Differentiating perinatal Insomnia Disorder and sleep disruption: a longitudinal study from pregnancy to 2 years postpartum.
Differentiating perinatal Insomnia Disorder and sleep disruption: a longitudinal study from pregnancy to 2 years postpartum.
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区分围产期失眠症和睡眠障碍：从怀孕到产后 2 年的纵向研究。
作者：
Quin,Nina;Lee,JinJoo;Pinnington,DonnaM;Newman,Louise;Manber,Rachel;Bei,Bei
研究目的失眠症的诊断需要持续的睡眠抱怨，尽管“充足的睡眠机会”。严重的围产期睡眠障碍使这一诊断具有挑战性。这项纵向研究区分了失眠症和围产期睡眠障碍及其睡眠和心理健康的相关性。（年龄M ±SD= 33.35 ± 3.42）参与了一项随机对照试验，在30岁时重复了杜克睡眠障碍结构化访谈和患者报告结果测量信息系统的睡眠和心理健康测量的失眠障碍模块。妊娠35周，产后1.5、3、6、12和24个月（944次访谈，完成1009份问卷）。我们比较了精神障碍诊断与统计手册（DSM-5）中精神障碍标准的临床特征，（无持续时间标准）为：（1）满足（失眠症），（2）不仅仅是因为睡眠机会标准（围产期睡眠中断），及（3）因其他标准而不符合结果妊娠早期和妊娠晚期子宫内膜异位症的发生率分别为16.0%和19.8%，产后子宫内膜异位症的发生率为5.3%-11.7%。如果不考虑睡眠机会标准，则各时间点的Increase率将高出2-4倍（21.4%-40.4%）。调整协变量的混合效应模型显示，与低投诉相比，失眠症和围产期睡眠障碍在失眠和睡眠障碍量表、睡眠努力和睡眠相关障碍方面的得分显著更高（p值< .01），但抑郁和焦虑的比例结论在评估睡眠问题时不考虑睡眠机会可能会导致围产期失眠症的过度诊断。失眠症和围产期睡眠中断都与不良的睡眠和情绪的结果，需要仔细区分和适当addressed.Clinical试验注册：种子项目（睡眠，饮食，情绪和发展）：一个随机对照试点研究围产期睡眠干预对母亲和婴儿的睡眠和健康。https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx? id=371634，澳大利亚和新西兰临床试验注册中心：ACTRN 12616001462471。
Study ObjectivesInsomnia Disorder diagnoses require persistent sleep complaints despite “adequate sleep opportunity.” Significant Perinatal Sleep Disruption makes this diagnosis challenging. This longitudinal study distinguished between Insomnia Disorder and Perinatal Sleep Disruption and their sleep and mental health correlates.MethodsOne hundred sixty-three nulliparous females (ageM±SD= 33.35 ± 3.42) participating in a randomized controlled trial repeated the Insomnia Disorder module of the Duke Structured Interview for Sleep Disorders and Patient-Reported Outcome Measurement Information System measures for sleep and mental health at 30- and 35-weeks’ gestation, and 1.5, 3, 6, 12, and 24 months postpartum (944 interviews, 1009 questionnaires completed). We compared clinical features when Diagnostic and Statistical Manual of Mental Disorders (DSM-5) Insomnia Disorder criteria (without the Duration criterion) were: (1) met (Insomnia Disorder), (2) not metonlybecause of the sleep opportunity criteria (Perinatal Sleep Disruption), and (3) not met due to other criteria (Low Complaint).ResultsProportions of Insomnia Disorder were 16.0% and 19.8% during early and late third trimester, and ranged 5.3%–11.7% postpartum. If the sleep opportunity criteria were not considered, rates of Insomnia would be 2–4 times higher (21.4%–40.4%) across time-points. Mixed-effects models adjusting for covariates showed that compared to Low Complaint, both Insomnia Disorder and Perinatal Sleep Disruption scored significantly higher on insomnia and sleep disturbance scales, sleep effort, and sleep-related impairments (pvalues < .01), but depression and anxiety were comparable (pvalues > .12).ConclusionAssessing sleep complaints without considering sleep opportunities can result in over-diagnosis of Insomnia Disorder in the perinatal periods. Insomnia Disorder and Perinatal Sleep Disruption were both associated with adverse sleep and mood outcomes, and need to be carefully differentiated and appropriately addressed.Clinical Trial Registration: The SEED Project (Sleep, Eat, Emotions, and Development): A randomized controlled pilot study of a perinatal sleep intervention on sleep and wellbeing in mothers and infants. https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=371634, Australian New Zealand Clinical Trials Registry: ACTRN12616001462471.