The Role of Sleep Disturbance in the Onset of Perinatal Depression
Open AccessThis project sought to clarify how normative variation in pregnancy sleep relates to the onset of perinatal depression symptoms. The sample consisted of 50 first-time pregnant women with no known medical or psychiatric illness. They completed measurements of depression, sleep quality and actigraphy over 10-days and 9-nights in the early third trimester. During the first three days of actigraphy, a mobile app prompted them to rate their mood and environmental stress 4x/day. Their postpartum depression symptoms were prospectively assessed at 2- and 6-weeks postpartum. Given that 90% of the sample engaged in daytime sleep (i.e., napping), naps were objectively scored. The first aim tested directionality of sleep-stress relationships using ecological momentary assessment of daily stress levels (demand and social conflict) that yielded average of eight readings per woman (range = 0 - 12; completed 4x/daily at max). In causal analyses, shorter nighttime sleep predicted higher next-day demand and conflict levels. Testing the opposite direction, higher stress levels also predicted shorter sleep the upcoming night. This effect was cumulative, showing declining sleep duration over nights of assessment. Results also supported a bidirectional relationship between self-reported morning sleep quality and conflict levels, only. The second aim tested whether shorter, lower efficiency nighttime sleep prospectively predicted growth in PD symptoms. Again, we found that lower sleep efficiency and shorter nighttime duration led to greater prenatal depression symptom levels in the early third trimester, adjusting for baseline depression assessed in the late second trimester. than did sleep duration. These results were explained by average level of stress, wherein women who experienced greater stress were likely to experience a steeper increase in PD in the presence of poorer sleep efficiency. Shorter, less efficient sleep during pregnancy also predicted greater postpartum depression symptom severity, relative to longer, more consolidated sleep. In aim 3, exploratory analyses indicated mean nap duration = 66 min (SD = 90 min). Nap start-time [Interquartile Range] =12:43 PM - 7:33 PM. Habitual nappers (1x daily for >50% of days; duration < 1.5 hrs per nap) experienced significantly less growth in depression symptom severity at both pregnancy and postpartum. This is the first known study that provides causal support during pregnancy for perceived daily stress increasing symptoms consistent with insomnia (i.e., delayed sleep onset, lower sleep efficiency and shorter sleep duration). Given that greater perceived stress caused decrements in more nighttime sleep parameters as compared to tests of the opposite direction, it is possible that the sleep-stress cycle begins with increases in perceived daily stress severity. The finding that stress predicted worsening reduction in sleep duration over nights of EMA-paired assessment implicates a positive feedback loop that amplifies sleep loss. Support for this feedback loop is reinforced by shorter sleep duration also increasing next-day stress severity. Habitual 40-minute naps, as an adjunctive prophylactic measure to compensate for short nighttime sleep, may represent a valuable addition to sleep interventions targeting pregnancy.
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Dhaliwal_gwu_0075A_15514.pdf | 2022-03-06 | Open Access |
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