Natural History of Sleep Disturbance in Childbearing Women: A Feasibility Study

项目摘要/摘要 关于女性从孕前到孕期过渡到 产后需要预测孕产妇和婴儿的健康结果。新妈妈的睡眠障碍 它无处不在，不仅对母亲的健康和福祉构成了深刻的挑战，而且对 他们的孩子。虽然一些睡眠障碍可能是正常的，并通过分娩和适应 初为人母，其他人可能不适应，并增加不良妊娠和/或糟糕的母亲或 婴儿健康结果。例如，全球测量的睡眠障碍与 产前抑郁、早产、较长的产程、更多的剖腹产和产后抑郁。 哪些睡眠障碍明确地赋予了风险，现在才被描绘出来。需要进行纵向研究来 确定睡眠障碍在什么时候、对谁和在什么条件下引起的病理。预期 然而，这种性质的研究一直有限，因为在招募大型、有代表性的人方面存在挑战。 样本，维护登记的参与者，并确保及时完成研究工具。在保持 通过R21机制，本研究旨在1)试验一种新的方法学方法的可行性 (通过国家投票机构和登记处进行招聘，使用在线问卷系统，提供 通过电子邮件和学习网站定期反馈，以及以彩票为基础的奖励制度)旨在系统和 有效地剔除这类纵向数据；2)尊重评估怀孕和非怀孕妇女的差异 累积睡眠障碍发病率，并确定哪些特定的睡眠障碍解释了这些差异；以及3) 收集有关睡眠障碍和母婴结局之间关系的试点数据。这样做的未分娩妇女 不打算在未来18个月内怀孕，打算在未来18个月内怀孕，目前正在 他们的头三个月将被招募参加16-18个月的研究。可行性将通过评估来评估 招聘、留住和合规率，以及这些是否满足预先指定的门槛标准。两者都有 将系统地跟踪与母婴有关的睡眠连续性和睡眠障碍症状 结果(例如，疲劳、嗜睡、情绪障碍、妊娠期糖尿病、妊娠丢失发生率、 早产发生率和出生体重)。给出了支持这些战略可行性的数据， 所提出的方法学包可应用于许多纵向设计，包括 拟议的研究。最后，拟议研究的内容将有助于对 睡眠障碍与母婴健康之间的关联(即，睡眠障碍与母婴健康之间的总体关联 两套措施)和评估特定关联(例如，与睡眠呼吸暂停相关的症状和 妊娠糖尿病)。最终，如果成功，这项研究计划可能有助于确定何时出现睡眠障碍 需要采取干预措施，以促进产妇健康和良好的婴儿结局。

PROJECT ABSTRACT/SUMMARY Prospective data on the sleep of women as they transition from pre-pregnancy through pregnancy and to postpartum are needed to predict maternal and infant health outcomes. Sleep disturbance among new mothers is ubiquitous and presents a profound challenge, not only to mothers' health and well-being, but also to that of their infant. While some sleep disruptions may be normative and resolve with childbirth and the adaptation to new motherhood, others may be maladaptive and confer risk for adverse pregnancy and/or poor maternal or infant health outcomes. For example, sleep disturbance, globally measured, has been associated with antenatal depression, preterm birth, longer labors, more C-section deliveries, and postpartum depression. Which sleep disorders specifically confer risk is only now being delineated. Longitudinal studies are needed to determine when, for whom, and under what conditions, sleep disturbance gives rise to pathology. Prospective studies of this nature, however, have been limited, due to challenges in recruiting large, representative samples, maintaining enrolled participants, and ensuring timely completion of study instruments. In keeping with the R21 mechanism, the present study is designed to 1) pilot the feasibility of a novel methodological approach (recruitment via a national polling agency and registry, the use of an online questionnaire system, the provision of regular feedback via email and a study website, and a lottery-based incentive system) aimed to systematically and efficiently cull longitudinal data of this kind; 2) evaluate pregnant and non-pregnant women for differences with respect to cumulative sleep disorder morbidity, and determine which specific sleep disorders account for these differences; and 3) gather pilot data on the association between sleep disturbance and maternal-infant outcomes. Nulliparous women who do not intend to conceive in the next 18 months, who intend to conceive in the next 18 months, and who are currently in their first trimester, will be recruited to participate in a 16-18 month study. Feasibility will be assessed by evaluating recruitment, retention, and compliance rates and whether these meet pre-specified threshold criteria. Both sleep continuity and sleep disorder symptoms will be systematically tracked in relation to maternal and infant outcomes (e.g., fatigue, sleepiness, mood disturbance, gestational diabetes, incidence of pregnancy loss, incidence of pre-term birth, and birth weight). Given data to support the feasibility of these strategies, the methodological package proposed can be applied to numerous longitudinal designs, including, and apart from, the proposed study. Finally, the content of the proposed study will serve to allow an estimation of the overall association between sleep disturbance and maternal and infant health (i.e., an overall association between the two sets of measures) and for the evaluation of specific associations (e.g., OSA-related symptoms and gestational diabetes). Ultimately, if successful, this program of research may help define when sleep disorder interventions are needed to promote both maternal health and good infant outcomes.