experiences associated with perinatal distress during the COVID-19 pandemic. BMC Pregnancy Childbirth 2022; 22:572. [PMID: 35850668 PMCID: PMC9294838 DOI: 10.1186/s12884-022-04876-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Accepted: 06/21/2022] [Indexed: 11/10/2022] Open
Abstract
Background Rates of perinatal mental health difficulties (experienced during pregnancy and the 12-months postpartum) increased worldwide during the COVID-19 pandemic. In the UK, anxiety and depression were estimated to affect more than half of perinatal women during the first national lockdown. However, little is known about women’s qualitative experiences of distress. This study aimed to extend published quantitative findings resulting from the same data set (Harrison et al., Women Birth xxxx, 2021; Harrison et al., J Reprod Infant Psychol 1–16, 2021) to qualitatively explore: 1) the feelings and symptoms associated with maternal perinatal distress during the COVID-19 pandemic; and 2) the associated sources of distress. Methods As part of an online survey during May 2020, 424 perinatal women responded to an open-ended question regarding a recent experience of distress. Qualitative data were analysed using an initial content analysis, followed by an inductive thematic analysis adopting a realist approach. Data were explored in the context of self-reported perinatal anxiety and depression symptoms. Results Initial content analysis of the data identified twelve distinct categories depicting participants’ feelings and symptoms associated with psychological distress. Despite the high rates of probable depression in the sample, women’s descriptions were more indicative of anxiety and general distress, than of symptoms traditionally related to depression. In terms of the associated psychosocial stressors, a thematic analysis identified five themes: Family wellbeing; Lack of support; Mothering challenges; Loss of control due to COVID-19; and Work and finances. Unsurprisingly given the context, isolation was a common challenge. Additionally, psychological conflict between maternal expectations and the reality of pregnancy and motherhood, loss of autonomy and control, and fears surrounding family health, safety, and wellbeing underlay many of the themes. Conclusions This study presents an array of feelings and symptoms expressed by perinatal mothers which may be useful to consider in relation to perinatal wellbeing. Furthermore, our data highlights several common sources of distress, including multiple COVID-19 specific factors. However, many were related to more general perinatal/maternal experiences. Our findings also point to considerations that may be useful in alleviating distress in pregnancy and early motherhood, including social support, realistic perinatal/maternal expectations, and support for those with perceived perinatal trauma.
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Affiliation(s)
- Katie Jones
- School of Psychology and Counselling, The Open University, Milton Keynes, UK.
| | - Virginia Harrison
- School of Psychology and Counselling, The Open University, Milton Keynes, UK
| | | | - Lisa Lazard
- School of Psychology and Counselling, The Open University, Milton Keynes, UK
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14
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Raiff EM, D’Antonio KM, Mai C, Monk C. Mental Health in Obstetric Patients and Providers During the COVID-19 Pandemic. Clin Obstet Gynecol 2022; 65:203-215. [PMID: 34857681 PMCID: PMC8767924 DOI: 10.1097/grf.0000000000000668] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Psychiatric morbidity is the most common childbirth complication with 1 in 5 women experiencing a perinatal mood or anxiety disorder. The cost of this psychiatric morbidity is pervasive, contributing to devastating maternal health, child developmental, and economic consequences. The coronavirus disease 2019 (COVID-19) pandemic, and associated changes to perinatal experiences, resulted in profound psychological reactions including increased anxiety, depression, stress disorders, and sleep disturbance, further impacting obstetric patients. Providers' mental health has been challenged by moral injury and shared trauma. This article reviews mental health outcomes in regard to the COVID-19 pandemic for obstetric patients and their providers.
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Affiliation(s)
| | | | - Christine Mai
- College of Medicine, University of Cincinnati, Cincinnati, Ohio
| | - Catherine Monk
- Departments of Obstetrics and Gynecology
- Psychiatry, Vagelos College of Physicians and Surgeons, Columbia University
- New York State Psychiatric Institute, Columbia University Irving Medical Center, New York, New York
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15
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Quin N, Lee JJ, Pinnington DM, Newman L, Manber R, Bei B. Differentiating perinatal Insomnia Disorder and sleep disruption: a longitudinal study from pregnancy to 2 years postpartum. Sleep 2022; 45:6497951. [PMID: 34989808 PMCID: PMC9013000 DOI: 10.1093/sleep/zsab293] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Revised: 12/07/2021] [Indexed: 01/07/2023] Open
Abstract
STUDY OBJECTIVES Insomnia Disorder diagnoses require persistent sleep complaints despite "adequate sleep opportunity." Significant Perinatal Sleep Disruption makes this diagnosis challenging. This longitudinal study distinguished between Insomnia Disorder and Perinatal Sleep Disruption and their sleep and mental health correlates. METHODS One hundred sixty-three nulliparous females (age M ± SD = 33.35 ± 3.42) participating in a randomized controlled trial repeated the Insomnia Disorder module of the Duke Structured Interview for Sleep Disorders and Patient-Reported Outcome Measurement Information System measures for sleep and mental health at 30- and 35-weeks' gestation, and 1.5, 3, 6, 12, and 24 months postpartum (944 interviews, 1009 questionnaires completed). We compared clinical features when Diagnostic and Statistical Manual of Mental Disorders (DSM-5) Insomnia Disorder criteria (without the Duration criterion) were: (1) met (Insomnia Disorder), (2) not met only because of the sleep opportunity criteria (Perinatal Sleep Disruption), and (3) not met due to other criteria (Low Complaint). RESULTS Proportions of Insomnia Disorder were 16.0% and 19.8% during early and late third trimester, and ranged 5.3%-11.7% postpartum. If the sleep opportunity criteria were not considered, rates of Insomnia would be 2-4 times higher (21.4%-40.4%) across time-points. Mixed-effects models adjusting for covariates showed that compared to Low Complaint, both Insomnia Disorder and Perinatal Sleep Disruption scored significantly higher on insomnia and sleep disturbance scales, sleep effort, and sleep-related impairments (p values < .01), but depression and anxiety were comparable (p values > .12). CONCLUSION Assessing sleep complaints without considering sleep opportunities can result in over-diagnosis of Insomnia Disorder in the perinatal periods. Insomnia Disorder and Perinatal Sleep Disruption were both associated with adverse sleep and mood outcomes, and need to be carefully differentiated and appropriately addressed. Clinical Trial Registration: The SEED Project (Sleep, Eat, Emotions, and Development): A randomized controlled pilot study of a perinatal sleep intervention on sleep and wellbeing in mothers and infants. https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=371634, Australian New Zealand Clinical Trials Registry: ACTRN12616001462471.
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Affiliation(s)
- Nina Quin
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, VIC, Australia,Women’s Mental Health Service, Royal Women’s Hospital, Parkville, VIC, Australia
| | - Jin Joo Lee
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, VIC, Australia,Women’s Mental Health Service, Royal Women’s Hospital, Parkville, VIC, Australia
| | - Donna M Pinnington
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, VIC, Australia,Women’s Mental Health Service, Royal Women’s Hospital, Parkville, VIC, Australia
| | - Louise Newman
- Department of Psychiatry, University of Melbourne, Melbourne, VIC, Australia
| | - Rachel Manber
- Department of Psychiatry and Behavioral Sciences, Stanford University, Palo Alto, CA, USA
| | - Bei Bei
- Corresponding author. Bei Bei, Turner Institute for Brain and Mental Health, School of Psychological Sciences, Faculty of Medicine, Nursing and Health Sciences, Monash University, 18 Innovation Walk, Clayton Campus, VIC 3800, Australia.
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16
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Quin N, Tikotzky L, Stafford L, Fisher J, Bei B. Preventing postpartum insomnia by targeting maternal versus infant sleep: a protocol for a randomized controlled trial (the Study for Mother-Infant Sleep “SMILE”). SLEEP ADVANCES 2022; 3:zpab020. [PMID: 35156040 PMCID: PMC8824577 DOI: 10.1093/sleepadvances/zpab020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Revised: 11/23/2021] [Indexed: 11/19/2022]
Abstract
Symptoms of insomnia are common during the perinatal periods and are linked to adverse parent/infant outcomes. Theories on insomnia development (e.g. 3P model) suggest that significant sleep disruption (e.g. nighttime infant care) can precipitate, while unhelpful sleep-related cognitions/behaviors can perpetuate parental insomnia symptoms. This study aims to examine how two interventions, one addressing infant sleep as the precipitator, the other targeting maternal sleep-related cognitions/behaviors as the perpetuator, might prevent postpartum insomnia. Participants are 114 nulliparous females 26 to 32 weeks gestation, with self-reported insomnia symptoms (Insomnia Severity Index scores ≥ 8). Participants are randomized to one of three conditions and receive: (1) a “responsive bassinet” used until 6 months postpartum, designed to boost/consolidate infant sleep and target infant sleep as a precipitator of insomnia, (2) therapist-assisted cognitive behavioral therapy for insomnia, addressing unhelpful sleep-related cognitions/behaviors as perpetuators of insomnia, or (3) a sleep hygiene booklet (control condition). The primary outcome is maternal insomnia symptoms. Secondary outcomes include maternal sleep duration/quality, mental health (e.g. depression, anxiety), and wellbeing-related variables (e.g. sleep-related impairment). Outcomes are assessed using validated instruments at 26–32 and 35–36 weeks’ gestation, and 2, 6, and 12 months postpartum. This study adopts an early-intervention approach and longitudinally compares two distinct approaches to prevent postpartum insomnia in an at-risk population. If interventions are efficacious, findings will demonstrate how interventions targeting different mechanisms mitigate insomnia symptoms in perinatal populations. This will provide empirical evidence for future development of multi-component sleep intervention to improve mother-infant wellbeing. Clinical Trial Registration: The Study for Mother-Infant Sleep (The SMILE Project): reducing postpartum insomnia using an infant sleep intervention and a maternal sleep intervention in first-time mothers. https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=377927, Australian New Zealand Clinical Trials Registry: ACTRN12619001166167.
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Affiliation(s)
- Nina Quin
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia
- Women’s Mental Health Service, Royal Women’s Hospital, Melbourne, Victoria, Australia
| | - Liat Tikotzky
- Department of Psychology, Ben-Gurion University of the Negev, Be’er Sheva, Israel
| | - Lesley Stafford
- Women’s Mental Health Service, Royal Women’s Hospital, Melbourne, Victoria, Australia
- School of Psychological Sciences, University of Melbourne, Melbourne, Victoria, Australia
| | - Jane Fisher
- Global and Women’s Health, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Bei Bei
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia
- Women’s Mental Health Service, Royal Women’s Hospital, Melbourne, Victoria, Australia
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17
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Kalmbach DA, Cheng P, Roth A, Roth T, Swanson LM, O'Brien LM, Fresco DM, Harb NC, Cuamatzi-Castelan AS, Reffi AN, Drake CL. DSM-5 insomnia disorder in pregnancy: associations with depression, suicidal ideation, and cognitive and somatic arousal, and identifying clinical cutoffs for detection. SLEEP ADVANCES : A JOURNAL OF THE SLEEP RESEARCH SOCIETY 2022; 3:zpac006. [PMID: 35391758 PMCID: PMC8981986 DOI: 10.1093/sleepadvances/zpac006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Revised: 02/18/2022] [Indexed: 11/23/2022]
Abstract
Study Objectives The study had three primary goals. First, we estimated survey-assessed DSM-5 insomnia disorder rates in pregnancy, and described associated sociodemographics, and sleep-wake and mental health symptoms. Second, we derived cutoffs for detecting DSM-5 insomnia disorder using common self-report measures of sleep symptoms. Third, we identified clinically relevant cut-points on measures of nocturnal cognitive and somatic arousal. Methods Ninety-nine women (85.9% in the 2nd trimester) completed online surveys including DSM-5 insomnia disorder criteria, the Insomnia Severity Index (ISI), Pittsburgh Sleep Quality Index (PSQI), Presleep Arousal Scale's Cognitive (PSASC) and Somatic (PSASS) factors, and Edinburgh Postnatal Depression Scale. Results DSM-5 insomnia disorder rate was 19.2%. Insomnia was associated with depression, suicidality, nocturnal cognitive and somatic arousal, and daytime sleepiness. An ISI scoring method that aligns with DSM-5 criteria yielded excellent metrics for detecting insomnia disorder and good sleep. Regarding quantitative cutoffs, ISI ≥ 10 and ISI ≥ 11 (but not ISI ≥ 15) were supported for detecting DSM-5 insomnia, whereas ISI ≤ 7 and ISI ≤ 9 performed well for detecting good sleep. PSQI cutoff of 5 was supported for detecting insomnia and good sleep. The optimal cutoff for nocturnal cognitive arousal was PSASC ≥ 18, whereas the optimal cutoff for somatic arousal was PSASS ≥ 13. Conclusions Insomnia disorder affects a large segment of pregnant women. Empirically derived cutoffs for insomnia, good sleep, cognitive arousal, and somatic arousal may inform case identification and future perinatal sleep research methodology.
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Affiliation(s)
- David A Kalmbach
- Thomas Roth Sleep Disorders & Research Center, Henry Ford Health System, Detroit, MIUSA.,Department of Pulmonary & Critical Care and Sleep Medicine, Wayne State University School of Medicine, Detroit, MIUSA
| | - Philip Cheng
- Thomas Roth Sleep Disorders & Research Center, Henry Ford Health System, Detroit, MIUSA
| | - Andrea Roth
- Pediatric Sleep Medicine, Thriving Minds Behavioral Health, Livonia, MIUSA
| | - Thomas Roth
- Thomas Roth Sleep Disorders & Research Center, Henry Ford Health System, Detroit, MIUSA
| | - Leslie M Swanson
- Department of Psychiatry, University of Michigan, Ann Arbor, MIUSA
| | - Louise M O'Brien
- Departments of Obstetrics & Gynecology and Neurology, University of Michigan, Ann Arbor, MIUSA
| | - David M Fresco
- Department of Psychiatry, University of Michigan, Ann Arbor, MIUSA
| | - Nicholas C Harb
- Thomas Roth Sleep Disorders & Research Center, Henry Ford Health System, Detroit, MIUSA
| | | | - Anthony N Reffi
- Thomas Roth Sleep Disorders & Research Center, Henry Ford Health System, Detroit, MIUSA
| | - Christopher L Drake
- Thomas Roth Sleep Disorders & Research Center, Henry Ford Health System, Detroit, MIUSA
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18
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De Chiara L, Mazza C, Ricci E, Koukopoulos AE, Kotzalidis GD, Bonito M, Callovini T, Roma P, Angeletti G. The Relevance of Insomnia in the Diagnosis of Perinatal Depression: Validation of the Italian Version of the Insomnia Symptom Questionnaire. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:12507. [PMID: 34886233 PMCID: PMC8656599 DOI: 10.3390/ijerph182312507] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Revised: 11/21/2021] [Accepted: 11/22/2021] [Indexed: 12/01/2022]
Abstract
BACKGROUND Sleep disorders are common in perinatal women and may underlie or trigger anxiety and depression. We aimed to translate and validate and evaluate the psychometric properties of the Italian version of the Insomnia Symptom Questionnaire (ISQ), in a sample of women during late pregnancy and 6-months postpartum according to the DSM-5 criteria. METHODS The ISQ was administered to 292 women prenatally along with other measures of sleep quality, depression, and anxiety, to examine its construct and convergent validity. Women were readministered the ISQ six months postdelivery to assess test-retest reliability. Women were divided into DSM-5 No-Insomnia (N = 253) and Insomnia (N = 39) groups. RESULTS The insomnia group had received more psychopharmacotherapy, had more psychiatric family history, increased rates of medically assisted reproduction, of past perinatal psychiatric disorders, and scored higher on almost all TEMPS-A dimensions, on the EPDS, HCL-32, PSQI, and on ISQ prenatally and postnatally. ISQ scores correlated with all scales, indicating adequate convergent and discriminant validity; furthermore, it showed antenatal-postnatal test-retest reliability, 97.5% diagnostic accuracy, 79.5% sensitivity, 94.9% specificity, 70.5% positive predictive power, and 92.8% negative predictive power. CONCLUSIONS The ISQ is useful, valid, and reliable for assessing perinatal insomnia in Italian women. The Italian version showed equivalent properties to the original version.
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Affiliation(s)
- Lavinia De Chiara
- Department of Neurosciences, Mental Health, Sensory Functions (NESMOS), Sant’Andrea University Hospital, Faculty of Medicine and Psychology, Sapienza University of Rome, Via Grottarossa 1035-1039, 00189 Rome, Italy; (L.D.C.); (G.D.K.); (G.A.)
| | - Cristina Mazza
- Department of Neuroscience, Imaging and Clinical Sciences, G. d’Annunzio University of Chieti-Pescara, Via dei Vestini 31, 66100 Chieti, Italy; (C.M.); (E.R.)
| | - Eleonora Ricci
- Department of Neuroscience, Imaging and Clinical Sciences, G. d’Annunzio University of Chieti-Pescara, Via dei Vestini 31, 66100 Chieti, Italy; (C.M.); (E.R.)
| | - Alexia Emilia Koukopoulos
- Department of Neuroscience/Mental Health, UOC Psichiatria, Psicofarmacologia Clinica, Azienda Ospedaliera Universitaria Policlinico Umberto I, Viale Regina Elena, 328, 00161 Rome, Italy;
| | - Georgios D. Kotzalidis
- Department of Neurosciences, Mental Health, Sensory Functions (NESMOS), Sant’Andrea University Hospital, Faculty of Medicine and Psychology, Sapienza University of Rome, Via Grottarossa 1035-1039, 00189 Rome, Italy; (L.D.C.); (G.D.K.); (G.A.)
| | - Marco Bonito
- Dipartimento Materno Infantile, San Pietro Fatebenefratelli Hospital, Via Cassia, 600, 00189 Rome, Italy;
| | - Tommaso Callovini
- Department of Medicine and Surgery, University of Milano Bicocca, Via Cadore 48, 20900 Monza, Italy;
| | - Paolo Roma
- Department of Human Neurosciences, Sapienza University of Rome, Viale Regina Elena 334, 00161 Rome, Italy
| | - Gloria Angeletti
- Department of Neurosciences, Mental Health, Sensory Functions (NESMOS), Sant’Andrea University Hospital, Faculty of Medicine and Psychology, Sapienza University of Rome, Via Grottarossa 1035-1039, 00189 Rome, Italy; (L.D.C.); (G.D.K.); (G.A.)
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19
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Felder JN, Epel ES, Neuhaus J, Krystal AD, Prather AA. Randomized controlled trial of digital cognitive behavior therapy for prenatal insomnia symptoms: Effects on postpartum insomnia and mental health. Sleep 2021; 45:6444826. [PMID: 34850238 DOI: 10.1093/sleep/zsab280] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Revised: 10/04/2021] [Indexed: 11/14/2022] Open
Abstract
STUDY OBJECTIVES To evaluate the effects of digital cognitive behavior therapy for insomnia (dCBT-I) delivered during pregnancy on subjective sleep outcomes, depressive symptoms, and anxiety symptoms through six months postpartum. METHODS People up to 28 weeks gestation (N=208) with insomnia were randomized to six weekly sessions of dCBT-I or standard care. We report follow-up data at three and six months postpartum. The primary outcome was insomnia symptom severity. Secondary sleep outcomes included global sleep quality and insomnia caseness. Mental health outcomes included depressive and anxiety symptom severity. We evaluated between-condition differences in change from baseline for each postpartum timepoint and categorical outcomes. RESULTS dCBT-I participants did not experience significantly greater improvements in insomnia symptom severity relative to standard care participants, but they did experience higher rates of insomnia remission and lower rates of insomnia caseness at six months postpartum. dCBT-I participants experienced greater improvements in depressive symptom severity from baseline to both postpartum timepoints, and in anxiety symptom severity from baseline to three months postpartum. The proportion of participants with probable major depression at three months postpartum was significantly higher among standard care (18%) than dCBT-I (4%, p=.006) participants; this between-condition difference was pronounced among the subset (n=143) with minimal depressive symptoms at baseline (18% vs 0%). CONCLUSION dCBT-I use during pregnancy leads to enduring benefits for postpartum insomnia remission. Findings provide strong preliminary evidence that dCBT-I use during pregnancy may prevent postpartum depression and anxiety, which is notable when considering the high frequency and importance of these problems.
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Affiliation(s)
- Jennifer N Felder
- Osher Center for Integrative Medicine, University of California, San Francisco, USA.,Department of Psychiatry, University of California, San Francisco, USA
| | - Elissa S Epel
- Department of Psychiatry, University of California, San Francisco, USA.,Center for Health and Community, University of California, San Francisco, USA
| | - John Neuhaus
- Department of Epidemiology and Biostatistics, University of California, San Francisco, USA
| | - Andrew D Krystal
- Department of Psychiatry, University of California, San Francisco, USA
| | - Aric A Prather
- Department of Psychiatry, University of California, San Francisco, USA.,Center for Health and Community, University of California, San Francisco, USA
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20
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Vine T, Brown GM, Frey BN. Melatonin use during pregnancy and lactation: A scoping review of human studies. BRAZILIAN JOURNAL OF PSYCHIATRY 2021; 44:342-348. [PMID: 34730672 PMCID: PMC9169489 DOI: 10.1590/1516-4446-2021-2156] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Accepted: 09/01/2021] [Indexed: 11/22/2022]
Abstract
OBJECTIVE The prevalence of sleep disorders during the perinatal period is high and large health administrative database surveys have shown that the use of exogenous melatonin in pregnant populations is quite common, about 4%. Much of the concern about using melatonin during pregnancy and breastfeeding stems from animal research. Thus, the objective of this article is to provide a critical review of human studies related to exogenous melatonin use during pregnancy and breastfeeding. METHODS The electronic databases Ovid, MEDLINE, Embase, and the Cochrane Library were searched using terms and keywords related to melatonin, pregnancy, and breastfeeding. RESULTS Fifteen studies were included in this review. Eight focused on melatonin use during pregnancy and seven focused on melatonin use during breastfeeding. There was a variety of study designs, including case reports, cohort studies, and clinical trials. There is a lack of randomized, controlled trials examining the efficacy and safety of melatonin as a treatment for sleep disorders during pregnancy or breastfeeding and, notably, insomnia was not the primary outcome measure in any of the studies included in this review. Clinical trials that used exogenous melatonin during pregnancy and breastfeeding for other clinical conditions have not suggested major safety concerns or adverse events. CONCLUSION Contrary to what animal studies have suggested, evidence from clinical studies to date suggests that melatonin use during pregnancy and breastfeeding is probably safe in humans. This review further emphasizes the need for clinical studies on sleep disorders, including exogenous melatonin, during pregnancy and lactation.
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Affiliation(s)
- Tya Vine
- Michael G. DeGroote School of Medicine, McMaster University, Hamilton, ON, Canada
| | - Gregory M Brown
- Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada.,Molecular Brain Science Department, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Benicio N Frey
- Women's Health Concerns Clinic and Mood Disorder Program, St Joseph's Healthcare Hamilton, Hamilton, ON, Canada.,Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON, Canada
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21
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Sedov ID, Tomfohr-Madsen LM. Trajectories of Insomnia Symptoms and Associations with Mood and Anxiety from Early Pregnancy to the Postpartum. Behav Sleep Med 2021; 19:395-406. [PMID: 32496138 DOI: 10.1080/15402002.2020.1771339] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Objective/Background: The current study identified heterogeneous trajectories of insomnia symptoms from early pregnancy to early postpartum. The relationship between demographic and psychological predictors of trajectories and associations between trajectory group membership and symptoms of postpartum depression and anxiety were also explored.Participants: 142 pregnant women were enrolled in a prospective online survey.Method: Women were recruited from a maternity clinic in Calgary, AB and completed measures of insomnia symptoms, depression, generalized anxiety, and interpersonal support at four time-points. Women were recruited and completed the first survey before 20 weeks gestation and were reassessed every 10 weeks. Women were on average 15 weeks gestation, 25 weeks gestation, 35 weeks gestation, and 6 weeks postpartum at the respective time-points. Group-based trajectory analysis was used to determine trajectories of pregnancy insomnia symptoms.Results: Three trajectory groups were identified. A no insomnia group (42.3%) in which women reported consistently low insomnia symptoms. A subclinical insomnia group (44.3%) in which women reported subclinical symptoms which briefly elevated to clinical levels in late-pregnancy, and a clinical insomnia group (13.4%) in which women reported consistently elevated insomnia symptoms. Baseline predictors of membership group included anxiety, depression, and ethnicity such that members of the clinical insomnia group were more likely to also endorse anxiety and depression. Membership in the clinical insomnia group was associated with higher postpartum generalized anxiety and depressive symptoms. Additionally, the clinical insomnia group were more likely to experience symptoms indicative of clinically significant depression.Conclusions: A small group of pregnant women experienced consistently high and elevated insomnia symptoms throughout pregnancy and another larger group endorsed consistently elevated but subthreshold symptoms. Future studies should explore long-term consequences of experiencing high insomnia symptomatology during pregnancy and early postpartum, as well as safe and efficacious interventions.
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Affiliation(s)
- Ivan D Sedov
- Department of Psychology, University of Calgary, Calgary, Alberta, Canada
| | - Lianne M Tomfohr-Madsen
- Department of Psychology, University of Calgary, Calgary, Alberta, Canada.,Child Health Psychology, Alberta Children's Hospital Research Institute for Child and Maternal Health (ACHRI), Calgary, Alberta, Canada.,Department of Pediatrics, Alberta Children's Hospital, Calgary, Alberta, Canada
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22
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Osnes RS, Eberhard-Gran M, Follestad T, Kallestad H, Morken G, Roaldset JO. Mid-Pregnancy Insomnia and its Association with Perinatal Depressive Symptoms: A Prospective Cohort Study. Behav Sleep Med 2021; 19:285-302. [PMID: 32228307 DOI: 10.1080/15402002.2020.1743705] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Objective/Background: Insomnia and depression are disorders that affect many perinatal women and that often are interrelated. The present study aimed to examine concurrent and prospective associations between mid-pregnancy insomnia and depression during mid-pregnancy and 8 weeks postpartum. Furthermore, differences in depression and in the sleep-related characteristics insomnia, chronotype, and sleep efficiency were explored between the two time points (mid-pregnancy versus 8 weeks postpartum), and between primiparous and multiparous participants.Participants/Methods: The study was part of the Norwegian population-based Depression and Anxiety in the Perinatal Period (DAPP) prospective cohort study. Among 539 women that were recruited for participation when receiving a routine ultrasound examination, we analyzed data from hospital birth records and questionnaire responses from pregnancy week 17 and postpartum week 8. We used the Edinburgh Postnatal Depression Scale to measure depression. The Bergen Insomnia Scale, the reduced Horne-Östberg Morningness-Eveningness Questionnaire, and three questions from the Pittsburgh Sleep Quality Index were used to measure the sleep-related characteristics.Results: Mid-pregnancy insomnia was significantly associated with concurrent depression (p < .001), but not with postpartum depression (p = .288), in a linear mixed model with adjustment for several reproductive and psychosocial variables. Sleep efficiency was reduced from mid-pregnancy to postpartum (from 88% to 77%), and primiparous women reported less efficient sleep than multiparous women after childbirth.Conclusions: The results indicate that mid-pregnancy insomnia may be a marker for concurrent depression but not a predictor of postpartum depression. Future research should examine the extent to which treatment of insomnia from mid-pregnancy on reduces both perinatal insomnia and depression.
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Affiliation(s)
- Rannveig S Osnes
- Department of Psychiatry, Ålesund Hospital, Møre & Romsdal Hospital Trust, Ålesund, Norway.,Department of Mental Health, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway
| | - Malin Eberhard-Gran
- Institute of Clinical Medicine, Campus Ahus, University of Oslo, Lørenskog, Norway.,Department of Infant Mental Health, Regional Center for Child and Adolescent Mental Health, Eastern and Southern Norway, Oslo, Norway
| | - Turid Follestad
- Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway
| | - Håvard Kallestad
- Department of Mental Health, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway.,Østmarka Department of Psychiatry, St Olavs Hospital HF, Trondheim University Hospital, Trondheim, Norway
| | - Gunnar Morken
- Department of Mental Health, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway.,Østmarka Department of Psychiatry, St Olavs Hospital HF, Trondheim University Hospital, Trondheim, Norway
| | - John Olav Roaldset
- Department of Mental Health, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway.,Centre for Research and Education in Forensic Psychiatry, Oslo University Hospital, Oslo, Norway
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23
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Wang J, Zhou Y, Qian W, Zhou Y, Han R, Liu Z. Maternal insomnia during the COVID-19 pandemic: associations with depression and anxiety. Soc Psychiatry Psychiatr Epidemiol 2021; 56:1477-1485. [PMID: 33891160 PMCID: PMC8063170 DOI: 10.1007/s00127-021-02072-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Accepted: 01/29/2021] [Indexed: 12/04/2022]
Abstract
BACKGROUND The COVID-19 outbreak has made people more prone to depression, anxiety and insomnia, and females are at a high risk of developing these conditions. As a special group, pregnant and lying-in women must pay close attention to their physical and mental health, as both have consequences for the mother and the fetus. However, knowledge regarding the status of depression, anxiety and insomnia among these women is limited. AIM This study aimed to examine insomnia and psychological factors among pregnant and lying-in women during the COVID-19 pandemic and provide theoretical support for intervention research. METHODS In total, 2235 pregnant and lying-in women from 12 provinces in China were surveyed; their average age was 30.25 years (SD = 3.99, range = 19-47 years). PARTICIPANTS AND SETTING The participants completed electronic questionnaires designed to collect demographic information and assess levels of depression, anxiety and insomnia. RESULTS The prevalence of insomnia in the sample was 18.9%. Depression and anxiety were significant predictors of insomnia. Participants in high-risk areas, those with a disease history, those with economic losses due to the outbreak, and those in the postpartum period had significantly higher insomnia scores. DISCUSSION The incidence of insomnia among pregnant and lying-in women is not serious in the context of the epidemic, which may be related to the sociocultural background and current epidemic situation in China. CONCLUSION Depression and anxiety are more indicative of insomnia than demographic variables.
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Affiliation(s)
- Jiazhou Wang
- grid.9227.e0000000119573309Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, 16 Lincui Road, Chaoyang District, Beijing, 100101 China ,grid.410726.60000 0004 1797 8419Department of Psychology, University of Chinese Academy of Sciences, Beijing, 100049 China
| | - Yongjie Zhou
- grid.452897.50000 0004 6091 8446Department of Psychiatric Rehabilitation, Shenzhen Kangning Hospital, Shenzhen, 518020 China
| | - Wei Qian
- grid.9227.e0000000119573309Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, 16 Lincui Road, Chaoyang District, Beijing, 100101 China
| | - Yueyue Zhou
- grid.9227.e0000000119573309Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, 16 Lincui Road, Chaoyang District, Beijing, 100101 China ,grid.410726.60000 0004 1797 8419Department of Psychology, University of Chinese Academy of Sciences, Beijing, 100049 China
| | - Ru Han
- Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, 16 Lincui Road, Chaoyang District, Beijing, 100101, China. .,Department of Psychology, University of Chinese Academy of Sciences, Beijing, 100049, China.
| | - Zhengkui Liu
- Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, 16 Lincui Road, Chaoyang District, Beijing, 100101, China. .,Department of Psychology, University of Chinese Academy of Sciences, Beijing, 100049, China.
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24
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Xiao M, Huang G, Feng L, Luan X, Wang Q, Ren W, Chen S, He J. Impact of sleep quality on post-stroke anxiety in stroke patients. Brain Behav 2020; 10:e01716. [PMID: 33140545 PMCID: PMC7749555 DOI: 10.1002/brb3.1716] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2019] [Revised: 04/05/2020] [Accepted: 05/24/2020] [Indexed: 01/09/2023] Open
Abstract
OBJECTIVE To explore whether poor sleep is associated with post-stroke anxiety (PSA) in Chinese patients with acute ischemic stroke (AIS) and to verify whether poor sleep is a predictor of PSA. METHODS A total of 327 patients with AIS were enrolled and followed up for 1 month. Sleep quality within 1 month before stroke was evaluated using the Pittsburgh Sleep Quality Index (PSQI) at admission. The patients were divided into the poor sleep group (PSQI > 7, n = 76) and good sleep group (PSQI ≤ 7, n = 251). One month after stroke, patients with obvious anxiety symptoms and a Hamilton Anxiety Scale score >7 were diagnosed with PSA. RESULTS Eighty-seven patients (26.6%) were diagnosed with PSA. Compared to the good sleep quality group, the incidence of PSA in patients with poor sleep quality was higher (42.1% vs. 21.9%, p = .001). Poor sleep quality is more common in patients with PSA (35.6% vs. 18.8%, p = .001). A logistic regression analysis indicated that poor sleep quality was significantly associated with PSA (OR: 2.265, 95% CI: 1.262-4.067, p = .003). After adjusting for conventional and identified risk factors, poor sleep quality was found to be independently associated with PSA (OR: 2.676, 95% CI: 1.451-4.936, p = .001). CONCLUSIONS Poor sleep quality before stroke was associated with PSA and may be an independent risk factor of PSA 1 month after AIS onset.
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Affiliation(s)
- Meijuan Xiao
- Department of Neurology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Guiqian Huang
- Department of Neurology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Liang Feng
- Department of Neurology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Xiaoqian Luan
- Department of Neurology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Qiongzhang Wang
- Department of Neurology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Wenwei Ren
- Department of Neurology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Siyan Chen
- Department of Neurology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Jincai He
- Department of Neurology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
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25
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Wang Y, Zhu LY, Ma YF, Bo HX, Deng HB, Cao J, Wang Y, Wang XJ, Xu Y, Lu QD, Wang H, Wu XJ. Association of insomnia disorder with sociodemographic factors and poor mental health in COVID-19 inpatients in China. Sleep Med 2020; 75:282-286. [PMID: 32919351 PMCID: PMC7837174 DOI: 10.1016/j.sleep.2020.06.011] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2020] [Revised: 06/08/2020] [Accepted: 06/08/2020] [Indexed: 12/24/2022]
Abstract
PURPOSE To examine insomnia disorder and its association with sociodemographic factors and poor mental health in 2019 novel coronavirus (COVID-19) inpatients in Wuhan, China. DESIGN and Methods: A total of 484 COVID-19 inpatients in Wuhan Tongji Hospital were selected and interviewed with standardized assessment tools. Insomnia disorder was measured by the Chinese version of the Insomnia Severity Index (ISI-7), a total score of 8 or more was accepted as the threshold for diagnosing insomnia disorder. RESULTS The prevalence of insomnia disorder in the whole sample was 42.8%. Binary logistic regression analysis revealed that female gender, younger age, and higher fatigue and anxiety severity were more likely to experience insomnia disorder. CONCLUSION Given the high rate of insomnia disorder status among COVID-19 inpatients in Wuhan, China, and its negative effects, follow-up assessments and appropriate psychological interventions for insomnia disorder are needed in this population.
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Affiliation(s)
- Yu Wang
- Department of Nursing, Chinese Academy of Medical Sciences - Peking Union Medical College, Peking Union Medical College Hospital, Beijing, China
| | - Li-Yun Zhu
- Department of Nursing, Chinese Academy of Medical Sciences - Peking Union Medical College, Peking Union Medical College Hospital, Beijing, China
| | - Yu-Fen Ma
- Outpatient Department, Chinese Academy of Medical Sciences - Peking Union Medical College, Peking Union Medical College Hospital, Beijing, China
| | - Hai-Xin Bo
- Department of Nursing, Chinese Academy of Medical Sciences - Peking Union Medical College, Peking Union Medical College Hospital, Beijing, China
| | - Hai-Bo Deng
- Department of Cardiac Surgery, Chinese Academy of Medical Sciences - Peking Union Medical College, Peking Union Medical College Hospital, Beijing, China
| | - Jing Cao
- Department of Nursing, Chinese Academy of Medical Sciences - Peking Union Medical College, Peking Union Medical College Hospital, Beijing, China
| | - Ying Wang
- Nursing Administration Department of Tongji Hospital, Tongji Medical College of Huazhong University of Science and Technology, Wuhan, China
| | - Xiao-Jie Wang
- Department of Breast Surgery, Chinese Academy of Medical Sciences - Peking Union Medical College, Peking Union Medical College Hospital, Beijing, China
| | - Yuan Xu
- Department of Orthopedic Surgery, Chinese Academy of Medical Sciences - Peking Union Medical College, Peking Union Medical College Hospital, Beijing, China
| | - Qiao-Dan Lu
- Nursing College, Chinese Academy of Medical Sciences - Peking Union Medical College, Beijing, China
| | - Hui Wang
- Nursing Administration Department of Tongji Hospital, Tongji Medical College of Huazhong University of Science and Technology, Wuhan, China.
| | - Xin-Juan Wu
- Department of Nursing, Chinese Academy of Medical Sciences - Peking Union Medical College, Peking Union Medical College Hospital, Beijing, China.
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26
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Swanson LM, Kalmbach DA, Raglan GB, O’Brien LM. Perinatal Insomnia and Mental Health: a Review of Recent Literature. Curr Psychiatry Rep 2020; 22:73. [PMID: 33104878 PMCID: PMC9109228 DOI: 10.1007/s11920-020-01198-5] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/14/2020] [Indexed: 02/06/2023]
Abstract
PURPOSE OF REVIEW The perinatal period is a time of high risk for insomnia and mental health conditions. The purpose of this review is to critically examine the most recent literature on perinatal insomnia, focusing on unique features of this period which may confer specific risk, associations with depression and anxiety, and emerging work on perinatal insomnia treatment. RECENT FINDINGS A majority of perinatal women experience insomnia, which may persist for years, and is associated with depression and anxiety. Novel risk factors include personality characteristics, nocturnal perinatal-focused rumination, and obesity. Mindfulness and physical activity may be protective. Cognitive-behavioral therapy for insomnia is an effective treatment. Perinatal insomnia is exceedingly common, perhaps due to factors unique to this period. Although closely linked to perinatal mental health, more work is needed to establish causality. Future work is also needed to establish the role of racial disparities, tailor treatments, and determine whether insomnia treatment improves perinatal mental health.
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Affiliation(s)
- Leslie M. Swanson
- Department of Psychiatry, University of Michigan, Ann Arbor, MI;,Corresponding Author: Leslie M. Swanson, Department of Psychiatry, University of Michigan, 4250 Plymouth Rd, Ann Arbor, MI 48109,
| | - David A. Kalmbach
- Sleep Disorders and Research Center, Henry Ford Hospital, Detroit, MI
| | - Greta B. Raglan
- Department of Psychiatry, University of Michigan, Ann Arbor, MI
| | - Louise M. O’Brien
- Department of Neurology, Sleep Disorders Center, University of Michigan, Ann Arbor, MI
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27
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Felder JN, Epel ES, Neuhaus J, Krystal AD, Prather AA. Efficacy of Digital Cognitive Behavioral Therapy for the Treatment of Insomnia Symptoms Among Pregnant Women: A Randomized Clinical Trial. JAMA Psychiatry 2020; 77:484-492. [PMID: 31968068 PMCID: PMC6990703 DOI: 10.1001/jamapsychiatry.2019.4491] [Citation(s) in RCA: 77] [Impact Index Per Article: 19.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
IMPORTANCE Despite the prevalence and adverse consequences of prenatal insomnia, a paucity of research is available regarding interventions to improve insomnia symptoms during pregnancy. OBJECTIVE To test the efficacy of digital cognitive behavioral therapy for insomnia (CBT-I) compared with standard treatment among pregnant women with insomnia symptoms. DESIGN, SETTING, AND PARTICIPANTS This randomized clinical trial enrolled pregnant women from November 23, 2016, to May 22, 2018. Of the 2258 women assessed for eligibility using an online self-report questionnaire, 208 were randomized to receive digital CBT-I (n = 105) or standard treatment (n = 103) for insomnia. Participants were pregnant up to 28 weeks' gestation, and they either had elevated insomnia symptom severity or met the criteria for insomnia caseness as determined by self-report questionnaires. Participants completed outcome measures at 10 weeks (postintervention) and 18 weeks (follow-up) after randomization. All study visits were completed remotely, and the intervention was delivered digitally. Data were analyzed between December 12, 2018, and July 2, 2019. INTERVENTIONS Digital CBT-I consisted of 6 weekly sessions of approximately 20 minutes each. Standard treatment reflected standard care. Women receiving standard treatment had no limits placed on the receipt of nonstudy treatments, including medication and psychotherapy. MAIN OUTCOMES AND MEASURES All outcomes were assessed remotely using self-report questionnaires administered via online survey. The primary outcome was the change in insomnia symptom severity (measured by the Insomnia Severity Index) from baseline to postintervention. Secondary outcomes were sleep efficiency and nightly sleep duration (defined by sleep diary), global sleep quality (measured by the Pittsburgh Sleep Quality Index), depressive symptom severity (measured by the Edinburgh Postnatal Depression Scale), and anxiety symptom severity (measured by the Generalized Anxiety Disorder Scale-7). For each outcome, we also examined the change from baseline to follow-up. RESULTS The 208 participants had a mean (SD) age of 33.6 (3.7) years and a mean (SD) gestational age of 17.6 (6.3) weeks at baseline. Most of the participants were white (138 [66.3%]), married or cohabiting (196 [94.2%]), had a college degree (180 [86.5%]), and earned $100 000 or more per year (141 [67.8%]). Women randomized to receive digital CBT-I experienced statistically significantly greater improvements in insomnia symptom severity from baseline to postintervention compared with women randomized to receive standard treatment (time-by-group interaction, difference = -0.36; 95% CI, -0.48 to -0.23; χ2 = 29.8; P < .001; d = -1.03). Improvements from baseline to postintervention for all secondary outcomes, with the exception of sleep duration, were statistically significant. A similar pattern of results was evident for the change from baseline to follow-up. CONCLUSIONS AND RELEVANCE In this trial, digital CBT was an effective, scalable, safe, and acceptable intervention for improving insomnia symptoms during pregnancy. TRIAL REGISTRATION ClinicalTrials.gov identifier: NCT02805998.
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Affiliation(s)
- Jennifer N. Felder
- Osher Center for Integrative Medicine, University of California, San Francisco, San Francisco,Department of Psychiatry, University of California, San Francisco, San Francisco
| | - Elissa S. Epel
- Department of Psychiatry, University of California, San Francisco, San Francisco,Center for Health and Community, University of California, San Francisco, San Francisco
| | - John Neuhaus
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco
| | - Andrew D. Krystal
- Department of Psychiatry, University of California, San Francisco, San Francisco
| | - Aric A. Prather
- Department of Psychiatry, University of California, San Francisco, San Francisco,Center for Health and Community, University of California, San Francisco, San Francisco
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28
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Osnes RS, Eberhard-Gran M, Follestad T, Kallestad H, Morken G, Roaldset JO. Mid-pregnancy insomnia is associated with concurrent and postpartum maternal anxiety and obsessive-compulsive symptoms: A prospective cohort study. J Affect Disord 2020; 266:319-326. [PMID: 32056894 DOI: 10.1016/j.jad.2020.01.140] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2019] [Revised: 12/04/2019] [Accepted: 01/25/2020] [Indexed: 02/06/2023]
Abstract
BACKGROUND Although many perinatal women are affected by anxiety, few studies have focused on perinatal anxiety and its potential triggers. The primary aim of this study was to examine concurrent and prospective associations between mid-pregnancy insomnia and perinatal anxiety. Furthermore, we compared psychosocial and reproductive characteristics between participants with and without mid-pregnancy insomnia and explored changes in the prevalence of obsessive-compulsive disorder (OCD) symptoms from mid-pregnancy to 8 weeks postpartum. METHODS This study was part of the Norwegian Depression and Anxiety in the Perinatal Period (DAPP) prospective, population-based, cohort study. We analyzed hospital birth records and questionnaire responses from pregnancy week 17 and postpartum week 8 (n = 530). The Bergen Insomnia Scale was used to measure insomnia and the Hopkins Symptom Checklist to measure anxiety. OCD symptoms were measured based on questions from the Mini-International Neuropsychiatric Interview. RESULTS Mid-pregnancy insomnia was significantly associated with both concurrent and postpartum anxiety in a linear mixed model adjusted for several potential confounders. Participants with mid-pregnancy insomnia had significantly higher levels of perinatal anxiety and postpartum OCD symptoms than participants with normal mid-pregnancy sleep. OCD symptoms affected more women after delivery than before (6.4% vs. 3.8% p = 0.034). LIMITATIONS Immigrants were underrepresented in our sample. CONCLUSION Our results suggest that mid-pregnancy insomnia is a marker for concurrent anxiety and predictor of postpartum anxiety. Future research should examine whether insomnia treatment starting in mid-pregnancy reduces both perinatal insomnia and anxiety. Health providers should also be aware that postpartum women have an increased risk of developing OCD symptoms.
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Affiliation(s)
- Rannveig S Osnes
- Department of Psychiatry, Ålesund Hospital, Møre & Romsdal Health Trust, Ålesund, Norway; Department of Mental Health, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway.
| | - Malin Eberhard-Gran
- Institute of Clinical Medicine, Campus Ahus, University of Oslo, Lørenskog, Norway; Department of Infant Mental Health, Regional Center for Child and Adolescent Mental Health, Eastern and Southern Norway, Oslo, Norway
| | - Turid Follestad
- Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway
| | - Håvard Kallestad
- Department of Mental Health, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway; Østmarka Department of Psychiatry, St Olavs Hospital HF, Trondheim University Hospital, Trondheim, Norway
| | - Gunnar Morken
- Department of Mental Health, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway; Østmarka Department of Psychiatry, St Olavs Hospital HF, Trondheim University Hospital, Trondheim, Norway
| | - John Olav Roaldset
- Department of Mental Health, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway; Centre for Research and Education in Forensic Psychiatry, Oslo University Hospital, Oslo, Norway
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29
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Hassinger AB, Bletnisky N, Dudekula R, El-Solh AA. Selecting a pharmacotherapy regimen for patients with chronic insomnia. Expert Opin Pharmacother 2020; 21:1035-1043. [PMID: 32202451 DOI: 10.1080/14656566.2020.1743265] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
INTRODUCTION Chronic insomnia, whether it is primary or in combination with another medical or psychiatric disorder, is a prevalent condition associated with significant morbidity, reduced productivity, increased risk of accidents, and poor quality of life. Pharmacologic and behavioral treatments have equivalent efficacy with each having its own advantages and limitations. AREAS COVERED The purpose of this perspective is to delineate the limitations encountered in implementing cognitive behavioral therapy (CBT) and to review the pharmacological treatments designed to target the different phenotypes of insomnia. The discussions address how to choose the optimal medication or combination thereof based on patients' characteristics, available medications, and the presence of comorbid conditions. Selective nonbenzodiazepine sedative 'Z-drug' hypnotics, melatonin receptor agonist-ramelteon, and low-dose doxepin are the agents of choice for treatment of primary and comorbid insomnia. EXPERT OPINION A pharmacological intervention should be offered if cognitive behavioral therapy for insomnia is not available or has failed to achieve its goals. Increasing evidence of the significant adverse consequences of long-term benzodiazepines should limit the prescription of these agents to specific conditions. Testing novel dosing regimens with a combination of hypnotic classes augmented with CBT deserve further investigation.
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Affiliation(s)
- Amanda B Hassinger
- Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo , Buffalo, NY, USA.,VA Western New York Healthcare System , Buffalo, NY, USA
| | - Nikolas Bletnisky
- Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo , Buffalo, NY, USA.,VA Western New York Healthcare System , Buffalo, NY, USA
| | - Rizwan Dudekula
- Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo , Buffalo, NY, USA.,VA Western New York Healthcare System , Buffalo, NY, USA
| | - Ali A El-Solh
- Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo , Buffalo, NY, USA.,VA Western New York Healthcare System , Buffalo, NY, USA.,Department of Epidemiology and Environmental Health, Research and Development, School of Public Health, University at Buffalo , Buffalo, NY, USA
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30
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Wang WJ, Hou CL, Jiang YP, Han FZ, Wang XY, Wang SB, Ng CH, Jia FJ. Prevalence and associated risk factors of insomnia among pregnant women in China. Compr Psychiatry 2020; 98:152168. [PMID: 32105909 DOI: 10.1016/j.comppsych.2020.152168] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2019] [Revised: 01/10/2020] [Accepted: 02/12/2020] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND Insomnia is common during pregnancy but the prevalence and risk factors of insomnia in Chinese women during pregnancy is not well studied. This study aimed to examine the prevalence of insomnia and its risk factors in Chinese women during pregnancy. METHODS In this cross sectional study, 436 Chinese pregnant women with Insomnia Severity Index (ISI) ≥ 8 were clinically assessed using the insomnia criteria based on the combination of DSM-IV (Diagnostic and Statistical Manual-4th Edition) and ICD-10 (International Classification of Dieases, 10th Edition). Beck Depression Inventory (BDI), State-Trait Anxiety Inventory (STAI), Dysfunctional Beliefs and Attitudes about Sleep Scale (DBAS), Pregnancy Pressure Scale (PPS), Perceived physical discomfort level and number, Epworth Sleepiness Scale (ESS), and a general socio-demographic questionnaire were administered. RESULTS The results showed that about 20% of the pregnant women met the strict diagnosis criteria of insomnia. Independent-samples t-test revealed that several risk factors were correlated with the group with insomnia (N = 84) compared to the group without insomnia (N = 352). Binary Logistic regression analysis found that more significant bed partner influence (OR = 1.92, 95% CI: 1.03-3.60), depressive symptoms (OR = 1.07, 95% CI: 1.00-1.14), daytime sleepiness (OR = 1.07, 95% CI: 1.01-1.14), subjective somatic discomfort (OR = 2.27, 95% CI: 1.11-4.65), kinds of somatic discomfort (OR = 1.14, 95% CI: 1.03-1.27) and later gestation (OR = 1.05, 95% CI: 1.01-1.09) were significantly associated with insomnia. CONCLUSION In this cohort of Chinese pregnant women, about a fifth of women suffered from clinically significant insomnia. Measures to prevent the adverse effects of insomnia should be provided to pregnant women with depressive symptoms, Sleep disturbance of the bed partner, excessive daytime sleepiness and somatic discomfort, especially late in gestation.
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Affiliation(s)
- Wen-Jing Wang
- The Second School of Clinical Medicine, Southern Medical University, Guangzhou, Guangdong Province, China; Guangdong Mental Health Center, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong Province, China
| | - Cai-Lan Hou
- Guangdong Mental Health Center, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong Province, China.
| | - Yan-Ping Jiang
- Department of Obstetrics, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong Province, China
| | - Feng-Zhen Han
- Department of Obstetrics, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong Province, China
| | - Xiao-Yun Wang
- Department of Obstetrics, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong Province, China
| | - Shi-Bin Wang
- Guangdong Mental Health Center, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong Province, China
| | - C H Ng
- Department of Psychiatry, The University of Melbourne, Melbourne, Victoria, Australia
| | - Fu-Jun Jia
- The Second School of Clinical Medicine, Southern Medical University, Guangzhou, Guangdong Province, China; Guangdong Mental Health Center, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong Province, China.
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Specific relations of dimensional anxiety and manifest anxiety disorders during pregnancy with difficult early infant temperament: a longitudinal cohort study. Arch Womens Ment Health 2020; 23:535-546. [PMID: 31927695 PMCID: PMC7369131 DOI: 10.1007/s00737-019-01015-w] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2019] [Accepted: 12/18/2019] [Indexed: 01/01/2023]
Abstract
Anxiety in the antenatal period is a common experience, associated with adverse consequences for mother and child. Specific types of prenatal anxiety may have unique associations with infant temperament. This study examines the prospective relationships between general prenatal anxiety, fear of childbirth, and specific prenatal anxiety disorders and early infant temperament 8 weeks postpartum. Data were derived from the Akershus Birth Cohort (ABC), a longitudinal cohort study which targeted all women scheduled to give birth at Akershus University Hospital, Norway. Psychometric measures pertained to general prenatal anxiety (Hopkins Symptom Checklist), fear of childbirth (Wijma delivery expectancy questionnaire), screening for manifest prenatal anxiety disorders based on questions from the mini-international neuropsychiatric interview, and difficult infant temperament (Infant Characteristics Questionnaire). The sample for the present study included 2206 women. General prenatal anxiety, fear of childbirth, agoraphobia, generalized anxiety disorder, and specific phobia presented unique significant prospective contributions to difficult infant temperament 8 weeks postpartum. Separate hierarchical regression models indicated that general prenatal anxiety and fear of childbirth provided the strongest unique contributions. Considering the burden on mothers and the potential long-term effects on child development, the findings of this study highlight the importance of screening women for different types of prenatal anxiety in routine obstetric care. Clinical awareness of the condition and its consequences is warranted. Due to the complexity of infant temperament as a construct with various influences, future research should consider mechanisms and influential factors pertaining to the relationship between prenatal anxiety and infant temperament.
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32
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Sleep Pharmacotherapy for Common Sleep Disorders in Pregnancy and Lactation. Chest 2019; 157:184-197. [PMID: 31622589 DOI: 10.1016/j.chest.2019.09.026] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2019] [Revised: 09/03/2019] [Accepted: 09/21/2019] [Indexed: 12/18/2022] Open
Abstract
Sleep disturbances are common in pregnancy, and sleep disorders may worsen or present de novo in the course of gestation. Managing a pregnant patient is complicated by the risk of teratogenicity, pharmacokinetic changes, and the dynamic nature of pregnancy. Although nonpharmacologic interventions are likely safest, they are often ineffective, and a patient is left dealing with frustrations of the sleep disturbance, as well as the negative outcomes of poor sleep in pregnancy. As with any other condition in pregnancy, management requires an understanding of pregnancy physiology, knowledge of the impact of a given condition on pregnancy or fetal and neonatal outcomes, and an ability to weigh the risk of the exposure to an untreated, or poorly treated condition, against the risk of a given drug. In partnership with the pregnant patient or couple, options for therapy should be reviewed in the context of the impact of the condition on pregnancy and offspring outcomes, while understanding that data (positive or negative) on the impact of therapy on perinatal outcomes are lacking. This article reviews the epidemiology of sleep disorders in pregnancy, general principles of prescribing in pregnancy and lactation, and safety surrounding therapeutic options in pregnancy.
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González-Mesa E, Cuenca-Marín C, Suarez-Arana M, Tripiana-Serrano B, Ibrahim-Díez N, Gonzalez-Cazorla A, Blasco-Alonso M. Poor sleep quality is associated with perinatal depression. A systematic review of last decade scientific literature and meta-analysis. J Perinat Med 2019; 47:689-703. [PMID: 31393835 DOI: 10.1515/jpm-2019-0214] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2019] [Accepted: 07/17/2019] [Indexed: 12/22/2022]
Abstract
Background Although pregnancy is frequently associated with mental states of happiness, hope and well-being, some physical and psychological changes can contribute to increased sleep disturbances and worsened sleep quality. Sleep quality has been linked to negative emotions, anxiety and depression. The main objective of this paper was to systematically review the impact of sleep during pregnancy on maternal mood, studying the association between objective and subjective measures of sleep quality and perinatal depression. Methods We performed a systematic review according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, which included studies published between January 2008 and April 2019, and met the following criteria: (i) studies on pregnant women assessing the effects of sleep quality variables on perinatal mood disorders, (ii) studies published in English and (iii) full paper published in a peer-reviewed scientific journal with full-text format available. Results A total of 36 studies published in the last decade met the inclusion criteria for qualitative review and eight of them were suitable for meta-analysis. Both confirmed the negative effects of poor sleep on perinatal mood. However, qualitative analysis showed that unrepresentative samples and low participation rates falling below 80% biased some of the studies. The standard random-effects meta-analysis showed a pooled size effect [ln odds ratio (OR) 1.49 (95% confidence interval [CI] 1.19, 1.79)] for perinatal depression in cases of poor prenatal sleep quality, although heterogeneity was moderate to high [Q 16.05, P ≤ 0.025, H2 2.45 (95% CI 1.01, 13.70)]. Conclusion Poor sleep quality was associated with perinatal mood disturbances. The assessment of sleep quality along the pregnancy could be advisable with a view to offering preventative or therapeutic interventions when necessary.
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Affiliation(s)
- Ernesto González-Mesa
- Surgical Specialties, Biochemistry and Immunology Department, Malaga University School of Medicine, 32, Boulevard Louis Pasteur, 29071 Málaga, Spain
- Obstetrics and Gynecology at Malaga University Hospital, Málaga, Spain
| | | | | | | | | | - Ana Gonzalez-Cazorla
- Surgical Specialties, Biochemistry and Immunology Department, Malaga University School of Medicine, 32, Boulevard Louis Pasteur, 29071 Málaga, Spain
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