Sleep disturbance and cardiometabolic risk factors in early pregnancy: a preliminary study

Haney, Alyssa; Buysse, Daniel J.; Rosario, Bedda L.; Chen, Yifan; Okun, Michele L.

doi:10.1016/j.sleep.2014.01.003

Cited by 35 publications

(35 citation statements)

References 34 publications

(47 reference statements)

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“…Limited data on the association of sleep duration measures with hypertension in pregnancy are similarly conflicting. [20, 39] In our study of nulliparous women that excluded women with chronic hypertension, we failed to demonstrate a relationship between sleep duration and pregnancy-related hypertension. We were powered to detect an approximately 2-fold increase in risk, but cannot rule out the possibility of a more modest risk relationship.…”

Section: Discussionmentioning

confidence: 69%

Objectively measured short sleep duration and later sleep midpoint in pregnancy are associated with a higher risk of gestational diabetes

Facco

Grobman²,

Reid³

et al. 2017

American Journal of Obstetrics and Gynecology

145

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Background Experimental and epidemiologic data suggest that among non-pregnant adults, sleep duration may be an important risk factor for chronic disease. Although pregnant women commonly complain of poor sleep, few studies have objectively evaluated the quality of sleep in pregnancy or have explored the relationship between sleep disturbances and maternal and perinatal outcomes. Objectives Our objective was to examine the relationship between objectively assessed sleep duration, timing and continuity (measured via wrist actigraphy) and maternal cardiovascular and metabolic morbidity specific to pregnancy. Study Design This was a prospective cohort study of nulliparous women. Women were recruited between 16 0/7 and 21 6/7 weeks’ gestation. They were asked to wear a wrist actigraphy monitor and to complete a daily sleep log for a seven consecutive-day period. The primary sleep exposure variables were the averages of the following over the total valid nights (minimum 5, maximum 7 nights): short sleep duration during the primary sleep period (< 7 hours/night), late sleep midpoint (midpoint between sleep onset and sleep offset > 5 AM), and top quartile of minutes of wake time after sleep onset (WASO) and sleep fragmentation index. The primary outcomes of interest were a composite of hypertensive disorders of pregnancy (mild, severe, or superimposed preeclampsia; eclampsia; or antepartum gestational hypertension) and gestational diabetes (GDM). Chi-square tests were used to assess associations between sleep variables and categorical baseline characteristics. Crude odds ratios and 95% confidence intervals were estimated from univariate logistic regression models to characterize the magnitude of the relationship between sleep characteristics and hypertensive disorders of pregnancy and GDM. For associations that were significant in univariate analysis, multiple logistic regression was used to explore further the association of sleep characteristics with pregnancy outcomes. Results Nine-hundred and one eligible women consented to participate. Of these women 782 submitted valid actigraphy studies. Short sleep duration and a later sleep midpoint were associated with an increased risk of GDM (OR 2.24, 95% CI 1.11, 4.53; OR 2.58, 95% CI 1.24, 5.36, respectively) but not of hypertensive disorders. A model with both sleep duration and sleep midpoint as well as their interaction term revealed that while there was no significant interaction between these exposures, the main effects of both short sleep duration and later sleep midpoint with GDM remained significant (aOR 2.06, 95% CI 1.01, 4.19; aOR 2.37, 95% CI 1.13, 4.97, respectively). Additionally, after adjusting separately for age, BMI and race/ethnicity, both short sleep duration and later sleep midpoint remained associated with GDM. No associations were demonstrated between the sleep quality measures (WASO, sleep fragmentation) and hypertensive disorders or GDM. Conclusions Our results demonstrate a relationship between short sleep duration and later sleep midpoin...

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Section: Discussionmentioning

confidence: 69%

Objectively measured short sleep duration and later sleep midpoint in pregnancy are associated with a higher risk of gestational diabetes

Facco

Grobman²,

Reid³

et al. 2017

American Journal of Obstetrics and Gynecology

145

View full text Add to dashboard Cite

show abstract

“…This may be clinically relevant given the emerging evidence that sleep disturbance increases risk for adverse pregnancy outcomes. 33,66,67 Insomnia is associated with significant morbidities including an increased risk for depression, 18 stress, 65,68 and inadequate or excessive gestational weight gain. 69,70 Although depression and stress are well known consequences of insomnia, fewer studies have evaluated insomnia in relation to gestational weight gain.…”

Section: Discussionmentioning

confidence: 99%

Identifying Insomnia in Early Pregnancy: Validation of the Insomnia Symptoms Questionnaire (ISQ) in Pregnant Women

Okun

Buysse

Hall

2015

Journal of Clinical Sleep Medicine

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Study Objectives: Although a substantial number of pregnant women report symptoms of insomnia, few studies have used a validated instrument to determine the prevalence in early gestation. Identifi cation of insomnia in pregnancy is vital given the strong connection between insomnia and the incidence of depression, cardiovascular disease, or immune dysregulation. The goal of this paper is to provide additional psychometric evaluation and validation of the Insomnia Symptom Questionnaire (ISQ) and to establish prevalence rates of insomnia among a cohort of pregnant women during early gestation. Methods: The ISQ was evaluated in 143 pregnant women at 12 weeks gestation. The internal consistency and criterion validity of the dichotomized ISQ were compared to traditional measures of sleep from sleep diaries, actigraphy, and the Pittsburgh Sleep Quality Index using indices of sensitivity, specifi city, positive and negative predictive value (PPV, NPV), and likelihood ratio (LR) tests. Results: The ISQ identifi ed 12.6% of the sample as meeting a case defi nition of insomnia, consistent with established diagnostic criteria. Good reliability was established with Cronbach α = 0.86. The ISQ had high specifi city (most > 85%), but sensitivity, PPV, NPV, and LRs varied according to which sleep measure was used as the validating criterion. Conclusions: Insomnia is a health problem for many pregnant women at all stages in pregnancy. These data support the validity and reliability of the ISQ to identify insomnia in pregnant women. The ISQ is a short and cost-effective tool that can be quickly employed in large observational studies or in clinical practice where perinatal women are seen. 1 Among the many sleep complaints associated with pregnancy, diffi culty initiating or maintaining sleep or unrefreshing sleep, are the most frequently reported issues .1,2 Collectively these sleep symptoms comprise only one aspect of clinical insomnia. According to diagnostic criteria for insomnia, one must have: (1) a diffi culty initiating or maintaining sleep, and/or unrefreshing sleep despite adequate opportunity for sleep; (2) the duration of the sleep complaint is at least 1 mo; and (3) complaints of significant impairment in social, occupational, or daily functioning. 3,4 Insomnia is associated with activation of the stress system resulting in autonomic hyperarousa l. 5,6 It is also linked to various morbidities including depressi on.7-12 Emerging evidence implicates autonomic hyperarousal as a pathway through which the risk of depression is augmen ted. 13 This association is particularly relevant for pregnant women because there is evidence that depression is associated with an increased risk for preterm birth ( PTB), 14 and prenatal depression negatively impairs maternal-child bonding and neurocognitive develo pment.14-17 Having a simple diagnostic tool to identify clinical insomnia in pregnant women could be a fi rst step in reducing the incidence of depression, autonomic hyperarousal, as well as adverse pregnancy outcomes, such as PT...

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“…The seven components (range 0–3) are summed to yield a measure of global sleep quality with a range of 0 (good sleep quality) to 21 (poor sleep quality) [23]. This was used as a measure of chronic stress, as poor sleep is thought to increase AL [10, 24]. …”

Section: Methodsmentioning

confidence: 99%

Allostatic load in early pregnancy is associated with poor sleep quality

2017

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Background Allostatic load (AL) measures the cumulative impact of chronic stress and is associated with adverse health outcomes. A novel scoring system has previously been developed for AL in early pregnancy that is associated with pre-eclampsia. It was hypothesized that AL, as identified by the present model, is associated with psychosocial stressors and, specifically, poor sleep quality. Methods Women were selected from a low-risk, community-dwelling study population who enrolled at <15 weeks gestation. Nine physiologic components were divided among the domains of cardiovascular, metabolic, and inflammatory function. Spearman’s rank correlations were used to examine the association of AL with age, income, the Revised Prenatal Distress Questionnaire (NuPDQ), Inventory of Depressive Symptoms (IDS), and Pittsburgh Sleep Quality Index (PSQI). The Wilcoxon rank-sum test was used to compare AL by race and educational attainment. Results A total of 103 women were identified, with: a mean age of 29.8 ± 5.0 years, 17.5% black, and mean gestational age 12.2 ± 1.1 weeks. Allostatic load was positively correlated with the PSQI (ρ=0.23, p=0.018). There were no associations with age, income, prenatal distress, race, or depression scores. College-educated women had lower AL compared with those with less education (0.57 ± 0.43 vs 0.81 ± 0.55, p=0.045). Conclusion Higher AL, measured by the pregnancy-specific model, was associated with poorer sleep quality and lower educational attainment, both of which were considered to be chronic stressors. These relationships were consistent with previous findings in non-pregnant populations, and suggest that AL may be useful for capturing the physiologic impact of chronic stress in early pregnancy.

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Sleep disturbance and cardiometabolic risk factors in early pregnancy: a preliminary study

Cited by 35 publications

References 34 publications

Objectively measured short sleep duration and later sleep midpoint in pregnancy are associated with a higher risk of gestational diabetes

Objectively measured short sleep duration and later sleep midpoint in pregnancy are associated with a higher risk of gestational diabetes

Identifying Insomnia in Early Pregnancy: Validation of the Insomnia Symptoms Questionnaire (ISQ) in Pregnant Women

Allostatic load in early pregnancy is associated with poor sleep quality

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