Longitudinal Sleep Study in Pregnancy: Cohort Profile and Prevalence and Risk Factors for Sleep Symptoms in the First Trimester

Round 1

Reviewer 1 Report

This original study was performed in a large cohort of pregnant women to determine incidence of sleep problems and their adverse health outcomes during pregnancy and beyond.

Sleep symptoms and disorders were measured using STOP-Bang and Berlin questionnaires and Pittsburgh Sleep Quality Index.

The authors have found that sleep symptoms are highly prevalent in this cohort of pregnant women, especially sleep disordered breathing (SDB).

The study is interesting and well written, however the authors should address following aspects.

High results in clinical scales are not the same as clinical diagnosis. Are the reported high numbers for incidence of  sleep problems of real clinical significance? How many women did ask for help because of their poor sleep quality? How many did obtain treatment?

 How do authors explain the strong association of habitual snoring with irregular menstrual periods for one-year preceding pregnancy?

Only first sentence of the conclusions is a real conclusion based on study results. Two next sentences describe future research agenda.

 

Minor remarks

The last authors name in not visible

The text should be rechecked for misspellings, there are some even in the abstract  line 19 “the present here” should be “we present here”

 

Author Response

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Reviewer 2 Report

Abstract: "Sleep  disorders could influence pregnancy outcomes but evidence for longitudinal associations 17 is scarce."

Physical activity and physical exercise are two variables closely related to sleep quality. Have they been measured?

Methods: There is no information on the statistical analyses performed or how confounding factors were chosen. Please add.

Table 1: Why is the age variable shown dichotomised into above and below 35? It is not justified by making the groups of similar size. Perhaps it would be more informative to show the mean age of the participants.

Discussion: too much space is devoted to presenting data that are not relevant to the objective of the study. It would also be easier to read if comparisons with other studies were made and the reasons for differences or similarities highlighted. Too many percentages are presented, which makes it difficult to read. It is not specified whether the studies with which the results are compared have used the same questionnaire to measure sleep.

 

Author Response

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Reviewer 3 Report

Dear Author,

It is delightful to have the opportunity to review “Longitudinal sleep study in pregnancy: cohort profile and prevalence and risk factors for sleep symptoms in the first trimester”

I hope my opinions will contribute to the publication of this high-quality paper.

1)      Line 157 - Recruitment was started in January 2018 and completed in April 2020.

Considering the recruitment period, there are participants whose data collection was performed during the COVID-19 pandemic. Could it be that in this group of participants, due to the pandemic did not affect the pattern and quality of sleep?

Maybe it should be a limitation of the study, an unknown variable that can bias the results.

 

2)      Line 247-248 Higher age and moderate or severe anxiety at the baseline survey were associated with less trouble sleeping.

How was the robustness of this test ensured when the sample size relative to age is unequal? (Sample size under age 35 is nearly triple as the sample size for participants over 35). And the evidence indicates that age is a risk factor for sleep disorders in pregnancy. (Examples: https://doi.org/10.3390/healthcare10071156; https://doi.org/10.1111/aogs.13056; https://doi.org/10.1080/14767058.2017.1359831

https://doi.org/10.1186/s12884-019-2583-1

 

3)      I believe that’s is necessary to clarify what was the cutoff score for the PSQI.

“It may be necessary for the pregnant population to adjust the previously validated cutoff score (≥5) for the classification of poor sleep quality, and a higher score may be necessary to differentiate those who need further assessment and intervention.”

Healthcare 2022, 10(7), 1156; https://doi.org/10.3390/healthcare10071156

 

4)      Conclusions are short and the weakest part of the article. Perhaps rethink the main focus. I suggest focusing on the health professional and thinking what could be the impact of their intervention for women.

 

5)      I suggest: In the tables, replacing uppercase N with lowercase n. n for sample. N for the population.

 

Finally, congratulations on the work and the subject matter.

Best regards,

Author Response

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Author Response File: Author Response.docx