Poor sleep as a risk factor for postnatal depression

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My research is looking at whether poor sleep during pregnancy can increase the risk of developing postnatal depression. I am using polysomnography along with subjective measures of sleep to assess how 'poor sleep' might be defined

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Poor sleep as a risk factor for postnatal depression

  1. 1. Poor sleep as a risk factor for postnatal depression Lauren Kita, PhD student, Bournemouth University
  2. 2. Aims <ul><li>Background of topic </li></ul><ul><ul><li>The relationship between sleep and depression </li></ul></ul><ul><ul><li>Postnatal depression </li></ul></ul><ul><ul><li>Sleep during pregnancy and the postpartum period </li></ul></ul><ul><ul><li>The relationship between sleep and postnatal depression </li></ul></ul><ul><li>My PhD </li></ul><ul><li>Summary </li></ul>
  3. 3. Sleep and depression Depression Poor sleep <ul><li>Subjective sleep quality </li></ul><ul><li>Abnormal sleep stages / timings </li></ul><ul><li>Insomnia </li></ul>
  4. 4. Postnatal depression (PND) <ul><li>13% of women (O’hara, 2011) </li></ul><ul><li>Risk factors: Prior history of depression, social stress, poor social support, poverty, sleep disturbances. </li></ul><ul><li>Symptoms: </li></ul><ul><ul><li>Low mood </li></ul></ul><ul><ul><li>Weight changes </li></ul></ul><ul><ul><li>Loss of interest in previously enjoyed activities </li></ul></ul><ul><ul><li>Insomnia </li></ul></ul><ul><ul><li>Fatigue and feelings of energy loss </li></ul></ul><ul><ul><li>Feelings of worthlessness and inappropriate guilt </li></ul></ul><ul><ul><li>Diminished ability to think, concentrate, indecisiveness </li></ul></ul><ul><ul><li>Recurrent thoughts of death, suicidal ideation. </li></ul></ul><ul><ul><li>* Within 4 weeks of delivery </li></ul></ul>
  5. 5. Sleep in pregnancy & the postpartum period <ul><li>Sleep disturbances are common in pregnancy </li></ul><ul><ul><li>Backache, needing to urinate, snoring, restless legs syndrome (Baratte-Beebe & Lee, 1999; Facco et al. 2010) </li></ul></ul><ul><li>Sleep disturbances are common in postpartum period </li></ul><ul><ul><li>Hormonal changes </li></ul></ul><ul><ul><li>The baby! </li></ul></ul>
  6. 6. Sleep and PND <ul><li>What has been done so far? </li></ul><ul><li>Cross-sectional studies </li></ul><ul><ul><li>Poor subjective sleep quality is associated with PPD when controlling for other risk factors (Dorheim et al., 2009) </li></ul></ul><ul><li>Longitudinal studies </li></ul><ul><ul><li>Subjective sleep quality in pregnancy associated with postpartum mood (Wilkie & Shapiro, 1992) </li></ul></ul><ul><ul><li>Objective sleep has not been shown to differ in those who develop PND – but so far these studies have used actigraphy not polysomnography (Bei et al., 2010) </li></ul></ul>
  7. 7. My study <ul><li>Aims </li></ul><ul><ul><li>Assess the relationship between poor sleep quality during pregnancy and the development of PPD </li></ul></ul><ul><ul><li>Compare objective and subjective sleep </li></ul></ul><ul><ul><li>Assess how sleep differs in women with a history of depression </li></ul></ul><ul><li>Methods </li></ul><ul><ul><li>2 groups: 20 women history of depression / 20 women no history of depression </li></ul></ul><ul><ul><li>2 nights of polysomnography (PSG) during 3 rd trimester </li></ul></ul><ul><ul><li>Subjective questionnaires of sleep and depressive symptoms administered during pregnancy and 1 & 12 weeks postpartum </li></ul></ul><ul><ul><li>Demographics questionnaires to control for other risk factors </li></ul></ul>
  8. 8. Polysomnography <ul><li>EEG- measures electrical activity in the brain </li></ul><ul><li>EOG- measures eye movements </li></ul><ul><li>EMG- measures muscle tone </li></ul><ul><li>Tells us about sleep stages, arousals, awakenings, time spent asleep </li></ul><ul><li>PSG measured in pregnancy; is there anything different in women that go on to develop PND? </li></ul>
  9. 9. Polysomnography Example of a person in Stage 1 sleep
  10. 10. Polysomnography <ul><li>Why PSG? </li></ul><ul><li>Individuals with depression: </li></ul><ul><ul><li>Reduced amount of time before entering REM sleep in depression (Many antidepressants suppress REM sleep) </li></ul></ul><ul><ul><li>Less total sleep time, less sleep efficiency, increased wakefulness, longer to fall asleep, less slow wave sleep (Benca et al., 2002) </li></ul></ul><ul><li>State versus trait (Kupfer & Ehlers, 1989) </li></ul><ul><ul><li>Trait: Reduced REM latency, reduced slow wave sleep – exist prior to depressive episode </li></ul></ul><ul><ul><li>State: Reduced sleep efficiency </li></ul></ul>
  11. 11. Why is it important? <ul><li>Help to identify those at greater risk of PND </li></ul><ul><li>May help to recognise symptoms of pre-existing PND </li></ul><ul><ul><li>Easy to talk about sleep issues; harder to talk about signs of PND; may help to provide a talking point </li></ul></ul>
  12. 12. Summary <ul><li>PND is a serious condition and more research is needed to investigate risk factors </li></ul><ul><li>Poor sleep is both a symptom and precursor of depression, but less research has investigated PND </li></ul><ul><li>My PhD will investigate whether poor sleep predicts the onset of depression, and which aspects of sleep are most important </li></ul>
  13. 13. [email_address]

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