Thomas Roth Sleep Disorders & Research Center, Henry Ford Health System, Detroit, MI, USA.
Pulmonary & Critical Care and Sleep Medicine, Wayne State University School of Medicine, Detroit, MI, USA.
Sleep. 2021 Jun 11;44(6). doi: 10.1093/sleep/zsab028.
Depression is among the most prevalent perinatal complications, yet modifiable risk factors remain elusive. Over half of perinatal women endorse clinical insomnia symptoms, which are etiologically implicated in depression in nonperinatal samples. Yet, prospective data on perinatal insomnia and depression are mixed. We sought to clarify temporal associations of insomnia and depression during peripartum, and to investigate cognitive arousal as a potential mechanism facilitating this relationship.
Seventy pregnant women completed sociodemographic information and baseline sleep and mood symptoms between gestational weeks 25 and 30. Beginning at gestational week 30, participants completed 17 weekly online surveys assessing insomnia, depression, and three cognitive arousal indices (nocturnal cognitive arousal, perseverative thinking, and perinatal-focused rumination). Mixed effects models were conducted to test hypotheses.
Women were at risk for depression when experiencing insomnia (odds ratio [OR] = 2.36, 95% confidence interval [CI] = 1.28 to 4.35), nocturnal cognitive arousal (OR = 3.05, 95% CI = 1.60 to 5.79), perinatal-focused rumination (OR = 2.05, 95% CI = 1.11 to 3.79), and perseverative thinking (OR = 7.48, 95% CI = 3.90 to 14.32). Prospective analyses revealed bidirectional effects between insomnia and cognitive arousal, and both predicted future depression. Nocturnal cognitive arousal mediated 23-43% of the effect of insomnia on depression. Insomnia mediated 12%-18% of the effect of nocturnal cognitive arousal on depression. A similar pattern was observed with perinatal-focused rumination. Depression did not predict insomnia.
Nocturnal cognitive arousal, including ruminating on perinatal concerns while trying to fall asleep, fuels insomnia. In turn, lying awake at night provides an opportunity for nocturnal cognitive arousal. This cycle feeds perinatal depression. Daytime cognitive arousal may indirectly disrupt sleep as perseverating during the day persists into the night.
抑郁症是围产期最常见的并发症之一，但可改变的风险因素仍难以捉摸。超过一半的围产期女性都有临床失眠症状，这在非围产期样本中与抑郁症有关。然而，围产期失眠和抑郁症的前瞻性数据存在差异。我们试图阐明围产期失眠和抑郁之间的时间关联，并研究认知唤醒作为促进这种关系的潜在机制。
70 名孕妇在妊娠 25 至 30 周之间完成了社会人口统计学信息以及基线睡眠和情绪症状的评估。从妊娠 30 周开始，参与者每周完成 17 次在线调查，评估失眠、抑郁和三个认知唤醒指标（夜间认知唤醒、持续思维和围产期关注的沉思）。采用混合效应模型检验假设。
当女性经历失眠（优势比[OR] = 2.36，95%置信区间[CI] = 1.28 至 4.35）、夜间认知唤醒（OR = 3.05，95% CI = 1.60 至 5.79）、围产期关注的沉思（OR = 2.05，95% CI = 1.11 至 3.79）和持续思维（OR = 7.48，95% CI = 3.90 至 14.32）时，她们就有患抑郁症的风险。前瞻性分析显示，失眠和认知唤醒之间存在双向影响，两者都预测了未来的抑郁。夜间认知唤醒介导了失眠对抑郁影响的 23%-43%。失眠介导了夜间认知唤醒对抑郁影响的 12%-18%。类似的模式也出现在围产期关注的沉思中。抑郁没有预测失眠。
夜间认知唤醒，包括在试图入睡时对围产期问题的沉思，会导致失眠。反过来，晚上睡不着觉为夜间认知唤醒提供了机会。这种循环会导致围产期抑郁症。白天的认知唤醒可能会通过白天的持续思维间接扰乱睡眠，而这种思维会持续到晚上。
