Lawson Andrea, Murphy Kellie E, Sloan Eileen, Uleryk Elizabeth, Dalfen Ariel
Mount Sinai Hospital, Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada.
Mount Sinai Hospital, Department of Obstetrics & Gynecology, University of Toronto, Toronto, Ontario, Canada.
J Affect Disord. 2015 May 1;176:65-77. doi: 10.1016/j.jad.2015.01.017. Epub 2015 Jan 30.
Postpartum mental disorders (e.g., anxiety, depression, psychosis) are serious conditions that affect approximately 10-15% of women after childbirth, and up to 40% of women at risk for these disorders. Research reveals an association between poor sleep quality/quantity and symptoms of anxiety, depression and psychosis. The aim of this systematic review was to evaluate the available evidence for the relationship between sleep and postpartum mental disorders.
Searches included MEDLINE, EMBASE, and EBM Reviews - Cochrane Central Register of Controlled Trials, PsycINFO and EBSCOHost CINAHL through June 30, 2014. Manual searching was performed on reference lists of included articles. Published primary research in any language was included.
There were 3187 unique titles/abstracts and 44 full-text articles reviewed. Thirty-one studies were included. Evidence was found for the impact of self-reported poor sleep during pregnancy and the postpartum on the development of postpartum depression, with not enough evidence for either postpartum anxiety or psychosis. The evidence for objectively assessed sleep and the development of postpartum disorders was mixed. Among the 31 studies included, 1 was strong, 13 were moderate and 17 were weak.
Research design, method of assessment, timing of assessment, recruitment strategies, representative adequacy of the samples and inclusion/exclusion criteria all varied widely. Many studies did not use tools validated for the perinatal population and had small sample sizes without power analysis.
Sleep interventions represent a potential low-cost, non-pharmacological prevention and treatment strategy for postpartum mental illness. Further high-quality research is needed on this topic area.
产后精神障碍（如焦虑、抑郁、精神病）是严重的病症，影响约10% - 15%的产后女性，高危女性中这一比例高达40%。研究表明睡眠质量/数量不佳与焦虑、抑郁及精神病症状之间存在关联。本系统评价的目的是评估睡眠与产后精神障碍之间关系的现有证据。
检索截至2014年6月30日的MEDLINE、EMBASE、循证医学评价 - 考克兰对照试验中心注册库、PsycINFO和EBSCOHost护理学与健康领域数据库。对纳入文章的参考文献列表进行手工检索。纳入任何语言发表的原发性研究。
共检索到3187篇独特的标题/摘要，审阅了44篇全文文章。纳入31项研究。发现有证据表明孕期及产后自我报告的睡眠不佳会对产后抑郁的发生产生影响，而对于产后焦虑或精神病则证据不足。客观评估睡眠与产后疾病发生之间的证据不一。在纳入的31项研究中，1项证据力度强，13项中等，17项较弱。
研究设计、评估方法、评估时间、招募策略、样本代表性充分性以及纳入/排除标准差异很大。许多研究未使用针对围产期人群验证过的工具，且样本量小，未进行功效分析。
睡眠干预是产后精神疾病潜在的低成本、非药物预防和治疗策略。该主题领域需要进一步的高质量研究。
