Francesca L Facco1, Corette B Parker2, Shannon Hunter2, Kathryn J Reid3, Phyllis P Zee3, Robert M Silver4, Grace Pien5, Judith H Chung6, Judette M Louis7, David M Haas8, Chia-Ling Nhan-Chang9, Hyagriv N Simhan10, Samuel Parry11, Ronald J Wapner8, George R Saade12, Brian M Mercer13, Melissa Bickus10, Uma M Reddy14, William A Grobman15. 1. Department of Obstetrics, Gynecology and Reproductive Sciences, University of Pittsburgh School of Medicine, Pittsburgh, PA. Electronic address: faccof@upmc.edu. 2. RTI International, Research Triangle Park, NC. 3. Department of Neurology, Northwestern University, Chicago, IL. 4. Department of Obstetrics and Gynecology, University of Utah and Intermountain Healthcare, Salt Lake City, UT. 5. Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD. 6. Department of Obstetrics and Gynecology, University of California, Irvine, Irvine, CA. 7. University of South Florida Morsani College of Medicine, Tampa FL. 8. Department of Obstetrics and Gynecology, School of Medicine, Indiana University, Indianapolis, IN. 9. Department of Obstetrics and Gynecology, Columbia University, New York, NY. 10. Department of Obstetrics, Gynecology and Reproductive Sciences, University of Pittsburgh School of Medicine, Pittsburgh, PA. 11. Department of Obstetrics and Gynecology, University of Pennsylvania, Philadelphia, PA. 12. Department of Obstetrics and Gynecology, University of Texas Medical Branch, University of Texas, Galveston, TX. 13. Department of Obstetrics and Gynecology, Case Western Reserve University, Cleveland, OH. 14. Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, MD. 15. Department of Obstetrics, Gynecology-Maternal Fetal Medicine & Preventive Medicine, Northwestern University, Chicago, IL.
Abstract
BACKGROUND: Although uterine contractions have a diurnal periodicity and increase in frequency during hours of darkness, data on the relationship between sleep duration and sleep timing patterns and preterm birth are limited. OBJECTIVE: We sought to examine the relationship of self-reported sleep duration and timing in pregnancy with preterm birth. STUDY DESIGN: In the prospective Nulliparous Pregnancy Outcome Study: Monitoring Mothers-to-be cohort, women completed a survey of sleep patterns at 6-13 weeks gestation (visit 1) and again at 22-29 weeks gestation (visit 3). Additionally, at 16-21 weeks gestation (visit 2), a subgroup completed a weeklong actigraphy recording of their sleep. Weekly averages of self-reported sleep duration and sleep midpoint were calculated. A priori, sleep duration of <7 hours was defined as "short," and sleep midpoint after 5 am was defined as "late." The relationships among these sleep characteristics and all preterm birth and spontaneous preterm birth at <37 weeks gestation were examined in univariate analyses. Multivariable logistic regressions that controlled for age and body mass index alone (model 1) and with additional covariates (race, smoking, insurance, and employment schedule) following a backward elimination process (model 2) were performed. RESULTS: Of the 10,038 women who were enrolled, sleep survey data were available on 7524 women at visit 1 and 7668 women at visit 3. The rate of short sleep duration was 17.1% at visit 1 and 20.7% at visit 3. The proportion with a late sleep midpoint was 11.6% at visit 1 and 12.2% at visit 3. There was no significant relationship between self-reported short sleep and preterm birth across all visits. However, self-reported late sleep midpoint (>5 am) was associated with preterm birth . Women with a late sleep midpoint (>5 am) in early pregnancy had a preterm birth rate of 9.5%, compared with 6.9% for women with sleep midpoint ≤5 am (P=.005). Similarly, women with a late sleep midpoint had a higher rate of spontaneous preterm birth (6.2% vs 4.4%; P=.019). Comparable results were observed for women with a late sleep midpoint at visit 3 (all preterm birth 8.9% vs 6.6%; P=.009; spontaneous preterm birth 5.9% vs 4.3%; P=.023). All adjusted analyses on self-reported sleep midpoint (models 1 and 2) maintained statistical significance (P<.05), except for visit 1, model 2 for spontaneous preterm birth (P=.07). The visit 2 objective data from the smaller subgroup (n=782) demonstrated similar trends in preterm birth rates by sleep midpoint status. CONCLUSION: Self-reported late sleep midpoint in both early and late pregnancy, but not short sleep duration, is associated with an increased rate of preterm birth.
BACKGROUND: Although uterine contractions have a diurnal periodicity and increase in frequency during hours of darkness, data on the relationship between sleep duration and sleep timing patterns and preterm birth are limited. OBJECTIVE: We sought to examine the relationship of self-reported sleep duration and timing in pregnancy with preterm birth. STUDY DESIGN: In the prospective Nulliparous Pregnancy Outcome Study: Monitoring Mothers-to-be cohort, women completed a survey of sleep patterns at 6-13 weeks gestation (visit 1) and again at 22-29 weeks gestation (visit 3). Additionally, at 16-21 weeks gestation (visit 2), a subgroup completed a weeklong actigraphy recording of their sleep. Weekly averages of self-reported sleep duration and sleep midpoint were calculated. A priori, sleep duration of <7 hours was defined as "short," and sleep midpoint after 5 am was defined as "late." The relationships among these sleep characteristics and all preterm birth and spontaneous preterm birth at <37 weeks gestation were examined in univariate analyses. Multivariable logistic regressions that controlled for age and body mass index alone (model 1) and with additional covariates (race, smoking, insurance, and employment schedule) following a backward elimination process (model 2) were performed. RESULTS: Of the 10,038 women who were enrolled, sleep survey data were available on 7524 women at visit 1 and 7668 women at visit 3. The rate of short sleep duration was 17.1% at visit 1 and 20.7% at visit 3. The proportion with a late sleep midpoint was 11.6% at visit 1 and 12.2% at visit 3. There was no significant relationship between self-reported short sleep and preterm birth across all visits. However, self-reported late sleep midpoint (>5 am) was associated with preterm birth . Women with a late sleep midpoint (>5 am) in early pregnancy had a preterm birth rate of 9.5%, compared with 6.9% for women with sleep midpoint ≤5 am (P=.005). Similarly, women with a late sleep midpoint had a higher rate of spontaneous preterm birth (6.2% vs 4.4%; P=.019). Comparable results were observed for women with a late sleep midpoint at visit 3 (all preterm birth 8.9% vs 6.6%; P=.009; spontaneous preterm birth 5.9% vs 4.3%; P=.023). All adjusted analyses on self-reported sleep midpoint (models 1 and 2) maintained statistical significance (P<.05), except for visit 1, model 2 for spontaneous preterm birth (P=.07). The visit 2 objective data from the smaller subgroup (n=782) demonstrated similar trends in preterm birth rates by sleep midpoint status. CONCLUSION: Self-reported late sleep midpoint in both early and late pregnancy, but not short sleep duration, is associated with an increased rate of preterm birth.
Authors: Francesca L Facco; Corette B Parker; Shannon Hunter; Kathryn J Reid; Phyllis C Zee; Robert M Silver; David M Haas; Judith H Chung; Grace W Pien; Chia-Ling Nhan-Chang; Hyagriv N Simhan; Samuel Parry; Ronald J Wapner; George R Saade; Brian M Mercer; Caroline Torres; Jordan Knight; Uma M Reddy; William A Grobman Journal: J Clin Sleep Med Date: 2018-12-15 Impact factor: 4.062
Authors: David M Haas; Corette B Parker; Deborah A Wing; Samuel Parry; William A Grobman; Brian M Mercer; Hyagriv N Simhan; Matthew K Hoffman; Robert M Silver; Pathik Wadhwa; Jay D Iams; Matthew A Koch; Steve N Caritis; Ronald J Wapner; M Sean Esplin; Michal A Elovitz; Tatiana Foroud; Alan M Peaceman; George R Saade; Marian Willinger; Uma M Reddy Journal: Am J Obstet Gynecol Date: 2015-01-31 Impact factor: 8.661
Authors: Francesca L Facco; William A Grobman; Kathryn J Reid; Corette B Parker; Shannon M Hunter; Robert M Silver; Robert C Basner; George R Saade; Grace W Pien; Shalini Manchanda; Judette M Louis; Chia-Ling Nhan-Chang; Judith H Chung; Deborah A Wing; Hyagriv N Simhan; David M Haas; Jay Iams; Samuel Parry; Phyllis C Zee Journal: Am J Obstet Gynecol Date: 2017-06-07 Impact factor: 8.661
Authors: Michelle A Williams; Raymond S Miller; Chunfang Qiu; Swee May Cripe; Bizu Gelaye; Daniel Enquobahrie Journal: Sleep Date: 2010-10 Impact factor: 5.849
Authors: Till Roenneberg; Tim Kuehnle; Myriam Juda; Thomas Kantermann; Karla Allebrandt; Marijke Gordijn; Martha Merrow Journal: Sleep Med Rev Date: 2007-11-01 Impact factor: 11.609
Authors: Sandhya Kajeepeta; Sixto E Sanchez; Bizu Gelaye; Chunfang Qiu; Yasmin V Barrios; Daniel A Enquobahrie; Michelle A Williams Journal: BMC Pregnancy Childbirth Date: 2014-09-27 Impact factor: 3.007