The influence of pregnancy on systemic immunity

Pazos, Michael A.; Sperling, Rhoda; Moran, Thomas M.; Kraus, Thomas

doi:10.1007/s12026-012-8303-9

Cited by 212 publications

(196 citation statements)

References 73 publications

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“…33 These physiological processes are further affected by the remarkable fluctuations in immune and endocrine markers, especially inflammatory cytokines, progesterone, and estrogen, all of which have a substantial direct and indirect effect on sleep. [93][94][95][96][97][98][99][100] We assert that there is a need to identify pregnant women with insomnia, especially in early pregnancy, because insomnia could increase the risk of adverse outcomes to the mother and to the developing fetus. 33 The methods used to validate the ISQ (sleep diaries and/or actigraphy) are more commonly used than PSG when diagnosing insomnia, as well as when ascertaining sleep in pregnant women.…”

mentioning

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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mentioning

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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“…Along with fetal abortion, this caused a 5--15% drop in birth rate the following spring [83]. This pattern is typical of other influenza pandemics [84]. Mortality by influenza is heritable [85], so resistance to influenza may have been strongly selected for in recent human evolution, although this has been understudied.…”

Section: Infectious Disease and Selection During Pregnancymentioning

confidence: 95%

Many ways to die, one way to arrive: how selection acts through pregnancy

2013

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“…In both young and old, these conditions share one feature in common: each is characterized by alterations in innate immunity that in many instances constitute a form of low-grade inflammation known to cardiovascular scientists as "metabolic syndrome." [42][43][44][45][46] Among children who die of influenza, most have known immune disorders. In those with fatal influenza and no recognized disturbance in immune function, it is possible that unrecognized antecedent events have induced cytokine dysregulation and increased their vulnerability to influenza-related complications and death.…”

Section: Clinical and Epidemiologic Findings Suggest An Alternative Amentioning

confidence: 99%