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      Maternal Sleeping Problems Before and After Childbirth - A Systematic Review

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          Abstract

          The perinatal and postpartum period is of great significance for women due to physiological changes, shifts in circadian rhythms, social setting, and psychological well-being, all of which affect the quality and quantity of their sleep. A mixed-studies systematic review was undertaken to enhance our understanding of sleep disturbances and mood disorders in women in late pregnancy and the postpartum period, their connection with breastfeeding, and the assessment of interventions for sleep disturbance. Three electronic databases (PUBMED, EMBASE and Google Scholar) were searched for qualitative, observational, and mixed-method studies from the year 2016 to June 2023. Twenty-nine articles were included in the analysis. The results were synthesized into four overarching themes: (і) the sleep quality of women in the perinatal period; (ii) the relationship between sleep and breastfeeding; (iii) the relationship between sleep quality and emotional disturbance in the perinatal period; (iv) sleep interventions in the researched group. The subjective nature of the perception of sleep disturbances, along with the absence of an objective measurement tool is clearly an inconvenience. It is advisable to include the assessment of maternal sleep hygiene and family sleep patterns during postpartum healthcare provider appointments to develop strategies not only for women’s sleep quality but also for their mental well-being.

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          Most cited references62

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          The Pittsburgh sleep quality index: A new instrument for psychiatric practice and research

          Despite the prevalence of sleep complaints among psychiatric patients, few questionnaires have been specifically designed to measure sleep quality in clinical populations. The Pittsburgh Sleep Quality Index (PSQI) is a self-rated questionnaire which assesses sleep quality and disturbances over a 1-month time interval. Nineteen individual items generate seven "component" scores: subjective sleep quality, sleep latency, sleep duration, habitual sleep efficiency, sleep disturbances, use of sleeping medication, and daytime dysfunction. The sum of scores for these seven components yields one global score. Clinical and clinimetric properties of the PSQI were assessed over an 18-month period with "good" sleepers (healthy subjects, n = 52) and "poor" sleepers (depressed patients, n = 54; sleep-disorder patients, n = 62). Acceptable measures of internal homogeneity, consistency (test-retest reliability), and validity were obtained. A global PSQI score greater than 5 yielded a diagnostic sensitivity of 89.6% and specificity of 86.5% (kappa = 0.75, p less than 0.001) in distinguishing good and poor sleepers. The clinimetric and clinical properties of the PSQI suggest its utility both in psychiatric clinical practice and research activities.
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            Sleep patterns and sleep disturbances across pregnancy.

            This study sought to characterize sleep patterns and sleep problems in a large sample of women across all months of pregnancy.
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              Sleep quality during pregnancy: A meta-analysis

              Women's sleep quality has been reported to change during pregnancy; prevalence estimates of poor sleep quality during pregnancy vary widely. To further understand the observed variation of findings, we conducted a meta-analysis to quantify the prevalence of poor sleep quality during pregnancy. Articles (N = 24) that reported prevalence of poor sleep quality as captured by the Pittsburgh sleep quality index (PSQI) ≥ 5 were included, with a total of 11,002 participants contributing data. PubMed, PsycINFO, and Web of Science databases were systematically searched. Results indicated that the average PSQI score during pregnancy was 6.07, 95% confidence interval (CI) [5.30, 6.85], and 45.7%, 95% CI [36.5%, 55.2%], of pregnant women experienced poor sleep quality. Longitudinal studies indicated that sleep quality decreased from second (M = 5.31, SE = 0.40) to third trimester (M = 7.03, SE = 0.85) by 1.68 points, 95% CI [0.42, 2.94]. Gestational age moderated the average PSQI scores and prevalence of PSQI scores ≥5; older samples reported higher mean PSQI scores and higher prevalence of poor sleep quality. Clinicians should be aware that some reduction in sleep quality is expected during pregnancy, but complaints of very poor sleep quality could require intervention. Future research should examine various factors underlying poor sleep quality during pregnancy.
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                Author and article information

                Journal
                Int J Womens Health
                Int J Womens Health
                ijwh
                International Journal of Women's Health
                Dove
                1179-1411
                02 March 2024
                2024
                : 16
                : 345-371
                Affiliations
                [1 ]Department of Human Anatomy, Medical University of Warsaw , Warsaw, Poland
                [2 ]Department of Psychiatry, Narcology and Medical Psychology, Poltava State Medical University , Poltava, Ukraine
                [3 ]Chair and Department of Hygiene and Epidemiology, Medical University of Lublin , Lublin, Poland
                Author notes
                Correspondence: Malgorzata Witkowska-Zimny, Department of Human Anatomy, Medical University of Warsaw , 5 Chalubinskiego Str., Warsaw, 02-004, Poland, Email mwitkowska@wum.edu.pl
                Anastasiia Zhyvotovska, Department of Psychiatry, Narcology and Medical Psychology, Poltava State Medical University , 1 Medychna Str., Poltava, 36013, Ukraine, Email jyvotovskaaa@gmail.com
                [*]

                These authors contributed equally to this work

                Author information
                http://orcid.org/0000-0003-2167-8657
                http://orcid.org/0000-0002-6199-0146
                Article
                446490
                10.2147/IJWH.S446490
                10918694
                38455339
                2428f1da-d3f7-4404-ab50-f49f4e6dc38f
                © 2024 Witkowska-Zimny et al.

                This work is published and licensed by Dove Medical Press Limited. The full terms of this license are available at https://www.dovepress.com/terms.php and incorporate the Creative Commons Attribution – Non Commercial (unported, v3.0) License ( http://creativecommons.org/licenses/by-nc/3.0/). By accessing the work you hereby accept the Terms. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed. For permission for commercial use of this work, please see paragraphs 4.2 and 5 of our Terms ( https://www.dovepress.com/terms.php).

                History
                : 25 October 2023
                : 22 January 2024
                Page count
                Figures: 1, Tables: 4, References: 63, Pages: 27
                Funding
                Funded by: received no external funding;
                This research received no external funding.
                Categories
                Review

                Obstetrics & Gynecology
                childbirth,breastfeeding,maternal sleep,sleep quality,sleep disturbance,psycho-emotional states

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