Abstract
Purpose of Review
This article will provide a brief review of most recent findings of sleep, insomnia, obstructive sleep apnea, and restless leg syndrome during pregnancy.
Recent Findings
Recent meta-analyses have found that 38.2% of pregnant women experience insomnia, 15% experience obstructive sleep apnea, and 20% experience restless leg syndrome. Poor sleep during pregnancy is associated with increased odds of preterm birth, cesarean section, hypertension, gestational diabetes, and longer deliveries. OSA is also associated with poor outcomes such as maternal hypertension, gestational diabetes, preterm birth, and low infant Apgar score. Incidence of new-onset RLS increases with parity, gestational age, maternal age, and increased maternal adiposity. Typical treatments have been found to be effective for treating sleep disorders in pregnant women.
Summary
Obtaining sufficient sleep quality and quantity in addition to assessing and treating sleep disorders should be a priority for pregnant women and their providers.
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References
Sedov ID, Cameron EE, Madigan S, Tomfohr-Madsen LM. Sleep quality during pregnancy: a meta-analysis. Vol. 38, Sleep Medicine Reviews. W.B. Saunders Ltd; 2018. p. 168–76.
Ladyman C, Signal TL. Sleep health in pregnancy: a scoping review. Sleep Med Clin [Internet]. 2018;13(3):307–33. Available from: https://doi.org/10.1016/j.jsmc.2018.04.004.
Christian LM, Carroll JE, Teti DM, Hall MH. Maternal sleep in pregnancy and postpartum part I: mental, physical, and interpersonal consequences. Curr Psychiatry Rep. 2019;21(3).
Tsai SY, Lee PL, Lin JW, Lee CN. Persistent and new-onset daytime sleepiness in pregnant women: a prospective observational cohort study. Int J Nurs Stud [Internet]. 2017 Jan 1 [cited 2021 Apr 25];66:1–6. Available from: https://pubmed-ncbi-nlm-nih-gov.ezproxy.lib.uh.edu/27865988/.
Martin-Fairey CA, Zhao P, Wan L, Roenneberg T, Fay J, Ma X, et al. Pregnancy induces an earlier chronotype in both mice and women. J Biol Rhythms [Internet]. 2019 Jun 1 [cited 2021 Apr 27];34(3):323–31. Available from: https://pubmed-ncbi-nlm-nih-gov.ezproxy.lib.uh.edu/31018734/.
Garbazza C, Hackethal S, Riccardi S, Cajochen C, Cicolin A, D’Agostino A, et al. Polysomnographic features of pregnancy: a systematic review. Sleep Med Rev [Internet]. 2020;50:101249. Available from: https://doi.org/10.1016/j.smrv.2019.101249.
Sedov ID, Anderson NJ, Dhillon AK, Tomfohr-Madsen LM. Insomnia symptoms during pregnancy: a meta-analysis [Internet]. Vol. 30, Journal of Sleep Research. 2021. Available from: https://doi.org/10.1111/jsr.13207.
American Psychiatric Association. Diagnostic and statistical manual of mental disorders. 5th ed. 2013.
Felder JN, Baer RJ, Rand L, Jelliffe-Pawlowski LL, Prather AA. Sleep disorder diagnosis during pregnancy and risk of preterm birth. Obstet Gynecol. 2017;130(3):573–81.
Sweet L, Arjyal S, Kuller JA, Dotters-Katz S. A review of sleep architecture and sleep changes during pregnancy [Internet]. Vol. 75, Obstetrical and Gynecological Survey. Lippincott Williams and Wilkins; 2020 [cited 2021 Apr 30]. p. 253–62. Available from: https://pubmed-ncbi-nlm-nih-gov.ezproxy.lib.uh.edu/32324251/.
Reutrakul S, Anothaisintawee T, Herring SJ, Balserak BI, Marc I, Thakkinstian A. Short sleep duration and hyperglycemia in pregnancy: aggregate and individual patient data meta-analysis. Sleep Med Rev [Internet]. 2018;40:31–42. Available from: https://doi.org/10.1016/j.smrv.2017.09.003.
Facco FL, Parker CB, Hunter S, Reid KJ, Zee PC, Silver RM, et al. Association of adverse pregnancy outcomes with self-reported measures of sleep duration and timing in women who are nulliparous. J Clin Sleep Med. 2018;14(12):2047–56.
Christian LM, Carroll JE, Teti DM, Hall MH. Maternal sleep in pregnancy and postpartum part II: biomechanisms and intervention strategies. Curr Psychiatry Rep. 2019;21(19).
Zhu B, Bronas UG, Carley DW, Lee K, Steffen A, Kapella MC, et al. Relationships between objective sleep parameters and inflammatory biomarkers in pregnancy. Ann N Y Acad Sci. 2020;1473(1):62–73.
Osnes RS, Roaldset JO, Follestad T, Eberhard-Gran M. Insomnia late in pregnancy is associated with perinatal anxiety: a longitudinal cohort study. J Affect Disord [Internet]. 2019;248(January):155–65. Available from: https://doi.org/10.1016/j.jad.2019.01.027.
van der Zwan JE, de Vente W, Tolvanen M, Karlsson H, Buil JM, Koot HM, et al. Longitudinal associations between sleep and anxiety during pregnancy, and the moderating effect of resilience, using parallel process latent growth curve models. Sleep Med [Internet]. 2017 Dec 1 [cited 2021 Apr 30];40:63–8. Available from: https://pubmed-ncbi-nlm-nih-gov.ezproxy.lib.uh.edu/29221781/.
Tomfohr-Madsen L, Cameron EE, Schetter CD, Campbell T, O’Beirne M, Letourneau N, et al. Pregnancy anxiety and preterm birth: the moderating role of sleep. Heal Psychol. 2019;38(11):1025–35.
Osnes RS, Eberhard-Gran M, Follestad T, Kallestad H, Morken G, Roaldset JO. Mid-pregnancy insomnia is associated with concurrent and postpartum maternal anxiety and obsessive-compulsive symptoms: a prospective cohort study. J Affect Disord [Internet]. 2020;266(December 2019):319–26. Available from: https://doi.org/10.1016/j.jad.2020.01.140.
Nacar G, Taşhan ST. Relationship between sleep characteristics and depressive symptoms in last trimester of pregnancy. Afr Health Sci. 2019;19(4):2934–44.
Gelaye B, Addae G, Neway B, Larrabure-Torrealva GT, Qiu C, Stoner L, et al. Poor sleep quality, antepartum depression and suicidal ideation among pregnant women. J Affect Disord [Internet]. 2017 Feb 1 [cited 2021 Apr 30];209:195–200. Available from: https://pubmed-ncbi-nlm-nih-gov.ezproxy.lib.uh.edu/27930912/.
Gao M, Hu J, Yang L, Ding N, Wei X, Li L, et al. Association of sleep quality during pregnancy with stress and depression: a prospective birth cohort study in China. 2019;1:11–3.
Bacaro V, Benz F, Pappaccogli A, De Bartolo P, Johann AF, Palagini L, et al. Interventions for sleep problems during pregnancy: a systematic review. Sleep Med Rev [Internet]. 2020;50:101234. Available from: https://doi.org/10.1016/j.smrv.2019.101234.
Sedov I, Madsen JW, Goodman SH, Tomfohr-Madsen LM. Couples’ treatment preferences for insomnia experienced during pregnancy. Fam Syst Heal [Internet]. 2019 Mar 1 [cited 2021 Apr 29];37(1):46–55. Available from: https://pubmed-ncbi-nlm-nih-gov.ezproxy.lib.uh.edu/30589273/.
Sedov ID, Goodman SH, Tomfohr-Madsen LM. Insomnia treatment preferences during pregnancy. JOGNN - J Obstet Gynecol Neonatal Nurs [Internet]. 2017 May 1 [cited 2021 Apr 29];46(3):e95–104. Available from: https://pubmed-ncbi-nlm-nih-gov.ezproxy.lib.uh.edu/28343943/.
Qaseem A, Kansagara D, Forciea MA, Cooke M, Denberg TD. Management of chronic insomnia disorder in adults: a clinical practice guideline from the American College of Physicians. Ann Intern Med. 2016;165(2):125–33.
Manber R, Bei B, Simpson N, Asarnow L, Rangel E, Sit A, et al. Cognitive behavioral therapy for prenatal insomnia: a randomized controlled trial. In: Obstetrics and Gynecology. 2019. p. 911–9.
Felder JN, Epel ES, Neuhaus J, Krystal AD, Prather AA. Efficacy of digital cognitive behavioral therapy for the treatment of insomnia symptoms among pregnant women: a randomized clinical trial. JAMA Psychiatry [Internet]. 2020;77(5):484–92. Available from: https://jamanetwork.com/.
Balserak BI, Bourjeily G, Pien G, Kryger M, Sockrider M, Schotland H, et al. Sleep-disordered breathing in pregnancy part 1. Am J Respir Crit Care Med [Internet]. 2019 Nov 1 [cited 2021 Nov 11];200(9):P18–9. Available from: https://pubmed.ncbi.nlm.nih.gov/31674822/.
Liu L, Su G, Wang S, Zhu B. The prevalence of obstructive sleep apnea and its association with pregnancy-related health outcomes: a systematic review and meta-analysis [Internet]. Vol. 23, Sleep and Breathing. Sleep Breath; 2019 [cited 2021 Nov 11]. p. 399–412. Available from: https://pubmed.ncbi.nlm.nih.gov/30255484/.
Kidron D, Bar-Lev Y, Tsarfaty I, Many A, Tauman R. The effect of maternal obstructive sleep apnea on the placenta. Sleep. 2019;42(6):1–8.
Perkins A, Einion A. Pregnant pause: should we screen for sleep disordered breathing in pregnancy? Breathe (Sheffield, England) [Internet]. 2019 Mar 1 [cited 2021 Nov 11];15(1):36–44. Available from: https://pubmed.ncbi.nlm.nih.gov/30838058/.
Esposito G, Odelli V, Romiti L, Chiaffarino F, Di Martino M, Ricci E, et al. Prevalence and risk factors for restless legs syndrome during pregnancy in a Northern Italian population. J Obstet Gynaecol (Lahore) [Internet]. 2019 May 19 [cited 2021 Nov 11];39(4):480–4. Available from: https://pubmed.ncbi.nlm.nih.gov/30620232/.
Na M, Wu J, Li M, Hinkle SN, Zhang C, Gao X. New onset of restless legs syndrome in pregnancy in a prospective multiracial cohort: incidence and risk factors. Neurology [Internet]. 2020 Dec 15 [cited 2021 Nov 11];95(24):e3438–47. Available from: https://pubmed.ncbi.nlm.nih.gov/33177224/.
Goecke TW, Schnakenberg P, Frensch M, Chechko N. Restless legs syndrome during pregnancy and 12 weeks postpartum and its links to cardiovascular diseases, stressful life events, and psychiatric history. J Clin Med [Internet]. 2020 Sep 1 [cited 2021 Nov 11];9(9):1–16. Available from: https://pubmed.ncbi.nlm.nih.gov/32967350/.
Jahani Kondori M, Kolla BP, Moore KM, Mansukhani MP. Management of restless legs syndrome in pregnancy and lactation. J Prim Care Commun Health [Internet]. 2020;11:2150132720905950. Available from: https://pubmed.ncbi.nlm.nih.gov/32054396/.
Gupta R, Dhyani M, Kendzerska T, Pandi‐Perumal SR, BaHammam AS, Srivanitchapoom P, Pandey S, Hallett M. Restless legs syndrome and pregnancy: prevalence, possible pathophysiological mechanisms and treatment. Acta Neurol Scand. 2016;133(5):320-9. Available from: https://pubmed.ncbi.nlm.nih.gov/26482928/.
Funding
Preparation of this article was supported by National Institute of Nursing Research Grant R01NR018342 to Sara Nowakowski, South Central Mental Illness Research, Education, and Clinical Center; and Center of Innovations in Quality, Effectiveness and Safety (CIN 13–413), Department of Veteran Affairs.
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This article is part of the Topical Collection on Sleep Disorders