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Sleep disorders during pregnancy
Linköping University, Department of Clinical and Experimental Medicine, Division of Clinical Sciences. Linköping University, Faculty of Health Sciences. Region Östergötland, Center of Paediatrics and Gynaecology and Obstetrics, Department of Gynaecology and Obstetrics in Linköping.
2015 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Background

Sleep disorders are known to increase in prevalence during pregnancy, and associations between disturbed sleep during pregnancy and adverse outcomes for mother and child have been reported in a number of studies. However, most of these studies were retrospective and too small to satisfactorily demonstrate the association.

Aims

  • To prospectively investigate the development of snoring during pregnancy and assess if there is an association between snoring and sleepiness or adverse pregnancy outcomes.
  • To study the development of restless legs syndrome during and after pregnancy, and whether it is associated with snoring or other pregnancy-related symptoms.
  • To investigate the possible association between depressive symptoms in the postpartum period and sleep related problems during pregnancy, using screening instruments.
  • To objectively evaluate sleep disordered breathing in pregnant women compared to non-pregnant controls and to evaluate differences in Epworth Sleepiness Scale scores between the two groups.

Methods

Questionnaires containing subjective rating of snoring, Epworth Sleepiness Scale and symptoms of restless legs were used in all studies. Information from the medical records of the pregnant women was also utilized. For objective evaluation of sleep disordered breathing, nocturnal respiratory recordings were used. In the research for the first three papers the same cohort of 500 pregnant women was followed on three occasions during pregnancy and also after delivery, and for the last paper, 100 other pregnant women were compared to 80 nonpregnant controls.

Results and conclusions

Both snoring and restless legs syndrome increase during pregnancy, but this had no convincing impact on obstetric outcome. Sleep recordings could not verify an increased prevalence of obstructive sleep apnea among pregnant women. Restless legs syndrome was associated with snoring and could persist after delivery. Women who had high scores on the Epworth Sleepiness Scale in the last trimester of pregnancy showed more depressive symptoms in the postpartum period. No difference in item scoring of the Epworth Sleepiness Scale was found between pregnant women and controls.

Place, publisher, year, edition, pages
Linköping: Linköping University Electronic Press, 2015. , 80 p.
Series
Linköping University Medical Dissertations, ISSN 0345-0082 ; 1446
National Category
Public Health, Global Health, Social Medicine and Epidemiology Clinical Medicine
Identifiers
URN: urn:nbn:se:liu:diva-117869DOI: 10.3384/diss.diva-117869ISBN: 978-91-7519-121-8 (print)OAI: oai:DiVA.org:liu-117869DiVA: diva2:811489
Public defence
2015-05-29, Berzeliussalen, Ingång 65, Campus US, Linköpiong, 09:00 (English)
Opponent
Supervisors
Available from: 2015-05-12 Created: 2015-05-12 Last updated: 2016-04-24Bibliographically approved
List of papers
1. Snoring during pregnancy and its relation to sleepiness and pregnancy outcome - a prospective study
Open this publication in new window or tab >>Snoring during pregnancy and its relation to sleepiness and pregnancy outcome - a prospective study
2014 (English)In: BMC Pregnancy and Childbirth, ISSN 1471-2393, E-ISSN 1471-2393, Vol. 14, no 15Article in journal (Refereed) Published
Abstract [en]

Background: The incidence of snoring and sleepiness is known to increase during pregnancy, and this might impact maternal health and obstetric outcome. However, the association between snoring and sleepiness during pregnancy is not fully understood. This study was aimed at investigating the development of snoring during pregnancy and prospectively assessing if there is an association between snoring and sleepiness or adverse pregnancy outcomes, such as preeclampsia, mode of delivery, and fetal complications. Methods: Consecutively recruited pregnant women (n = 500) received a questionnaire concerning snoring and sleep at the 1st and 3rd trimester of pregnancy. The women who had rated their frequency of snoring at both occasions (n = 340) were divided into subgroups according to the development of snoring they reported and included in the subsequent analyses. Additional medical data were collected from the medical records. Results: The frequency of snoring was 7.9% in the 1st trimester and increased to 21.2% in the 3rd trimester of pregnancy. The women who snored already in early pregnancy had significantly higher baseline BMI (p = 0.001) than the women who never snored, but snoring was not associated with the magnitude of weight gain during pregnancy. Snoring women were more likely to experience edema in late pregnancy than the non-snorers. Women who started to snore during pregnancy had higher Epworth Sleepiness Scores than the non snorers in both early and late pregnancy. No significant association between obstetric outcome and snoring was found. Conclusion: Snoring does increase during pregnancy, and this increase is associated with sleepiness, higher BMI at the start of pregnancy and higher prevalence of edema, but not with weight gain.

Place, publisher, year, edition, pages
BioMed Central, 2014
Keyword
Pregnancy; Snoring; Sleepiness; Epworth sleepiness score; Body mass index; Edema; Pregnancy outcome
National Category
Clinical Medicine
Identifiers
urn:nbn:se:liu:diva-105253 (URN)10.1186/1471-2393-14-15 (DOI)000331215600004 ()
Available from: 2014-03-14 Created: 2014-03-14 Last updated: 2017-12-05
2. Restless legs syndrome during and after pregnancy and its relation to snoring
Open this publication in new window or tab >>Restless legs syndrome during and after pregnancy and its relation to snoring
2012 (English)In: Acta Obstetricia et Gynecologica Scandinavica, ISSN 0001-6349, E-ISSN 1600-0412, Vol. 91, no 7, 850-855 p.Article in journal (Refereed) Published
Abstract [en]

Objective. To study development of restless legs syndrome (RLS) during and after pregnancy, and whether RLS is related to snoring or other pregnancy-related symptoms. Design. Prospective study. Setting. Antenatal care clinics in the catchment area of Linkoping university hospital, Sweden. Population. Five hundred consecutively recruited pregnant women. Methods. Sleep disturbances, including symptoms of RLS and snoring, were assessed with questionnaires in each trimester. A complementary questionnaire was sent three years after delivery to women experiencing symptoms of RLS during pregnancy. Main outcome measures. Symptoms of RLS in relation to snoring in each trimester. Results. Symptoms of RLS were reported by 17.0% of the women in the first trimester, by 27.1% in the second trimester and by 29.6% in the third trimester. Snoring in the first trimester was correlated to increased prevalence of RLS in all three trimesters (p= 0.003, 0.017 and 0.044 in the first, second and third trimester, respectively). No correlation was found between RLS and anemia, parity or body mass index. Among the women who experienced RLS, 31% still had symptoms three years after delivery. Fifty-eight per cent of those whose symptoms had disappeared stated that this happened within one month after delivery. Conclusions. Symptoms of RLS progressed most between the first and second trimester. Women who snored in the first or second trimester of pregnancy had a higher prevalence of RLS in the third trimester, which indicates that snoring in early pregnancy might predict RLS later. Symptoms of RLS disappear quite soon after delivery, but about one-third of women with RLS during pregnancy may still have symptoms three years after childbirth.

Place, publisher, year, edition, pages
Informa Healthcare / Wiley-Blackwell, 2012
Keyword
Restless legs syndrome; pregnancy; snoring; sleep; sleep disturbance
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-79784 (URN)10.1111/j.1600-0412.2012.01404.x (DOI)000305328000013 ()
Available from: 2012-08-17 Created: 2012-08-14 Last updated: 2017-12-07
3. Postpartum depressive symptoms and its association to daytime sleepiness and restless legs during pregnancy
Open this publication in new window or tab >>Postpartum depressive symptoms and its association to daytime sleepiness and restless legs during pregnancy
2016 (English)In: BMC Pregnancy and Childbirth, ISSN 1471-2393, E-ISSN 1471-2393, 137Article in journal (Refereed) Published
Abstract [en]

Purpose: To investigate the possible association between depressive symptoms in the postpartum period and sleep related problems during pregnancy, using screening instruments.

Methods: In a prospective study 293 women in the last trimester of pregnancy answered a questionnaire about sleep related problems in terms of symptoms of restless legs, snoring and daytime sleepiness. They also completed the Epworth Sleepiness Scale (ESS). The same women were screened for depressive symptoms using the Edinburgh Postnatal Depression Scale (EPDS) four to ten weeks after giving birth. Additional information about social data, pregnancy and delivery was received from the medical charts.

Results: Women with postpartum depressive symptoms had higher prevalence of sleep related problems including excessive daytime sleepiness defined as ESS score ≥10 (OR 3.84, CI 1.57-9.39), and restless legs syndrome (OR 2.837 CI 1.18-6.84) in last trimester of pregnancy, when adjusted for sociodemographic factors and obstetric risk factors.

Conclusions: Depressive symptoms after childbirth are preceded by disturbed sleep already during pregnancy. The results from Epworth Sleepiness Scale completed during pregnancy might be used for detecting women at risk, enabling preventive interventions.

Place, publisher, year, edition, pages
BioMed Central, 2016
Keyword
Postnatal depression, sleep, restless legs syndrome, pregnancy, Epworth Sleepiness Scale
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:liu:diva-117867 (URN)10.1186/s12884-016-0917-9 (DOI)000377160400001 ()
Note

Funding agencies: This investigation was supported by grants from The Regional Council of Ostergotland, Sweden.

Vid tiden för disputationen förelåg publikationen endast som manuskript

Available from: 2015-05-12 Created: 2015-05-12 Last updated: 2017-12-04Bibliographically approved
4. Sleepiness and sleep disordered breathing during pregnancy
Open this publication in new window or tab >>Sleepiness and sleep disordered breathing during pregnancy
2016 (English)In: Sleep and Breathing, ISSN 1520-9512, E-ISSN 1522-1709, Vol. 20, no 4, 1231-1237 p.Article in journal (Refereed) Published
Abstract [en]

Study objectives: To investigate if sleep recordings show differences in prevalence of sleep-disturbed breathing among pregnant women compared to non-pregnant controls. To compare the Epworth sleepiness scale (ESS) scores between the two groups. To evaluate obstetric outcomes.

Setting: At one antenatal care center at an outpatient unit in Linköping, Sweden.

Participants: One hundred pregnant women (gestational week 24-34) and 80 non-pregnant women age- and body mass index-matched as controls.

Interventions: Whole-night respiratory recordings were performed in the homes of all participants, who also answered the same questionnaire, including the Epworth Sleepiness Scale.

Measurements and results: Objectively recorded snoring was more common among the pregnant women (median value 10% of total estimated sleep time) than among the non-pregnant controls (2.5% of total sleep time, p<0.001). The prevalence of obstructive events was low and similar in pregnant and non-pregnant women (1% vs. 3% had obstructive apnea-hypopnea index ≥5). The total ESS score was higher among pregnant women than controls (median 9 vs. 7, p<0.001) but no significant differences were found between the two groups in the scores for the separate items of the ESS. Sleep-disturbed breathing and snoring showed no impact on obstetric outcome. There were no significant associations between either subjectively reported or objectively recorded snoring and ESS scores.

Conclusion: Snoring increases during pregnancy, but sleep recordings could not verify an increased prevalence of obstructive sleep apnea among pregnant women. Development of obstructive sleep apnea is not a likely explanation for the increased daytime sleepiness seen in pregnant women.

Place, publisher, year, edition, pages
Springer Publishing Company, 2016
Keyword
Pregnancy, snoring, sleep recordings, sleep disordered breathing, obstructive sleep apnea, Epworth Sleepiness Scale
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:liu:diva-117868 (URN)10.1007/s11325-016-1345-9 (DOI)
Note

The previous status of this publication was manuscript, and the working title was: "Snoring, sleepiness and sleep-disordered breathing during pregnancy"

Available from: 2015-05-12 Created: 2015-05-12 Last updated: 2017-12-04Bibliographically approved

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