title: Sleep quality during pregnancy: associations with depressive and anxiety symptoms.
abstract: BACKGROUND
  Sleep disturbances are common during pregnancy, yet underdiagnosed and under-investigated. We evaluated sleep quality during pregnancy and assessed associated factors, especially depressive and anxiety symptoms.
  
  
  METHODS
  A total of 78 healthy pregnant women from the FinnBrain Birth Cohort Study were studied twice prospectively during pregnancy (in mid-pregnancy and late pregnancy). Sleep quality was evaluated by the Basic Nordic Sleep Questionnaire, depressive symptoms by the Edinburgh Postnatal Depression Scale, and anxiety symptoms by the State-Trait Anxiety Inventory.
  
  
  RESULTS
  Poor general sleep quality, difficulty falling asleep, the number of nocturnal awakenings per night, and too-early morning awakenings increased in late pregnancy compared with mid-pregnancy (all p-values < 0.020). The total insomnia score (p < 0.001) and sleep latency increased (p = 0.005), but sleep duration and preferred sleep duration did not change. Women tended to snore more often in late pregnancy, but apneas remained rare. Almost one-fourth of the women reported both morning and daytime sleepiness, but the frequencies did not increase during the follow up. In late pregnancy, depressive and anxiety symptoms were cross-sectionally related to sleep disturbances, but depressive or anxiety symptoms in mid-pregnancy were not associated with sleep disturbances in late pregnancy.
  
  
  CONCLUSIONS
  We found deterioration in sleep quality across pregnancy. However, no increase in negative daytime consequences was found, presumably indicating a compensatory capacity against sleep impairment. Additionally, depressive and anxiety symptoms and sleep disturbances were only cross-sectionally associated. Our study calls for further research on the factors that influence sleep disturbances during pregnancy.
authors.affiliation: Department of Obstetrics and Gynecology, Turku University Hospital and University of Turku, Turku, Finland.|Sleep Research Unit, University of Turku, Turku, Finland.
authors.forename: Päivi
authors.identifier: http://orcid.org/0000-0003-0665-0306
authors.initials: P
authors.lastname: Polo-Kantola
authors.affiliation: Department of Obstetrics and Gynecology, Central Hospital of Seinäjoki, Seinäjoki, Finland.
authors.forename: Linda
authors.identifier: http://orcid.org/0000-0003-1930-2984
authors.initials: L
authors.lastname: Aukia
authors.affiliation: FinnBrain Birth Cohort Study, Turku Brain and Mind Center, Insitute of Clinical Medicine, University of Turku, Turku, Finland.|Department of Psychiatry, Turku University Hospital and University of Turku, Turku, Finland.
authors.forename: Hasse
authors.identifier: http://orcid.org/0000-0002-4992-1893
authors.initials: H
authors.lastname: Karlsson
authors.affiliation: FinnBrain Birth Cohort Study, Turku Brain and Mind Center, Insitute of Clinical Medicine, University of Turku, Turku, Finland.|Department of Child Psychiatry, Turku University Hospital and University of Turku, Turku, Finland.
authors.forename: Linnea
authors.identifier: http://orcid.org/0000-0002-4725-0176
authors.initials: L
authors.lastname: Karlsson
authors.affiliation: National Institute for Health and Welfare, Helsinki, Finland.|Department of Child Psychiatry, University of Helsinki, Helsinki, Finland.
authors.forename: E Juulia
authors.identifier: http://orcid.org/0000-0002-1421-9877
authors.initials: EJ
authors.lastname: Paavonen
mesh_terms: D000328:Adult; D001007:Anxiety / Q000150:complications*; D015992:Body Mass Index; D015331:Cohort Studies; D003863:Depression / Q000150:complications*; D005260:Female; D006801:Humans; D008423:Maternal Age; D010298:Parity; D011247:Pregnancy; D011248:Pregnancy Complications; D011264:Pregnancy Trimesters; D012893:Sleep Wake Disorders / Q000150:complications*; D012913:Snoring / Q000150:complications; D055815:Young Adult
keywords: Sleep; anxiety; depression; insomnia; nocturnal breathing problem; pregnancy; sleep disturbance; sleepiness; woman