Abstract
Circadian rhythms influence sleep and wakefulness. Circadian activity rhythms (CAR) are altered in individuals with dementia or seasonal affective disorder. To date, studies exploring CAR and sleep in postpartum women are rare. The purpose of this report is to describe relationships between CAR, sleep disturbance, and fatigue among 72 first-time mothers during their second week postpartum while their newborn remain hospitalized in intensive care unit. Seventy-two mothers were included in this secondary data analysis sample from three separate studies. Participants completed the general sleep disturbance scale (GSDS), numerical rating scale for fatigue, and a sleep diary. The objective sleep data included total sleep time (TST), wake after sleep onset (WASO), and CAR determined by the circadian quotient (amplitude/mesor) averaged from at least 48-h of wrist actigraphy monitoring. The TST of mothers who self-reported as poor sleepers was 354 min (SEM = 21.9), with a mean WASO of 19.5% (SEM = 2.8). The overall sleep quality measured by the GSDS was clinically, significantly disrupted (M = 5.5, SD = 1.2). The mean score for morning fatigue was 5.8 (SD = 2.0), indicating moderate fatigue severity. The CAR was 0.62 (SEM = 0.04), indicating poor synchronization. The self-reported good sleepers (GSDS < 3) had better CAR (M = 0.71, SEM = 0.02) than poor sleepers (GSDS > 3) (t[70] = 2.0, p < 0.05). A higher circadian equation was associated with higher TST (r = 0.83, p < 0.001), less WASO (r = −0.50, p < 0.001), lower self-reported sleep disturbance scores (r = −0.35, p = 0.01), and less morning fatigue (r = −0.26). Findings indicate that mothers with a hospitalized infant have both nocturnal sleep problems and disturbed circadian activity rhythms. Factors responsible for these sleep and rhythm disturbances, the adverse effects on mother's physical and mental well-being, and mother–infant relationship require further study.
Highlights
Maternal stress associated with caring for a newborn requiring intensive medical care initiates a cascade of psychological and physiological sequelae (Miles et al, 1999; Holditch-Davis and Miles, 2000; Lee et al, 2005b)
Only one report used wrist actigraphy data to address circadian activity rhythm (CAR) with a very small sample of early stage postpartum women, and better CAR was evident when mothers had more nocturnal total sleep time and less daytime sleep (Lee and Kimble, 2009). The purpose of this secondary analysis was, to describe how CAR was related to self-reported sleep disturbances and fatigue severity among mothers with an infant hospitalized in intensive care unit (ICU) during the early postpartum period (5th- to 12th-day postpartum)
We sought to determine (1) what are the sleep and CAR characteristics among mothers with an infant hospitalized in the ICU during their early postpartum period? and (2) what are the relationships between CAR, objective and subjective sleep measures, and maternal fatigue? We hypothesized during the early postpartum stage, mothers characterized as poor CAR will experience more sleep disruption and higher level of fatigue severity compared to women who are good CAR
Summary
Maternal stress associated with caring for a newborn requiring intensive medical care initiates a cascade of psychological and physiological sequelae (Miles et al, 1999; Holditch-Davis and Miles, 2000; Lee et al, 2005b). Circadian processes, which are regulated primarily by the suprachiasmatic nuclei (SCN), are highly influenced by extrinsic stimuli such as ambient illumination and social interactions (Lee et al, 2009) These stimuli may be altered while a newborn infant receives care within the hospital environment. Only one report used wrist actigraphy data to address CAR with a very small sample of early stage postpartum women, and better CAR was evident when mothers had more nocturnal total sleep time and less daytime sleep (Lee and Kimble, 2009) The purpose of this secondary analysis was, to describe how CAR was related to self-reported sleep disturbances and fatigue severity among mothers with an infant hospitalized in ICU during the early postpartum period (5th- to 12th-day postpartum). We sought to determine (1) what are the sleep and CAR characteristics among mothers with an infant hospitalized in the ICU during their early postpartum period? and (2) what are the relationships between CAR, objective and subjective sleep measures, and maternal fatigue? We hypothesized during the early postpartum stage, mothers characterized as poor CAR will experience more sleep disruption and higher level of fatigue severity compared to women who are good CAR
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