Introduction
Black women disproportionately experience poor perinatal outcomes compared to other racial/ethnic groups. Poor sleep has emerged as a strong contributor to adverse pregnancy outcomes and, in the non-pregnant population, sleep-wake disturbances have a high prevalence with often greater severity among Blacks. Nonetheless, the majority of studies have included largely White populations which has restricted our understanding of race-specific burdens and morbidities of sleep disturbance. The goal was to describe the burden of sleep-wake disturbance in Black pregnant women and associations with pregnancy outcomes.
Methods
Black women at least 18years and >28 weeks pregnant were recruited from prenatal clinics. All women completed questionnaires about their sleep including the presence and timing of habitual-snoring (pre-pregnancy or pregnancy-onset), the Epworth Sleepiness Scale (ESS), and the General Sleep Disturbances Scale (GSDS) to determine poor sleep quality and poor daytime function as well as symptoms of insomnia. We also analyzed three commonly-reported sleep problems as individual question items (difficulty getting to sleep, wake up during sleep period, and wake up too early at the end of a sleep period). Demographic information and diagnoses were abstracted from medical records.
Results
Overall, 235 women enrolled; mean age was 27.6 + 6.2 years, mean BMI 31.7 + 9.8kg/m2, and 64% were in receipt of Medicaid. Eighty-percent of women reported >three sleep-wake disturbances, and almost half experienced a burden of >five disturbances. Women with pregnancy-onset habitual-snoring (but not those with pre-pregnancy habitual-snoring) had increased odds of poor sleep quality aOR 8.2 (95% CI 1.9, 35.9), trouble staying asleep aOR 3.6 (95% CI 1.0, 12.5), waking up too early aOR 2.7 (95% CI 1.1, 6.2), excessive daytime sleepiness aOR 2.3 (95% CI 1.1, 4.7), and poor daytime function aOR 8.7 (95% CI 2.5, 29.9). In contrast, women with pre-pregnancy habitual-snoring had increased odds for chronic hypertension, preterm delivery and fetal growth restriction; aOR 2.6 (95% CI 1.1, 6.3), aOR 2.8 (95% CI 1.1, 6.9), and aOR 5.1 (95% CI 1.7, 15.2), respectively.
Conclusion
Black women have a significant burden of sleep-wake disturbances. These findings highlight the excess risk that habitual-snoring confers to sleep-wake disturbances and perinatal outcomes in an infrequently studied yet highly vulnerable population.
Support (if any)
NIH NHLB-IHL089918