title: Persistent and new-onset daytime sleepiness in pregnant women: A prospective observational cohort study.
abstract: BACKGROUND
  Daytime sleepiness is a frequent complaint in women during pregnancy. It has also been linked to negative obstetric consequences. Although high prevalence of excessive daytime sleepiness throughout pregnancy is well-documented, neither the causes of persistent daytime sleepiness nor new-onset daytime sleepiness during pregnancy have been investigated. Identifying predictive factors may play an important role in the management of daytime sleepiness in pregnant women and improve prenatal care and maternal-fetal outcomes.
  
  
  OBJECTIVE
  To examine first-trimester maternal characteristics associated with the persistence and new-onset daytime sleepiness in pregnant women.
  
  
  METHODS
  A longitudinal, prospective cohort design.
  
  
  METHODS
  One medical center in Taipei, Taiwan and participating women's homes.
  
  
  METHODS
  A total of 204 pregnant women.
  
  
  METHODS
  First-trimester pregnant women recruited from an outpatient obstetric clinic at a medical center provided socio-demographic and health information, wore an actigraphy monitor for 7 days, and completed sleep, mood, and daytime sleepiness questionnaires. Data were collected again when the women were in the second and third trimester.
  
  
  RESULTS
  Thirty-one (15.2%) women experienced excessive daytime sleepiness that persisted across all three trimesters. Nulliparous women and women who snored in the first trimester were 2.28 and 2.10 times more at risk of being classified of persistent daytime sleepiness than multiparous women and women who did not snore in the first trimester, respectively. Thirty-one (15.2%) women developed new-onset daytime sleepiness with advancing gestation. Women were more likely to develop new-onset daytime sleepiness if they worked longer hours per week (OR=1.04, p<0.001), if they reported snoring (OR=6.75, p<0.001), and if they had elevated depressive symptoms in the first trimester of pregnancy (OR=1.09, p=0.01).
  
  
  CONCLUSIONS
  Snoring in the first trimester is involved in both the persistence and new-onset of daytime sleepiness with elevated depressive symptoms related to new-onset daytime sleepiness in pregnant women. Findings suggest that intervention strategies for alleviating daytime sleepiness in pregnant women should focus on managing snoring and symptoms of depression in early trimesters with special attention to nulliparous and employed women.
authors.affiliation: School of Nursing, National Taiwan University, No. 1, Sec. 1, Jen-Ai Rd, Taipei, 10051, 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.
authors.forename: Pei-Lin
authors.initials: PL
authors.lastname: Lee
authors.affiliation: Department of Medicine, National Taiwan University, Taipei, Taiwan.
authors.forename: Jou-Wei
authors.initials: JW
authors.lastname: Lin
authors.affiliation: Department of Obstetrics and Gynecology, National Taiwan University, Taipei, Taiwan.
authors.forename: Chien-Nan
authors.initials: CN
authors.lastname: Lee
mesh_terms: D000328:Adult; D015331:Cohort Studies; D004651:Employment; D005221:Fatigue; D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D011247:Pregnancy; D011261:Pregnancy Trimester, First; D012890:Sleep; D013624:Taiwan
keywords: Pregnancy; Sleep; Sleepiness; Women