Sleep during pregnancy · 2020. 7. 28. · Late Pregnancy to 6 wks Late Pregnancy to 6 mos Late...

7/22/20

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Sleep during pregnancyMarquis Hawkins, PhD

Assistant ProfessorDepartment of Epidemiology

Email: [email protected]

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Welcome SWIMMERS!

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Outline

• Motivation for studying sleep during pregnancy• Epidemiology of sleep during pregnancy

• The short-term consequences of poor sleep during pregnancy• Factors affecting sleep

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Pregnancy as a window to future health for mother and child

Castillo-Castrejon M, Powell TL. Placental Nutrient Transport in Gestational Diabetic Pregnancies [published correction appears in Front Endocrinol (Lausanne). 2019 Jan 28;10:5]. Front Endocrinol (Lausanne). 2017;8:306. Published 2017 Nov 7. doi:10.3389/fendo.2017.00306

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Motivation for studying sleep during pregnancy*• What does sleep health look like during pregnancy?• Does sleep health influence maternal health during

pregnancy?• What are the determinants of sleep health during

pregnancy• Is perinatal sleep health a window to future health

of mother and child?• Can we reduce overall morbidity and pre-mature

mortality in human populations by understanding and addressing perinatal sleep health?

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Never/rarely getting a good night sleep

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10

20

30

40

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Pregnant Postpartum Other women

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National Sleep Foundation, 2007 Sleep in American Poll

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Other changes in sleep during pregnancy• Total Sleep Time ←→• Napping ↑

• Sleep onset latency ←→• WASO ↑

1. Garbazza C, et al. Polysomnographic features of pregnancy: A systematic review. Sleep Med Rev. 2020;50:101249. 2. Plancoulaine S, et al. Sleep Trajectories Among Pregnant Women and the Impact on Outcomes: A Population-Based Cohort Study. Matern Child Health J. 2017;21(5):1139-1146. 3. Tomfohr LM, et al. Trajectories of Sleep Quality and Associations with Mood during the Perinatal Period. Sleep. 2015;38(8):1237-1245. Published 2015 Aug 1.

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Other changes in sleep during pregnancy• Sleep architecture

• ↓ REM• ↓ SWS

• Sleep Disorders• ↑ prevalence of OSA (5% to 20%)• ↑ Insomnia symptoms• ↑ Restless leg syndrome

ZZZ ZZZ ZZZ

Garbazza C, Hackethal S, Riccardi S, et al. Polysomnographic features of pregnancy: A systematic review. Sleep Med Rev. 2020;50:101249. doi:10.1016/j.smrv.2019.101249

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Ladyman C, Signal TL. Sleep Health in Pregnancy: A Scoping Review. Sleep Med Clin. 2018;13(3):307-333. doi:10.1016/j.jsmc.2018.04.004

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Trajectories of insomnia during and after pregnancy

Sivertsen B, Hysing M, Dørheim SK, Eberhard-Gran M. Trajectories of maternal sleep problems before and after childbirth: a longitudinal population-based study. BMC Pregnancy Childbirth. 2015;15:129. Published 2015 Jun 2. doi:10.1186/s12884-015-0577-1

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Long-term effects of pregnancy and childbirth on sleep satisfaction and duration

David Richter, Michael D Krämer, Nicole K Y Tang, Hawley E Montgomery-Downs, Sakari Lemola, Long-term effects of pregnancy and childbirth on sleep satisfaction and duration of first-time and experienced mothers and fathers, Sleep, Volume 42, Issue 4, April 2019, zsz015, https://doi.org/10.1093/sleep/zsz015

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Long-term effects of pregnancy and childbirth on sleep satisfaction and duration

David Richter, Michael D Krämer, Nicole K Y Tang, Hawley E Montgomery-Downs, Sakari Lemola, Long-term effects of pregnancy and childbirth on sleep satisfaction and duration of first-time and experienced mothers and fathers, Sleep, Volume 42, Issue 4, April 2019, zsz015, https://doi.org/10.1093/sleep/zsz015

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https://doi.org/10.1093/sleep/zsz015

https://doi.org/10.1093/sleep/zsz015

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Racial differences in sleep duration in women

Amyx M, Xiong X, Xie Y, Buekens P. Racial/Ethnic Differences in Sleep Disorders and Reporting of Trouble Sleeping Among Women of Childbearing Age in the United States. Matern Child Health J. 2017;21(2):306-314. doi:10.1007/s10995-016-2115-9

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Actigraphy estimated sleep characteristics by race/ethnicity

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The health consequences of sleep disturbances during pregnancy

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Sleep quality during pregnancy and gestational diabetes

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Sleep duration and timing and gestational diabetes

Facco FL, Grobman WA, Reid KJ, et al. Objectively measured short sleep duration and later sleep midpoint in pregnancy are associated with a higher risk of gestational diabetes. Am J Obstet Gynecol. 2017;217(4):447.e1-447.e13. doi:10.1016/j.ajog.2017.05.066

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Maternal sleep quality and fetal outcomes

Warland J, Dorrian J, Morrison JL, O'Brien LM. Maternal sleep during pregnancy and poor fetal outcomes: A scoping review of the literature with meta-analysis. Sleep Med Rev. 2018;41:197-219. doi:10.1016/j.smrv.2018.03.004

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Disproportionate burden of sleep-related pre-term birth among African American women

Blair LM, Porter K, Leblebicioglu B, Christian LM. Poor Sleep Quality and Associated Inflammation Predict Preterm Birth: Heightened Risk among African Americans. Sleep. 2015;38(8):1259-1267. Published 2015 Aug 1. doi:10.5665/sleep.4904

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Sleep disturbances and inflammatory gene expression in African American and White women

Carroll JE, Rentscher KE, Cole SW, et al. Sleep disturbances and inflammatory gene expression among pregnant women: Differential responses by race [published online ahead of print, 2020 Apr 28]. Brain Behav Immun. 2020;S0889-1591(20)30090-8. doi:10.1016/j.bbi.2020.04.065

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Factors affecting sleep

• Hormonal• Physical (e.g., growing fetus)

• Psychosocial• Anxiety related to pregnancy (e.g., complications, health

of the infant, childcare, etc.)

• Behavioral• Sleep hygiene• Physical activity

1. Enninga EA, et al. Immunomodulatory effects of sex hormones: requirements for pregnancy and relevance in melanoma. Mayo Clin Proc. 2014;89(4):520-535; 2. Sowers MF, et al. Sex steroid hormone profiles are related to sleep measures from polysomnography and thePittsburgh Sleep Quality Index. Sleep. 2008;31(10):1339-1349.

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Sleep hygiene practices in good and poor sleepers during pregnancy

Tsai SY, Lee CN, Wu WW, Landis CA. Sleep Hygiene and Sleep Quality of Third-Trimester Pregnant Women. Res Nurs Health. 2016;39(1):57-65. doi:10.1002/nur.21705

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Impact of a sleep hygiene intervention on sleep outcomes

-1.4

-1.2

-1

-0.8

-0.6

-0.4

-0.2

0

0.2

PSQI Global Score Sleep dur at ion, hrs Fat igue Daytime sleepiness Sleep dis turbance

Sleep Educat ion Sleep Educat ion and Wearable Device

Hsiao, WS, Paterno, MT, Iradukunda, F, Hawkins, MS. The preliminary efficacy of a sleep self-management intervention using a personalized health monitoring device during pregnancy (Under Review)

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The impact of a perinatal lifestyle intervention on sleep quality in Hispanic women

-2.5

-2

-1.5

-1

-0.5

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0.5

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Late Pregnancy to 6 wks Late Pregnancy to 6 mos Late Pregnancy to 12 mos

∆ PS

QI S

core

Sleep Quality (PSQI Score)

Lifestyle Health & Wellness

Hawkins MS, Pekow P, Rosal MC, Tucker KL, Spencer R, Chasan-Taber L. The impact of a randomized controlled trial of a lifestyle intervention on sleep among Hispanic postpartum women. (Under Review)

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-80

-70

-60

-50

-40

-30

-20

-10

0


∆ Sl

eep

Dura

tion

(min

/nig

ht)

Sleep Duration (min/night)



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-8

-6

-4

-2

0

2

4

6

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∆ Sl

eep

Effic

ienc

y (%

)

Sleep Efficiency (%)



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Summary

• Sleep disturbances and disorders are common during pregnancy• Sleep is important for short-term maternal and

fetal outcomes pregnancy• Perinatal health is important for long-term of

mother and child• Sleep health is important promoting perinatal

health• Sleep disturbances and disorders are common, but

modifiable

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Thank you!Enjoy the rest of SWIM!

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Sleep during pregnancy · 2020. 7. 28. · Late Pregnancy to 6 wks Late Pregnancy to 6 mos Late...

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