Division of Sleep Medicine, Henry Ford Health System, Detroit, Michigan.
Department of Psychiatry, University of Michigan, Ann Arbor, Michigan.
Behav Sleep Med. 2022 Mar-Apr;20(2):143-163. doi: 10.1080/15402002.2021.1895793. Epub 2021 Mar 15.
Insomnia affects over half of pregnant and postpartum women. Early evidence indicates that cognitive-behavioral therapy for insomnia (CBTI) improves maternal sleep and mood. However, standard CBTI may be less efficacious in perinatal women than the broader insomnia population. This study sought to identify patient characteristics in a perinatal sample associated with poor response to CBTI, and characterize patient feedback to identify areas of insomnia therapy to tailor for the perinatal experience.
Secondary analysis of 46 pregnant women with insomnia symptoms who were treated with digital CBTI in a randomized controlled trial.
We assessed insomnia, cognitive arousal, and depression before and after prenatal treatment, then 6 weeks postpartum. Patients provided feedback on digital CBTI.
Residual cognitive arousal was the most robust factor associated with treatment non-response. Critically, CBTI responders and non-responders differed on no other sociodemographic or pretreatment metrics. After childbirth, short sleep (<6 hrs/night) was associated with maternal reports of poor infant sleep quality. Patient feedback indicated that most patients preferred online treatment to in-person treatment. Although women described digital CBTI as convenient and helpful, many patients indicated that insomnia therapy would be improved if it addressed sleep challenges unique to pregnancy and postpartum. Patients requested education on maternal and infant sleep, flexibility in behavioral sleep strategies, and guidance to manage infant sleep.
Modifying insomnia therapy to better alleviate refractory cognitive arousal and address the changing needs of women as they progress through pregnancy and early parenting may increase efficacy for perinatal insomnia.Name: Insomnia and Rumination in Late Pregnancy and the Risk for Postpartum DepressionURL: clinicaltrials.govRegistration: NCT03596879.
失眠影响超过一半的孕妇和产后女性。早期证据表明，失眠的认知行为疗法（CBTI）可改善产妇的睡眠和情绪。然而，标准的 CBTI 在围产期女性中的疗效可能不如更广泛的失眠人群。本研究旨在确定围产期样本中与 CBTI 反应不佳相关的患者特征，并描述患者的反馈意见，以确定针对围产期体验进行失眠治疗的调整方向。
对一项随机对照试验中接受数字 CBTI 治疗的 46 名有失眠症状的孕妇进行二次分析。
我们在产前治疗前后以及产后 6 周评估了失眠、认知唤醒和抑郁情况。患者对数字 CBTI 提供了反馈。
残留的认知唤醒是与治疗无反应最相关的最强因素。至关重要的是，CBTI 反应者和无反应者在其他社会人口统计学或治疗前指标上没有差异。分娩后，睡眠时间短（每晚<6 小时）与母亲报告的婴儿睡眠质量差有关。患者反馈表明，大多数患者更喜欢在线治疗而非面对面治疗。尽管女性表示数字 CBTI 方便且有帮助，但许多患者表示，如果失眠治疗能解决妊娠和产后特有的睡眠挑战，治疗效果会更好。患者要求提供有关母婴睡眠、行为睡眠策略的灵活性以及管理婴儿睡眠的指导方面的教育。
修改失眠治疗方法，以更好地减轻顽固的认知唤醒，并满足女性在妊娠和早期育儿过程中不断变化的需求，可能会提高围产期失眠的疗效。
晚期妊娠失眠与产后抑郁风险
clinicaltrials.gov
NCT03596879
