Petrosellini Chiara, Eriksson Sofia H, Meyer Nicholas, Antony Edwin, Protti Olivia, Donaldson Lucinda, van Hees Vincent, Petrie Aviva, McQuillin Andrew, Siassakos Dimitrios
Elizabeth Garrett Anderson Institute for Women's Health, University College London, 84-86 Chenies Mews, London, WC13 6HU, UK.
Division of Psychiatry, University College London, London, UK.
BMC Psychiatry. 2025 Jun 2;25(1):569. doi: 10.1186/s12888-025-07017-6.
Postpartum Psychosis (PP) is a severe perinatal psychiatric disorder affecting 1-2 in 1000 individuals following childbirth. Most episodes emerge within the first two weeks postpartum and commonly present with mania and decreased need for sleep. The postnatal period is a time of profound sleep disruption and sleep deprivation is a known trigger for mania and psychosis. Despite growing recognition of the role of sleep in the onset and progression of PP, this relationship remains poorly understood. Existing research is largely retrospective, relies on self-reported data and primarily focuses on women with pre-existing bipolar disorder. This prospective study will integrate subjective and objective sleep measures to investigate the relationship between sleep disturbance and postnatal mania. We aim to establish whether sleep patterns in late pregnancy or the early postpartum period can predict mania as a marker of PP.
This prospective observational cohort study is recruiting pregnant women and will follow participants from the late third trimester until two weeks postpartum. We aim to recruit 100 participants, including individuals with and without psychiatric illness, to ensure broader applicability of the findings and capture the full spectrum of postnatal mania risk. Participants will wear a wrist accelerometer continuously during this period to monitor rest-activity patterns and infer objective sleep parameters including sleep duration, efficiency and fragmentation. Self-reported sleep quality and mood symptoms will be measured using the Pittsburgh Sleep Quality Index (PSQI), Altman Self-Rating Mania Scale (ASRM) and Edinburgh Postnatal Depression Scale (PSQI) at baseline and at days 3-5 and 12-14 postpartum. Actigraphy data will be analysed using the GGIR package in R. Associations between sleep measures and ASRM scores will be assessed using Pearson and Spearman correlation coefficients.
This study is the first to prospectively investigate sleep and postnatal mania risk in a cohort including both high- and low-risk individuals. By integrating actigraphy with validated self-report measures, it aims to identify rest-activity patterns that may serve as early indicators of PP. Early recognition of sleep disturbances associated with postnatal mania could inform targeted interventions, improving clinical outcomes for women and families affected by PP.
产后精神病（PP）是一种严重的围产期精神障碍，每1000名分娩后的女性中有1至2人受其影响。大多数发作在产后两周内出现，常见症状为躁狂和睡眠需求减少。产后时期是睡眠严重紊乱的时期，而睡眠剥夺是已知的躁狂和精神病触发因素。尽管人们越来越认识到睡眠在产后精神病的发作和进展中的作用，但这种关系仍未得到充分理解。现有研究大多是回顾性的，依赖自我报告数据，且主要关注患有双相情感障碍的女性。这项前瞻性研究将整合主观和客观睡眠测量方法，以调查睡眠障碍与产后躁狂之间的关系。我们旨在确定妊娠晚期或产后早期的睡眠模式是否能够预测作为产后精神病标志的躁狂。
这项前瞻性观察性队列研究正在招募孕妇，并将从妊娠晚期一直跟踪参与者至产后两周。我们的目标是招募100名参与者，包括有精神疾病和无精神疾病的个体，以确保研究结果具有更广泛的适用性，并涵盖产后躁狂风险的全谱。在此期间，参与者将持续佩戴手腕加速度计，以监测休息 - 活动模式，并推断包括睡眠时间、效率和碎片化程度在内的客观睡眠参数。在基线以及产后第3 - 5天和第12 - 14天，使用匹兹堡睡眠质量指数（PSQI）、阿尔特曼自我评定躁狂量表（ASRM）和爱丁堡产后抑郁量表（PSQI）测量自我报告的睡眠质量和情绪症状。将使用R语言中的GGIR软件包分析活动记录仪数据。将使用Pearson和Spearman相关系数评估睡眠测量值与ASRM评分之间的关联。
本研究首次在前瞻性队列中调查包括高风险和低风险个体在内的睡眠与产后躁狂风险。通过将活动记录仪与经过验证的自我报告测量方法相结合，旨在识别可能作为产后精神病早期指标的休息 - 活动模式。早期识别与产后躁狂相关的睡眠障碍可为有针对性的干预提供依据，改善受产后精神病影响的女性及其家庭的临床结局。
