Wołyńczyk-Gmaj Dorota, Majewska Aleksandra, Bramorska Aleksandra, Różańska-Walędziak Anna, Ziemka Simon, Brzezicka Aneta, Gmaj Bartłomiej, Czajkowski Krzysztof, Wojnar Marcin
Department of Psychiatry, Medical University of Warsaw, Nowowiejska 27, 00-665 Warsaw, Poland.
Department of Psychology, University of Social Sciences and Humanities, Chodakowska 19/31, 03-815 Warsaw, Poland.
J Clin Med. 2022 Sep 23;11(19):5607. doi: 10.3390/jcm11195607.
During late pregnancy, sleep deterioration is regularly observed. In concert with these observations, in previous studies by other researchers, a slight objective cognitive decline in pregnant women has been found. Sleep is essential for memory consolidation. The hypothesis of the study was that cognitive impairment could be related to sleep deterioration during pregnancy. The study included 19 pregnant women in their third trimester of pregnancy (28−40 weeks, median 33 weeks (IQR 32−37)) recruited at the Department of Gynecology and Obstetrics, Medical University of Warsaw, and 20 non-pregnant women as controls. The assessment was performed using the vocabulary subtest from the Wechsler Adult Intelligence Scale (WAIS), D2 Test of Attention, OSPAN task (Operational Span Task) to assess cognitive performance, actigraphy to examine sleep parameters, and a set of self-report instruments: Athens Insomnia Scale (AIS), Beck Depression Inventory (BDI), Ford Insomnia Response to Stress (FIRST), Regenstein Hyperarousal Scale (HS), and Epworth Sleepiness Scale (ESS). Although there were no differences between the groups in WAIS (p = 0.18), pregnant women had worse scores in working memory capacity (overall number of remembered letters: p = 0.012, WM span index: p = 0.004) and a significantly lower score in attention (p = 0.03). Pregnant women also had lower sleep efficiency (p = 0.001), more awakenings from sleep (p = 0.001), longer average awakenings (p < 0.0001), longer wake after sleep onset (WASO, p < 0.0001), and longer total time in bed (p < 0.0001). In psychological assessment, pregnant women had only a higher FIRST score (p = 0.02). Using mediation analysis, we found that frequent awakening might be the major factor contributing to deterioration in working memory performance, explaining almost 40% of the total effect. In conclusion, sleep fragmentation in the third trimester of pregnancy may impair working memory consolidation. Pregnant women often complain about poor daily performance as well as non-restorative sleep. In this study, we showed that there is a relationship between lower sleep quality in pregnancy and worse cognitive functioning. We can expect a cognitive decline in women with sleep disturbances in pregnancy. Therefore, we should pay more attention to the treatment of sleep disorders in pregnancy.
在妊娠晚期，睡眠质量下降的情况经常被观察到。与这些观察结果一致的是，在其他研究人员之前的研究中，发现孕妇存在轻微的客观认知能力下降。睡眠对于记忆巩固至关重要。该研究的假设是，认知障碍可能与孕期睡眠质量下降有关。该研究纳入了19名妊娠晚期（28 - 40周，中位数33周（四分位间距32 - 37周））的孕妇，她们是在华沙医科大学妇产科招募的，以及20名非孕妇作为对照。评估使用了韦氏成人智力量表（WAIS）中的词汇子测验、注意力D2测试、用于评估认知表现的OSPAN任务（操作广度任务）、用于检查睡眠参数的活动记录仪，以及一组自我报告工具：雅典失眠量表（AIS）、贝克抑郁量表（BDI）、福特失眠应激反应量表（FIRST）、雷根斯坦高唤醒量表（HS）和爱泼华嗜睡量表（ESS）。虽然两组在WAIS上没有差异（p = 0.18），但孕妇在工作记忆能力方面得分较低（记住字母的总数：p = 0.012，工作记忆广度指数：p = 0.004），且注意力得分显著更低（p = 0.03）。孕妇的睡眠效率也更低（p = 0.001），睡眠中醒来的次数更多（p = 0.001），平均每次醒来的时间更长（p < 0.0001），睡眠开始后的清醒时间更长（WASO，p < 0.0001），在床上的总时间更长（p < 0.0001）。在心理评估中，孕妇只有FIRST得分更高（p = 0.02）。通过中介分析，我们发现频繁醒来可能是导致工作记忆表现下降的主要因素，几乎解释了总效应的40%。总之，妊娠晚期的睡眠碎片化可能会损害工作记忆巩固。孕妇经常抱怨日常表现不佳以及睡眠没有恢复感。在这项研究中，我们表明孕期睡眠质量较低与较差的认知功能之间存在关联。我们可以预期孕期睡眠障碍女性会出现认知能力下降。因此，我们应该更加关注孕期睡眠障碍的治疗。
