School of Nursing, College of Medicine, National Taiwan University, Taipei, Taiwan; Adjunct Supervisor, National Taiwan University Hospital, Taipei, Taiwan.
Department of Internal Medicine, National Taiwan University, Taipei, Taiwan; Center of Sleep Disorder, National Taiwan University Hospital, Taipei, Taiwan; Attending Physician, Division of Pulmonary and Critical Care Medicine, National Taiwan University Hospital, Taipei, Taiwan.
Int J Nurs Stud. 2021 Aug;120:103966. doi: 10.1016/j.ijnurstu.2021.103966. Epub 2021 Apr 29.
Sleep disturbances are one of the most frequent chief complaints brought to the healthcare professionals during routine prenatal care visits. Sleep and mood disturbances are often intertwined, and depression in particular is a leading cause of disability and disease burden worldwide with women more likely to be affected than men. However, limited studies have prospectively investigated the association between sleep disturbances and longitudinal risk of depression in pregnant women, with no studies using actigraphy to objectively estimate daytime and nighttime sleep duration and the extent of sleep disruption.
To examine the predictive and longitudinal association of objective actigraphic and subjective sleep disturbances with depressive symptoms in pregnant women.
A prospective observational cohort study.
204 1st trimester pregnant women recruited from a university-affiliated hospital provided socio-demographic and health information, wore a wrist actigraph for 7 days, and completed Pittsburgh Sleep Quality Index, Center for Epidemiologic Studies - Depression Scale, and Epworth Sleepiness Scale. Identical data collection procedures were implemented again in the 2nd and 3rd trimester, with each data collection scheduled at least 8 weeks apart. We estimated unadjusted and multivariable adjusted odds ratios and 95% confidence intervals to evaluate various types of sleep disturbances at 1st trimester and risk of depression at follow-ups.
121 (59.3%) 1st trimester women had a sleep efficiency of < 85% by actigraphy, and 92 (45.1%) had Pittsburgh Sleep Quality Index global scores > 5 indicative of poor sleep quality. In multivariable adjusted models, 1st trimester objectively measured sleep efficiency < 85% was associated with 2.71-, 3.87-, and 5.27-fold increased odds having risk of depression at 2nd trimester, 3rd trimester, and both 2nd and 3rd trimesters, respectively.
Healthy pregnant women experience both objective and subjective sleep disturbances during the early trimester, with a substantial proportion of them also having high depressive symptoms throughout the pregnancy. Objectively assessed poor sleep quality in the 1st trimester, but not self-reported characteristics of disturbed sleep, may play a role in the development of both elevated and persistent high depressive symptoms in pregnancy. Future studies using objective sleep measurements and clinical diagnostic interviews are warranted to examine whether an early intervention aiming at improving sleep may help reduce high depressive symptom risk and lower depression rate in women during pregnancy. Tweetable abstract: Objectively assessed poor sleep efficiency in the 1st trimester predicts both elevated and persistent high depressive symptoms in pregnancy.
睡眠障碍是孕妇在常规产前保健就诊时最常出现的主要问题之一。睡眠和情绪障碍常常交织在一起，尤其是抑郁症是全球导致残疾和疾病负担的主要原因，女性比男性更容易受到影响。然而，有限的研究前瞻性地调查了孕妇睡眠障碍与抑郁纵向风险之间的关联，没有研究使用活动记录仪客观估计孕妇日间和夜间的睡眠时间和睡眠中断程度。
研究客观活动记录仪和主观睡眠障碍与孕妇抑郁症状的预测和纵向关联。
一项前瞻性观察队列研究。
从一所大学附属医院招募了 204 名孕早期妇女，她们提供了社会人口统计学和健康信息，佩戴了手腕活动记录仪 7 天，并完成了匹兹堡睡眠质量指数、流行病学研究中心抑郁量表和埃普沃斯嗜睡量表。在孕中期和孕晚期同样实施了相同的数据收集程序，每次数据收集之间至少相隔 8 周。我们估计了未经调整和多变量调整后的优势比和 95%置信区间，以评估孕早期各种类型的睡眠障碍与随访时的抑郁风险。
121 名（59.3%）孕早期妇女的活动记录仪睡眠效率<85%，92 名（45.1%）的匹兹堡睡眠质量指数总分>5 分，表明睡眠质量差。在多变量调整模型中，孕早期客观测量的睡眠效率<85%与孕中期、孕晚期和孕中期和孕晚期的抑郁风险分别增加 2.71、3.87 和 5.27 倍相关。
健康孕妇在孕早期经历了客观和主观的睡眠障碍，其中相当一部分孕妇在整个孕期都有较高的抑郁症状。孕早期客观评估的睡眠质量差，但自我报告的睡眠障碍特征，可能在孕期升高和持续的高抑郁症状发展中发挥作用。未来需要使用客观睡眠测量和临床诊断访谈的研究来检验早期干预旨在改善睡眠是否有助于降低孕妇的高抑郁症状风险和降低抑郁率。可推特点摘要：孕早期客观评估的睡眠效率差可预测孕期升高和持续的高抑郁症状。
