The Impact of Objective and Subjective Sleep Parameters on Depressive Symptoms during Pregnancy in Women with a Mental Disorder: An Explorative Study.

Babette Bais,Leontien Van Ravesteyn,Joke Tulen,Witte Hoogendijk,Mijke Lambregtse-Van Den Berg,Robert Lindeboom,Astrid Kamperman

doi:10.3390/ijerph16091587

Abstract

Poor sleep quality during pregnancy is associated with both antepartum and postpartum depression and adverse birth outcomes. This study evaluated both objective and subjective sleep quality and the effects on the subsequent course of antepartum depressive symptoms in psychiatric patients. This observational explorative study was embedded in an ongoing study focusing on pregnant women with a mental disorder and was performed in 18 patients (24–29 weeks pregnant). Depressive symptoms were assessed throughout pregnancy using the Edinburgh Postnatal Depression Scale (EPDS) with 5-week intervals. Sleep was assessed with actigraphy, the Pittsburgh Sleep Quality Index (PSQI) and sleep diaries at the start of the study. We studied correlations between sleep parameters and EPDS scores cross-sectionally using Spearman correlation. Next, we studied the course of antepartum EPDS scores over time per sleep parameter using generalized linear mixed modelling analysis. Objectively measured fragmentation index, total PSQI score and 4 PSQI subscales (sleep quality, sleep duration, sleep disturbances and daytime dysfunctions) were significantly correlated with EPDS scores when measured cross-sectionally at the start. Six objectively and subjectively measured sleep parameters had moderate to large effects on the course of depressive symptoms through the third trimester, but these effects were not statistically significant. More research is necessary to explore the causality of the direction between sleep problems and antepartum depressive symptoms we found in psychiatric patients.

Highlights

Depression during pregnancy is a common and high impact disease, with a prevalence of approximately 11–13% [1]
The present study studied 18 pregnant women with a mental disorder to explore if and how objectively and subjectively measured sleep parameters would be associated with antepartum depressive symptoms
We found that some sleep parameters had a notable impact on the course of antepartum depressive symptoms during the third trimester, both unadjusted and adjusted for Edinburgh Postnatal Depression Scale (EPDS) score at the start and different separate confounders

Summary

Methods

Research) aimed to evaluate the effectiveness of a group-based multicomponent psychotherapy intervention for pregnant women with a mental disorder, compared to individual counseling (care as usual). Both arms showed similar effects on depressive symptoms [27]. Eligible participants were pregnant women, diagnosed with a mental disorder, confirmed by the Structured Clinical Interview for DSM-IV diagnosis by one trained medical doctor [28]. A convenience subsample of participants was recruited to perform the actigraphy, PSQI and sleep diary assessments between 24 and 29 weeks of pregnancy. Participants were recruited in the second trimester, since sleep is more affected by pregnancy in the third trimester [29]. Exclusion criteria were suffering from a tremor or somatic conditions that could affect sleep, or an insufficient proficiency in Dutch

Results

Discussion

Conclusion