title: Cross-sectional and longitudinal associations between sleep and health-related quality of life in pregnant women: A prospective observational study.
abstract: BACKGROUND
  Sleep disturbances are common in women, especially during pregnancy. Previous studies have confirmed the importance of sleep disturbances as a risk factor of adverse pregnancy outcomes and the need for screening and treatment of inadequate sleep. These reports, however, did not examine health-related quality of life which may be affected by sleep long before adverse clinical consequences are detectable in women during pregnancy.
  
  
  OBJECTIVE
  To examine the cross-sectional and longitudinal association between sleep and health-related quality of life in pregnant women.
  
  
  METHODS
  A prospective observational study.
  
  
  METHODS
  A university-affiliated hospital in Taiwan and participants' homes.
  
  
  METHODS
  A total of 164 pregnant women completed questionnaires and wore a wrist actigraphy monitor for 7 days each trimester.
  
  
  METHODS
  Objective sleep was measured by actigraphy, subjective sleep was measured by the Pittsburgh Sleep Quality Index, and health-related quality of life was measured using the SF-12v2 questionnaire across three trimesters. Multiple linear regression analyses were performed to evaluate the cross-sectional and longitudinal associations between sleep and health-related quality of life.
  
  
  RESULTS
  Sixty-four (39.0%) women consistently had an average sleep efficiency<85% by actigraphy and 40 (24.4%) had a Pittsburgh Sleep Quality Index global score>5 in all three trimesters. Cross-sectionally, more actigraphic daytime sleep (p=0.04) and better subjective sleep quality (p<0.01) were associated with better physical health-related quality of life in first-trimester pregnant women. Better actigraphic sleep efficiency (p=0.04) and better subjective sleep quality (p<0.01) were associated with better mental health-related quality of life in second-trimester pregnant women. Longer actigraphic total nighttime sleep (p<0.01) and better subjective sleep quality (p<0.01) were associated with better mental health-related quality of life in third-trimester pregnant women. Longitudinally, first-trimester actigraphic total nighttime sleep (p<0.05) and subjective sleep quality (p<0.01) predicted mental health-related quality of life in the second and third trimester.
  
  
  CONCLUSIONS
  Sleep disturbances are a highly prevalent and persistent problem in pregnant women. Adequate sleep is essential for women at all pregnancy stages and improving nocturnal sleep quantity and quality in early gestation is of utmost importance for an optimal health-related quality of life later in pregnancy.
authors.affiliation: Department of Nursing, National Taiwan University, Taipei, Taiwan. Electronic address: stsai@ntu.edu.tw.
authors.forename: Shao-Yu
authors.initials: SY
authors.lastname: Tsai
authors.affiliation: Department of Internal Medicine, National Taiwan University, Taipei, Taiwan; Center of Sleep Disorder, National Taiwan University Hospital, Taipei, Taiwan; Division of Pulmonary and Critical Care Medicine, National Taiwan University Hospital, Taipei, Taiwan. Electronic address: peilin1986@gmail.com.
authors.forename: Pei-Lin
authors.initials: PL
authors.lastname: Lee
authors.affiliation: Department of Medicine, National Taiwan University, Taipei, Taiwan. Electronic address: jouweilin@yahoo.com.
authors.forename: Jou-Wei
authors.initials: JW
authors.lastname: Lin
authors.affiliation: Department of Obstetrics and Gynecology, National Taiwan University, Taipei, Taiwan. Electronic address: leecn@ntu.edu.tw.
authors.forename: Chien-Nan
authors.initials: CN
authors.lastname: Lee
mesh_terms: D000328:Adult; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D011247:Pregnancy; D011446:Prospective Studies; D011788:Quality of Life; D012890:Sleep; D013624:Taiwan
keywords: Health-related quality of life; Pregnancy; Sleep; Women