Construct of the Association between Sleep Quality and Perinatal Depression: A Literature Review
Abstract
:1. Introduction
2. Materials and Methods
2.1. Review Question
2.2. Inclusion and Exclusion Criteria
2.3. Search Strategy
2.4. Selection of Studies
2.5. Data Extraction
2.6. Methodological Quality Assessment
3. Results
4. Discussion
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
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Database | Limiters | Search Strategy |
---|---|---|
CINAHL (EBSCOhost) (date of a most recent survey: 9 January 2022) | Full text; summary available; publication date: 1 January 2016–31 December 2021; English language; peer-reviewed. Expanders—apply equivalent subjects. Search Modes—Boolean/Phrase. | S11: S1 AND S9 AND S10 S10: S7 OR S8 S9: S2 OR S3 OR S4 OR S5 S8: AB Edinburgh postnatal depression scale OR AB EPDS S7: AB perinatal depression OR TI perinatal depression S6: AB PSQI OR AB Pittsburgh-sleep-quality-index S5: AB sleep-wake disorders OR TI sleep-wake disorders S4: AB sleep problem * OR TI sleep problem * S3: AB sleep quality OR TI sleep quality S2: (MH “Sleep”) S1: (MH “Pregnancy”) |
MEDLINE with full text (EBSCOhost) (date of a most recent survey: 9 January 2022) | Full text; summary available; publication date: 1 January 2016–31 December 2021; English language; peer-reviewed. Expanders—apply equivalent subjects. Search Modes—Boolean/Phrase | S11: S1 AND S9 AND S10 S10: S7 OR S8 S9: S2 OR S3 OR S4 OR S5 S8: AB Edinburgh postnatal depression scale OR TI edinburgh postnatal depression scale S7: AB perinatal depression OR TI perinatal depression S6: AB (PSQI or Pittsburgh -sleep-quality-index) OR TI (PSQI or Pittsburgh-sleep-quality-index) S5: AB sleep-wake disorders OR TI sleep-wake disorders S4: AB sleep problem * OR TI sleep problem * S3: AB sleep quality OR TI sleep quality S2: (MH “sleep quality”) S1: (MH “pregnancy”) |
SCOPUS (date of most recent search: 25 January 2022) | NA | (TITLE-ABS-KEY (sleep AND quality) AND TITLE-ABS-KEY (sleep AND problem) AND TITLE-ABS-KEY (perinatal AND depression)) AND PUBYEAR > 2016 AND PUBYEAR < 2022 |
Author (Year), Periodical | Design | Data Collection Instruments | Study Population | Main Results * | Limitations * |
---|---|---|---|---|---|
Ernesto González-Mesa et al. [11] J Perinatal Med | Meta-analysis | NA | 36 articles were included, of which eight were quantitative and used in meta-analysis | “(1) Both quantitative and qualitative reviews confirmed the negative relationship between the effects of poor sleep and perinatal mood changes, as demonstrated by the vast majority of studies, regardless of the objective or subjective assessment used. (2) It is not yet understood whether the links between poor sleep and perinatal depression are cause-effect or simply associative; therefore, more work is needed to address this gap in understanding the issue, including an investigation of the effects of medications and cognitive-behavioral therapies on sleep quality.” | “Heterogeneity of included studies with differences in the study designs: sample characteristics regarding cultural differences according to nationality, ethnicity or socioeconomic level, different selected assessment time points and different measurement tools.” |
Ivan D. Senov et al. [12] Sleep Medicine Reviews | Meta-analysis | NA | Meta-analysis with 24 articles that measured the prevalence of sleep quality with the Pittsburgh Sleep Quality Index | “(1) The meta-analysis results indicate that the mean PSQI score during pregnancy is 6.07 and 45.7% of mothers experienced poor sleep quality as defined by a PSQI score ≥ 5. (2) A average PSQI score increased from the second to the third quarter by 1.68 points. (3) The cutoff score used to differentiate between good and bad sleepers suggested by the PSQI identifies the average number of pregnant women with poor sleep quality. (4) Future research should investigate longitudinal changes during sleep from preconception and throughout pregnancy to understand the relationship between sleep and gestational age.” | “Sleep poorly is still a reality during pregnancy, which complicates determining what pregnant women expect regarding the need for additional assessment and treatment. The previously validated cutoff score of five may be inappropriate for the pregnant population, and a higher score may be needed to differentiate those who need further assessment and intervention.” |
David A. Kalmbach et al. [13] Sleep medicine | Randomized controlled trial | (1) Insomnia Severity Index (2) Edinburgh Postnatal Depression Scale (3) Presleep arousal scale cognitive | 267 pregnant women in the 2nd and 3rd trimesters in a row at six hospitals in Detroit, USA | “(1) Women from the second half of pregnancy have bad insomnia, nocturnal rumination, depression, and suicidal tendencies. (2) Sociodemographic factors associated with higher rates of these complications during pregnancy include low economic income, absence of insurance, Black and non-Hispanic race, and obesity. (3) Clinical depression and suicidal ideation rates are higher for pregnant women with clinical levels of insomnia and high rumination. Rumination content may play an important role in disease risk, as pregnant women who ruminate specifically about their pregnancy and/or newborn have substantially higher depression and suicidal ideation rates than those of pregnant women who do not ruminate about perinatal concerns.” | “Only women identifying as non-Hispanic White and non-Hispanic Black were well-represented in this study, thus limiting generalizability to women outside of these racial groups. All sleep data were self-reported. There is no objective measurement of the sleep.” |
Kempler L. et al. [14] Sleep Res Soc | Randomized controlled trial | (1)Pittsburgh Sleep Quality Index (2) Insomnia Severity Index (3) Multidimensional Assessment of Fatigue (4) Epworth Sleepiness Scale | 215 healthy pregnant women in the 3rd trimester expecting their first child Sydney, Australia | “(1) Sleep quality declines for both groups at six weeks postpartum and with no statistically significant differences between groups. However, statistically, significant differences are observed between the 6th week and the 4th month postpartum, with the intervention group having the best sleep quality. The intervention consisted of a psychoeducation program. (2) The program proved to be simple, easy to adhere to, with low cost, and that it could easily be integrated into prenatal care.” | “It may be that the 4–6 month postpartum period is more sensitive to the effects of behavioral interventions. Due to the characteristics of the sample, it is not possible to generalize the results to a nonmetropolitan community setting. The sample elements with the poorest sleep during pregnancy were less likely to complete the study. Unselected women pregnant with their first child were recruited, which likely limited the scope for positive effects on some outcomes.” |
Päivi Polo- Kantola et al. [15] Minutes Obstetrics et gynecological Scandinavian | Prospective cohort study | (1) Basic Nordic Sleep Questionnaire (2) Edinburgh Postnatal Depression Scale (3) State-Trait anxiety inventory | 78 pregnant women with Gestational Age between 18 and 22 weeks of pregnancy at clinics in Turku, Finland | “(1) The quality of sleep generally declines as the pregnancy proceeds. (2) At the end of pregnancy, multiparous women reported greater difficulty falling asleep. (3) Insomnia and snoring get worse during pregnancy. (4) However, morning or daytime sleepiness and sleep duration did not increase despite sleep changes. (5) Results showed that mild to moderate levels of depressive and anxiety symptoms were related to sleep disturbances in late pregnancy.” | “Investigated self-reported sleep quality with no objective sleep measurements. It was not evaluated the occurrence of Willis–Ekbom Disease (Restless Legs Syndrome), which increases during pregnancy and may account for at least partially for sleep disturbances.” |
Ming Gao et al. [16] BMC Pregnancy and Childbirth | Prospective cohort study | (1) Pittsburgh Sleep Quality Index pregnancy (2) Pressure Scale Edinburgh Postnatal (3) Depression scale | 1152 2nd trimester pregnant women in a row at 54 hospitals and community health centers in urban areas of Shenyang, China | “(1) The linear regression model demonstrates that participants with poor sleep quality are more likely to experience stress during pregnancy, prenatal depression, and postnatal depression than participants with good sleep quality are. (2) Pregnant women aged 30 and over are at increased risk of prenatal stress and depression. (3) The association between sleep quality and postnatal depression was statistically significant in the group of women aged 30 years and over.” | “There may be residual confounders that were not taken into account. The findings are based on a regional population and may not generalize to other settings. There is no objective measurement of sleep (actigraphy).” |
Haiyan et al. [17] Psychol Health Med | Prospective cohort study | (1) Pittsburgh Sleep Quality Index (2) 10-item Kessler psychological distress scale (3) Perceived stress scale (4) Edinburgh Postnatal Depression Scale | 228 pregnant women in the 3rd trimester from the obstetrics and gynecology outpatient clinics of two hospitals in Shandong province, China | “(1) One month after delivery, 26.3% of women suffered from perinatal depression. (2) Univariate analysis of sociodemographic factors showed that postpartum depression was significantly associated with age and traumatic experience (e.g., death of a partner, divorce, financial bankruptcy). In addition, younger participants who had traumatic experiences in the past six months were more likely to have symptoms of depression. (3) Logistic regression analysis showed that poor sleep quality during pregnancy is associated with perinatal depression, regardless of risk factors such as psychological distress and stress.” | “It was used as a convenience sample; consequently, generalization of these findings maybe limited. Only used self-reported subjective measures.” |
Michele L. et al. [18] J Behav Med | Cross-sectional | (1) Pittsburgh sleep quality index (2) Edinburgh postnatal depression scale (3) Overall Anxiety Severity and Impairment Scale (4) Patient Health Questionnaire -9-item | 116 pregnant and postpartum women, Los Angeles, USA | “(1) Poor sleep quality was significantly associated with increased symptoms of depression and anxiety. (2) Sleep quality is a risk factor to affect the postpartum period. (3) Assessment of sleep hygiene during motherhood is worth considering as a component to identify women at risk for postpartum depression and anxiety.” | “This is a preliminary report of sleep quality measured only once. Sleep is recognized to change and often worsen across the perinatal period. There is no objective measurement of sleep (actigraphy).” |
Ella Volkovich et al. [19] Arch Women’s Ment Health | Prospective cohort study | (1) Pittsburgh sleep quality index (2) Edinburgh postnatal depression scale (3) Beck anxiety inventory | 148 pregnant women in the 3rd trimester expecting their first child, Helsinki, Finland | “(1) 50.3% of pregnant women reported poor sleep quality (defined as overall PSQI > 5). (2) 45% of women were awake on average for more than 30 min at night, and 27% had more than three night-time wakes per night. (3) Emotional distress (i.e., anxiety and severity of depressive symptoms) was significantly associated with self-reported sleep disturbances. (4) More quantitative PSQI components, such as sleep efficiency, were not associated with depressive and anxiety symptoms in the present study. The fact that correlations between emotional distress and different aspects of sleep subjectivity, as assessed by the PSQI, had variability suggests that the results are not merely the result of a self-report bias but likely reflect the complexity of the relationships between sleep and sleep emotional distress in pregnant women.” | “The sample characteristics (e.g., medium to high socioeconomic status, expecting a first child, and relatively low incidence of women scoring in the clinical range of depression) limit the generalizability of the results. Results may also not generalize to earlier stages of pregnancy.” |
Yang Ying et al. [20] The Journal of Maternal-Fetal and Neonatal Medicine | Cross-sectional | (1) Pittsburgh Sleep Quality Index (2) Edinburgh Postnatal Depression Scale (3) Multidimensional scale of perceived social support | 500 pregnant women from the obstetrics and gynecology outpatient clinic of two teaching hospitals in central China | “(1) Pregnant women had worse sleep quality in the third trimester. (2) In addition, depressive symptoms increase with age and gestational age, which is why they are one of the determinants of sleep quality in pregnant women. (3) Recommendation that health professionals pay more attention to sleep problems and provide sleep counseling during antenatal examinations, particularly for pregnant women with depressive tendencies and advanced maternal age.” | They are not mentioned. |
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Poeira, A.F.; Zangão, M.O. Construct of the Association between Sleep Quality and Perinatal Depression: A Literature Review. Healthcare 2022, 10, 1156. https://doi.org/10.3390/healthcare10071156
Poeira AF, Zangão MO. Construct of the Association between Sleep Quality and Perinatal Depression: A Literature Review. Healthcare. 2022; 10(7):1156. https://doi.org/10.3390/healthcare10071156
Chicago/Turabian StylePoeira, Ana Filipa, and Maria Otília Zangão. 2022. "Construct of the Association between Sleep Quality and Perinatal Depression: A Literature Review" Healthcare 10, no. 7: 1156. https://doi.org/10.3390/healthcare10071156